B iliary s ystem
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B iliary S ystem. Prefinal topic . Gall Bladder. is pear-shaped sac, composed of three-parts – fundus , body and neck. 7 – 10 cm long, 3 cm wide and normally holds 30 to 40cc’s of bile. 3 – primary Functions. store and concentrate bile and contract when stimulated.

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B iliary s ystem

Biliary System

Prefinal topic

Prepared by: Aries Paul P. Zeta, RRT

Gall bladder

Gall Bladder

is pear-shaped sac, composed of three-parts – fundus, body and neck.

7 – 10 cm long, 3 cm wide and normally holds 30 to 40cc’s of bile.

3 primary functions

3 – primary Functions

store and concentrate bile and contract when stimulated.

Bile is concentrated w/in the gallbladder due to hydrolysis.

Gallbladder normally contracts when foods such as fats or fatty acids are in duodenum.

Biliary ducts

Biliary ducts

Right & Left hepatic ducts

Common hepatic duct

Cystic duct

Common medical terms

Common Medical Terms

Chole – “bile” is a bitter yellowish, blue and green fluid secreted by hepatocytes from the liver .

Cysts- is a closed sac having a distinct membrane and division on the nearby tissue

Angio – refers to the arteries or veins or blood vessels

Gallbladder and biliary duct radiographic terminology

Gallbladder and Biliary duct Radiographic Terminology

  • Cholecystography

    • Radiographic examination specifically of the gallbladder.

  • Cholangiogram

    • radiographic examination of the biliary ducts.

  • Cholegraphy

    • – general term used to denote specialized exam. Of the biliary ducts.

  • Cholecystocholangiogram

    • examination of the gallbladder and biliary ducts.

  • Cholecystopaques(OCG)

    • termed for visulaization of the gallbladder by the used of contrast media.

Administration of contrast medium

*Administration of Contrast Medium*

  • by mouth (oral)

  • by injection into a vein in a single bolus or drip infusion (intravenous)

  • by direct injection into the ducts ;

    • through percutaneoustranshepatic puncture

    • during biliary tract surgery (operative or immidiate)

    • through an indwelling drainage tube ( post-operative, delayed, or T-tube)

B iliary s ystem

  • Each method of examination is named according to;

    • The route of entry of the medium

    • The portion of the biliary tract examined

Oral cholecystography

Oral Cholecystography

Oral cholecystography1

Oral Cholecystography

Is a non-invasive radiographic procedures that is used if a inconclusive ultrasound report.

It is a simple, economical and least invasive and highly effective method of investigating the gallbladder problems

The route of entry is by mouth.

B iliary s ystem

  • Purpose:

    • Study radiographically the anatomy and function of the biliary system.

  • Function:

    • It measures the functional ability of the liver to remove the orally administered contrast medium from the blood stream and to excrete it along with the bile.



Advanced hepatorenal disease, those with renal impairement.

Active gastrointestinal disease such as vomiting or diarrhea, which would prevent absorption of oral contrast medium.

Hypersensitivity to iodine containing compound.

Clinical indications

Clinical Indications:


Biliary stenosis – narrowing of the biliary ducts

Congenital anomalies

Cholelithiasis – condition of having gallstone.

Cholecystitis – inflammation and blockage of the cystic duct restricts the flow of bile into the cbd due to stones.



Oral cholecystography2

Oral Cholecystography

  • Preliminary Diet

    • an evening meal that is fat free to prevent the possibility of emptying the gallbladder.

    • A noon meal that is rich in simple fats and an evening meal that is free of fats.

      • Oral media are usually administered about 3-hrs after evening meal.

      • Nothing by mouth.

      • Breakfast is usually withheld in all methods.

Fatty meal b oyden m eal

Fatty Meal (Boyden Meal)

Consisted of a commercially available bar or eggs and milk or eggnog.

It is important to have a fatty meal as to serve as stimulant for the gallbladder.

Without the fatty meal we cannot observe the function of the gallbladder empting its bile's.

Routine positions

Routine Positions

  • Supine

  • Prone

  • Prone oblique

  • Upright

  • Lateral decubitus

Success of oral cholecytogram

Success of oral cholecytogram:

The intestinal mucosa in absorbing the contrast substance and liberating it into the portal bloodstream for conveyance to the liver.

The liver in removing the opaque substance from the blood and excreting it with the bile.

The GB in concentrating the opacified bile by removing 90% water content in storing the concentrated bile during interdigestive period.

Intravenous cholangiogram

Intravenous Cholangiogram

Intravenous cholangiogram1

Intravenous Cholangiogram

  • Demonstrates the biliary ducts to determine if an obstruction exists due to calculi or other pathology.

  • Is employed in the investigation of;

    • Biliary ducts of cholecystectomized patients.

