DELAYED OR POST OPERATIVE CHOLANGIOGRAPHY OR T-TUBE ANATOMY & PHYSIOLOGY GALLBLADDER -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 th the 9 cost cartilage 3 PARTS OF GALLBLADDER Fundus Body Neck FUNCTIONS OF THE GALLBLADDER 1. To store bile 2. To concentrate bile 3. To contract when stimulated BILE DUCT FUNCTIONS OF THE BILE DUCT 1. aid in the digestion of fats by emulsifying/breaking down of fats globules 2. absorption of fat for following digestion 3. 3contains cholesterol which is made soluble in the bile by the bile salts.

INDICATIONS . Patient must have t-tube insitu . Patients with possibility of residual small gallstones . Obstructive jaundice . Bile duct stricture . Surgeon unable to explore bile duct during cholecystectomy surgery PATHOLOGICAL CONDITIONS: *Cholelithiasis*Cholecystitisa. Acute cholecystitisb. Chronic cholecystitisPREPARATION . 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. T-TUBE CHOLANGIOGRAM .Telebrix Is a fluoroscopic procedure w/c contrast medium is injected through T-TUBE into the patients biliary tree. T-tube .Uromiro is most commonly inserted during the cholecystectomy operation when there is possibility of residual gallstone w/n . Conray the biliary tree ____________________________________________________________________________________________________________ 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 AP Projection Patient position CR Is directed vertically to the midpoint of the film. From the position, oblique the body approximately 45 degrees. Is directed vertically to the midpoint of the film. RP In lying tube which is centered to the midline of the table In- lying tube. Purpose

RAO Projection

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