DELAYED OR POST OPERATIVE CHOLANGIOGRAPHY OR T-TUBE

ANATOMY & PHYSIOLOGYGALLBLADDER -Is a long sac that store bile produce by the liver Pear shaped organ that is about 7-10 cm long (3-4”) 2-3 cm wide (about 1) It has the ability to hold about 50 milliliter of bile Located in the right upper abdominal quadrant around the 9th cost cartilage 3 PARTS OF GALLBLADDERFundusBodyNeck FUNCTIONS OF THE GALLBLADDER1. To store bile2. To concentrate bile3. To contract when stimulated

BILE DUCTFUNCTIONS OF THE BILE DUCT

1. aid in the digestion of fats by emulsifying/breaking down of fats globules

2. absorption of fat for following digestion3. 3contains cholesterol which is made soluble in the

bile by the bile salts.

T-TUBE CHOLANGIOGRAM Is a fluoroscopic procedure w/c contrast medium is injected through T-TUBE into the patient’s biliary tree. T-tube is most commonly inserted during the cholecystectomy operation when there is possibility of residual gallstone w/n the biliary tree

INDICATIONS . Patient must have t-tube insitu. Patient’s with possibility of residual small gallstones. Obstructive jaundice . Bile duct stricture . Surgeon unable to explore bile duct during cholecystectomy surgery

PATHOLOGICAL CONDITIONS:*Cholelithiasis- *Cholecystitis-

a. Acute cholecystitis-b. Chronic cholecystitis-

PREPARATION

. Drainage tube is clamped the day preceding the examination let the tube fill the bile . The preceding meal is withheld.. When indicated, a cleansing enema is administered about 1hr. before the examination

CONTRAST MEDIA PREP..Telebrix

.Uromiro

. Conray

____________________________________________________________________________________________________________PROCEDURES

PROJECTIONS:AP PROJECTION- scout Film

INJECTION PHASE. Before the C.M is to be injected aspirate the bile contents of the ducts thru the in lying for better visualization of the ducts. The attending physician or radiologist injects 10 cc of the C.M via tube and right after the injection, take 2 exposure simultaneously

Examination Patient position CR RP Purpose

AP Projection Is directed vertically to the midpoint of the film.

In lying tube which is centered to the midline of the table

RAO Projection

From the position, oblique the body approximately 45 degrees.

Is directed vertically to the midpoint of the film.

In- lying tube.

POST PROCEDURE CARE* PATIENT CAN EAT & DRINK NORMALLY* WARN PATIENT OR ADVISE OF ANY ITCHING OR RASH POST PROCEDURE*PATIENT REMAIN IN HOSPITAL FOR OBSERVATION FOR ATLEAST 24HRS POST PROCEDURE.* IF THE T-TUBE IS REMOVED AT THE END OF THE PROCEDURE, THE WOUND SHOULD BE CHECKED FOR BILE LEAKAGE FOR 24HRS.

COMPLICATIONS* PERISTENT BILIARY FISTULA ( RARE)* BILIARY PERITONITIS* CHOLANGITIS

Prepared by: ate cel “inang bayan” & JOBS