THE DIGESTIVE SYSTEM

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THE DIGESTIVE SYSTEM
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Accessory Organs of Digestive System

• Salivary Glands
• Gallbladder
• Pancreas
• Liver
• Function to

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Salivary Glands

• 3 Glands
• Parotid
• Sublingual
• Submandibular
• The Ducts
• Parotid duct
• Submandibular duct
• Ducts of Rivinus
• Procedure to study themSialography

• Bontrager, p 767

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Sialography

• Must examine one duct and its gland at a time
• Indications
• Ductal Obstruction
• Stones
• Strictures
• Tumors
• Inflammation of duct/ gland
• Fistulas

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Equipment Needed

• Fluoroscopy
• Small syringe (3ml)
• Cotton swabs, gloves
• Sterile gauze, tape
• Cannula, extension tubing
• Anesthetic, Lemon
• Overhead lamp

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• Consent form
• Remove dentures
• PositionsAP, PA, Oblique, Lateral
• Procedure is uncomfortable

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• The Procedure
• Supine or Seated Erect
• Connective tubing connected to cannula
• Duct cannulated and dilated
• Close mouth
• Tubing taped to pt cheek
• Contrast injected
• Radiographs taken

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Biliary Terms

• Chole
• Cysto
• Cholecystogram
• Cholangiogram
• Cholecystocholangiogram
• Cholecystectomy

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Review of Biliary Tree

• Drains liver of bile
• Carries bile to Gallbladder
• Delivers bile to duodenum
• Rt Lt Hepatic ducts - Common Hepatic duct
• Cystic duct
• Common Bile Duct - Duodenum
• Pancreatic duct merges w/ CBD at Ampulla of Vater
• Sphincter of Oddi

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What is Cholecystokinin?

• What is Cholecystokinin?
• What are Functions of Gallbladder?

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Where is the Gallbladder
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• Location of Gallbladder- ½ between Xiphoid tip
  and lower lateral rib margin (p. 528 Body habitus
  and GB location)
• Procedures
• OCG (Oral Cholecystogram)
• Operative Cholangiogram
• T-Tube cholangiogram
• ERCP

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OCG

• Purpose
• Function
• Investigate ducts
• Concentrating and contracting ability
• R/O stones, masses, stenosis
• Choledocolithiasis-
• Cholelithiasis-
• Cholecystitis-

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• NPO 8 hours
• Pt should have fatty foods 2 days before
• Low fat diet day before
• 4-6 tables evening before exam

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• Imaging Routine
• Scout (PA)
• LAO and RT LAT Decub or Erect
• Layer out stones
• Fluoroscopy
• Now US and/ or Nuclear Medicine used

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Ultrasound of Gallbladder

• Non- invasive
• Non-ionizing radiation
• Detection of small calculi
• No contrast needed
• Less patient preparation
• NPO 4 hrs.

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Operative Cholangiogram

• Performed in OR during cholecystectomy ( removal
  GB)
• If any suspected stones remain- small catheter
  inserted into cystic duct
• C- arm or regular x-rays taken

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T-Tube Cholangiogram

• Radiology dept- done 4-6 weeks post surgery
• Undetected stones suspected
• T-tube catheter in common bile ductDrain bile w/
  emesis basin
• Contrast injected
• Watch for bubbles resemble stones

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ERCP

• What do the letters stand for?
• Examines biliary and main pancreatic ducts
• Duodenenscope- fiber-optic used
• Can be diagnostic or interventional
• Who is in the room?

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• Procedure
• Prone or slight LAO
• Endoscope inserted via mouth
• Positioned in duodenum
• Sphincter of Oddi
• Ampulla of Vater
• Duct selected and contrast injected

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CT Abdomen

• Contrast Media
• GI tract
• Oral and/ or rectal contrast required
• 3 intervals
• Night before (large bowel)
• 1 hour before (SB)
• Immediately before (stomach)
• Rectal contrast if it hasnt reached rectum
• IV contrast to evaluate liver pancraes
• Vessels VS. masses

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Lithotripsy

• High energy shock waves
• Non- Invasive
• Kidney Biliary Stones
• Water Bath or flexible water containing device
• Provides pathway
• Can be done as OP