2

Dr. Mustafa Zuhair Mahmoud

B.Sc; SUST {Khartoum, Sudan}M.Sc; AAU {Khartoum, Sudan} & JUREI

{Philadelphia, USA}Ph.D, Ludes {Lugano, Swiss}

Ph.D, SUST {Khartoum, Sudan}

Sudan University of Science and Technology {SUST}

College of Medical Radiological Sciences

BiliaryApparatus(Cholegraphy)

Quick Anatomical

Review

The Biliary Apparatus:◙ The bile is drained from the liver by two main ducts, theRight& Left hepatic ducts. ◙ The right &Left hepatic ducts leave the liver at the porta hepatic& unites to form the Common Hepatic Duct.

◙ The Common Hepatic Duct -about 3cm in length- joined the cystic duct. (This is the duct from the Gall Bladder)◙ The Cystic Duct& the Common Hepatic Duct together form the Common Bile Duct.

◙ The Common Bile Duct which is about 7.5 cm in length passes behind the 1st part of duodenum& then unites with the pancreatic duct to enter the 2nd part of the duodenum, on the surface of the duodenal papilla.◙ The opening through the duodenum is surrounded by a sphincter muscles, the sphincter of Oddi.

The Gall Bladder:◙ The gall bladder is a pear-shaped sac which lies on the under surface of the liver, to which it is attached by connective tissue.◙ The gall bladder is divided for descriptive purposed into:●Fundus.●●Body.●●●Neck.

Structure of the Gall Bladder:◙ The wall of the gall bladder is composed of three coats:● An outer Serous Coat.● A middle Fibrous tissue& Smooth muscles coat.● An inner Mucous coat.

Biliary Tract& Gall Bladder Radiography◙Several techniques can be used to examine the gall bladder and the biliary tract.◙ In many institution, Sonography is the modality of choice.Terms:¤ Cholegraphy: Is the general term for a radiographic study of the biliary system.¤ Cholecystography: Is the radiographic investigation of the gall bladder.¤ Cholangiography: Is the radiographic study of the biliary ducts.¤ Radiography of both the gall bladder& the biliary ducts is Cholecystangiography or Cholecystocholangiography.¤ Endoscopic Reterograde Cholangio-pancreatogrphy (ERCP) is the procedure to diagnose biliary and pancreatic pathological conditions.

Indications for imaging- Gallstones, (cholelithiasis).

- Stones of the bile ducts, (choledocholithiasis).

- Cholangitis.

- Cholecystitis.

- Bile duct cancer.

- Infection of the pancreas, liver, or the bile ducts.

Patients Preparation

- On the day before the procedure you will likely be asked not to eat, and to drink only clear liquids.

- Complete fasting in the morning of the examination.

◙ Routes of administration are as follow:

1. By Mouth __ Oral.

Contrast Media administration Methods

Contrast Media

Biloptin

◙ Route of administration: ●By Mouth __ Oral.

Oral Cholecystogram (OCG)

2. By injection in a vein in a single bolus or by drip infusion __ Intravenous.

Contrast Media

Urographin or Omnipaque

●●By injection in a vein in a single bolus or by drip infusion __ Intravenous.

◙ Route of administration:

Intravenous Cholangiogram

3. By direct injection into the ducts:a. Percutaneous Transhepatic Cholangiography (PTC).

Contrast Media

Urographin or Omnipaque

◙ Routes of administration:

●●●By direct injection into the ducts.

PTC Examination

3. By direct injection into the ducts:b. During biliary tract surgery (operative or

immediate), through an indwelling drainagetube, termed a T-Tube (postoperative or delayed).

Contrast Media

Urographin or Omnipaque

◙ Routes of administration:

●●●By direct injection into the ducts.

Postoperative Cholangiogram, performed with a T-tube

Endoscopic Reterograde Cholangio-pancreatogrphy (ERCP)

is the procedure to diagnose biliary and pancreatic pathological conditions.

◙ Endoscopic Reterograde Cholangio-pancreatogrphy (ERCP) is the procedure to diagnose biliary and pancreatic pathological conditions.

Contrast Media

Urographin or Omnipaque

ERCP

THANKS