    • The biliary duct and gallbladder of non-cholecystectomized patients.

Preliminary cleansing of the colon

Preliminary Cleansing of the Colon:


Restricted diet


Breakfast is withheld

Contrast medium

Contrast Medium

10 min. – timed from the completion of the injection until satisfactory visualization.

30 – 40 min. maximum pacification.



Not indicated for patients who have liver disease or for those whose biliary ducts are not intact.

Percutaneous transhepatic cholangiography


Percutaneous transhepatic cholangiography1


Another type that demonstrate the biliary ducts.

More invasive, but it gives the radiologist more options in the diagnosis and treatment of biliary conditions.

Involves direct puncture of biliary ducts with needle.

Obstructed jaundice

Obstructed jaundice

is caused by an interruption to the drainage of bile in the biliary system. The most common causes are gallstones in the common bile duct, and pancreatic cancer in the head of the pancreas

Specific responsibilities of the rad tech

Specific responsibilities of the Rad. Tech.

Prepare the fluoroscopic suite

Set-up the sterile tray and include the long, thin-walled needle used for puncture.

Select and prepare the contrast media.

Take the appropriate scout films to verify position and technique.

Monitor the patient during the procedure.

Change fluoro-spot films as needed.

Operative post operative cholangiography

Operative & post-operative cholangiography

Operative or immediate cholangiogram

Operative or immediate cholangiogram

Perform during surgery and cholecystectomy.

Introduced by mirizzi in 1932.

Used in the investigation of the patency of the bile ducts and of functional status of the sphincter of hepatopancreaticampulla to reveal the presence of calculi.

Functions purpose

Functions / purpose:

Investigate the patency of the biliary tract.

Determine the functional status of the hepatopancreaticampulla.

Reveal any choleliths not previously detected.

Demonstrated small lesions, strictures or dilations within the biliary ducts.



Obstructive jaundice


Stones in the biliary passages

Strictures of common bile ducts

Choledochal cysts

T tube postoperative or delayed cholangiography

T – tube, postoperative, or delayed cholangiography

T tube postoperative or delayed cholangiography1

T – tube, postoperative, or delayed cholangiography

Radiologic terms applied to the biliary tract examination that is determined by way of the T – shaped tube left in CBD for postoperative drainage.



Performed to demonstrate the caliber and patency of the ducts.

The status of the sphincter of the hepatopancreaticampulla.

Presence of residual or previously undetected stones or other pathologic conditions

Preliminary preparation

Preliminary preparation:

Drainage tube is clamped the day preceding the examination to let the tube fill with bile as preventive measure against air bubbles entering the ducts.

The preceding meal is withheld.

When indicated, a cleansing enema is administered about an hour before the examination.

Contrast agent

Contrast agent

Is one of the water-soluble, organic contrast media.

25 – 30% density of contrast medium is used.



Patient must have T-tube

patient's with possibility of residual small gallstones

post cholecystectomy obstructive jaundice

bile duct stricture

surgeon unable to explore bile duct during cholecystectomy surgery



non-consent by patient to procedure

contrast or iodine allergy

pregnancy (? pregnancy test required)

barium study within last 3 days



RPO with the right upper quadrant of the abdomen is centered to the midline of the table.

Stern – stress the importance of obtaining a lateral position to demonstrate the anatomic branching of the hepatic ducts and to detect any abnormality.



The patient is positioned supine on the x-ray table

A slightly RPO position can help to ensure the CBD is not superimposed over the patient's spine.

A preliminary/scout image of the RUQ should be acquired.

The tip of the t-tube is cleaned with antiseptic

the t-tube should be raised and tapped to ensure there are no air bubbles lurking in the tube.

B iliary s ystem

A butterfly needle should be inserted into the T-tube

The syringe plunger is withdrawn to remove bile from within the duct. (optional)

An early filling image should be obtained.

The entire biliary tree should be imaged during injection of contrast medium.

B iliary s ystem

Injection should continue until the entire biliary tree is opacified and there is passage of contrast into the deuodenum.

If the intrahepatic ducts do not fill, the patient can be tilted trendelenburg and further contrast injected into the T-tube.

The patient may need to lie on their left hand side to fill the left hepatic duct.

At least 2 views of the entire biliary tree should be recorded by spot film, oblique views are often taken

Ercp endoscopicretrograde cholangiopancreotography


Ercp endoscopicretrograde cholangiopancreotography1


Procedure used to diagnose biliary and pancreatic pathologic conditions.

Where a catheter is passed through the hepatopancreaticampulla and a contrast media is injected in a retrograde fashion into the biliary ducts.



Investigate the patency of the biliary/pancreatic ducts.

Reveal any choleliths not previously detected.

Demonstrate small lesions, strictures or dilatations within the biliary/pancreatic ducts.



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