The gallbladder and also biliary system is composed of the gallbladder and also cystic duct; right and also left hepatic ducts, i beg your pardon come together as the common hepatic duct; and also the common bile duct, which is formed when the cystic duct and the usual hepatic duct join. The common bile duct empties into the duodenum. Number 10-3 evaluate the anatomy of the bile duct system.

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Several radiography studies, all using contrast media, are easily accessible for the check of the gallbladder and also biliary tree. Cholecystography, percutaneous transhepatic cholangiography, and T-tube cholangiography room presented in this section.

Cholecystography

Cholecystography, also known together a gallbladder (GB) series, is the radiographic visualization of the gallbladder using a radiopaque, iodinated contrast medium. The comparison medium have the right to be ingested in the form of pills, oral cholecystography, or it can be administered via intravenous injection.

Indications because that the test include suspected gallstones, gallbladder inflammation, and also cystic duct obstruction. Contraindications room allergies come iodine contrast media and also diseases that the digestive street that may interfere through the absorb of orally ingested comparison media.

Normal Findings. Regular gallbladder anatomy and absence of pathology.

Variations native Normal. Assorted gallbladder disorders can be diagnosed via cholecystography. These incorporate gallstones, polyps, and chronic

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Figure 70-3. Structures of the biliary system

cholecystitis. Tliis examination have the right to identify cystic duct obstruction and also gallbladder cancer. Biopsy is vital to confirm any cancer diagnosis.

Interfering Circumstances. Vomiting and diarrhea impact the absorb of orally ingested comparison media. Residual barium, normally the result of an upper GI collection or barium enema, and an incomplete bowel prepare interfere v gallbladder visualization. Any type of tests that require barium have to be booked after the cholecystography exam.

Percutaneous Transhepatic Cholangiography (PTC, PTHC)

Percutaneous transhepatic cholangiography (PTC, PTHC), a radiographic examination of the biliary system and sometimes the gallbladder, provides an io-

dinated comparison medium that is injected through the liver right into an intrahepatic bile duct. Visualization of the intra- and also extrahepatic bile ducts, and also occasionally the gallbladder, is climate accomplished. Doubt duct obstruction and unexplained jaundice are the significant indications for this procedure. Contraindications incorporate allergies come the comparison media.

Normal Findings. Normal biliary duct anatomy and absence of pathology. If the gallbladder is visualized, normal gallbladder anatomy and lack of pathology.

Variations native Normal. Abnormal results encompass a variety of bile duct disorders such together tumors, strictures, or visibility of gallstones. Sclerosis that the biliary tree and also cysts of the common bile duct may likewise be identified.

T-Tube Cholangiography

T-tube cholangiography, a postoperative check of the hepatic and also common bile ducts, is completed by injecting an iodine comparison medium into the common bile duct via a T-tube. This test is generally done within ten job after cholecystectomy. Throughout gallbladder surgery a self-retaining T-tube is frequently placed in the common bile duct. The pipe is left in position until the patency that the hepatic and also common bile ducts have the right to be shown postoperatively. Indications because that this examination include detection of postoperative common bile duct stones and evaluation the bile flow into the duodenum. Figure 10-4 mirrors the location of the T-tube during this examination.

Normal Findings. Normal hepatic and common bile duct anatomy and absence of hepatic and common bile duct pathology.

Variations native Normal. T-tube cholangiography is able come identify typical bile duct stones, stricture or tumors resulting in obstruction, bile duct cysts, and also anatomic variations.

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Interfering Circumstances. Residual barium interferes through bile duct visualization. Any type of tests that require barium need to be scheduled after the T-tube cholangiography.