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    Cards (115)

    • ىطسولا ةينقتلا ةعماجلا
      University of Technology
    • ةيبطلاو ةيحصلا تاينقتلا ةيلك
      College of Medical and Health Technologies
    • ةعشلاا تاينقت مسق
      Department of Radiological Techniques
    • ةصاخ ةيعاعش تاصوحف
      • Special radiological examinations
      • Hepatobiliary system
    • ةيناثلا ةلحرملا
      Second stage
    • ةيلهلاو ةيموكحلا تاعماجلا ةانق
      Governmental and private universities channel
    • رضاحملا مسا
      Name of the instructor
    • ةفدهتسملا ةئفلا
      Target population
    • METHODS OF IMAGING THE HEPATOBILIARY SYSTEM
      • Plain film
      • Ultrasound (US)
      • Computed tomography (CT)
      • Magnetic resonance imaging (MRI)
      • Endoscopic retrograde cholangiopancreatography (ERCP)
      • Percutaneous transhepatic cholangiography (PTC)
      • Operative cholangiography
      • Postoperative (T-tube) cholangiography
      • Angiography—diagnostic and interventional
      • Radionuclide imaging
    • METHODS OF IMAGING THE PANCREAS
      • Plain abdominal films
      • US
      • CT
      • MRI
      • ERCP
      • Arteriography
    • Plain films
      Not a routine indication. May incidentally demonstrate air within the biliary tree or portal venous system, opaque calculi or pancreatic calcification.
    • Indications for ultrasound of the liver
      • Suspected focal or diffuse liver lesion
      • Jaundice
      • Abnormal liver function tests
      • Right upper-quadrant pain or mass
      • Hepatomegaly
      • Suspected portal hypertension
      • Staging known extrahepatic malignancy, superseded by CT
      • Pyrexia of unknown origin, now superseded by CT for patients over 30 years old
      • To provide real-time image guidance for the safe placement of needles for biopsy
      • Assessment of portal vein, hepatic artery or hepatic veins
      • Assessment of patients with surgical shunts or transjugular intrahepatic portosystemic shunt (TIPS) procedures
      • Follow-up after surgical resection or liver transplant
    • No contraindications for ultrasound of the liver
    • Patient Preparation
      Fasting or restriction to clear fluids only required if the gallbladder is also to be studied.
    • Equipment
      3–5-MHz transducer and contact gel. Selection of the appropriate preset protocol and positioning of focal zone will depend upon the type of machine, manufacturer and patient habitus.
    • Technique for ultrasound of the liver
      • Patient supine
      • Time-gain compensation set to give uniform reflectivity throughout the right lobe of the liver
      • Suspended inspiration
      • Longitudinal scans from epigastrium or left subcostal region across to right subcostal region
      • Transverse scans, subcostally, to visualize the whole liver
      • Additional scans if visualization is incomplete
    • Contrast-enhanced ultrasound of the liver
      Uses microbubble agents to enable the contrast enhancement pattern of focal liver lesions, analogous to contrast-enhanced CT or MRI, to be assessed and thus to characterize them.
    • Additional views for ultrasound of the liver
      • Hepatic veins
      • Portal vein
      • Hepatic artery
      • Common bile duct
      • Spleen
    • Indications for ultrasound of the gallbladder and biliary system
      • Suspected gallstones
      • Right upper quadrant pain
      • Jaundice
      • Fever of unknown origin
      • Acute pancreatitis
      • To assess gallbladder function
      • Guided percutaneous procedures
    • No contraindications for ultrasound of the gallbladder and biliary system
    • Patient Preparation
      Fasting for at least 6 h, preferably overnight. Water is permitted.
    • Equipment
      3–5-MHz transducer and contact gel. Selection of the appropriate preset protocol and positioning of focal zone will depend upon the type of machine, manufacturer and patient habitus. A stand off may be used for a very anterior-sited gallbladder.
    • Technique for ultrasound of the gallbladder and biliary system
      • The patient is supine
      • The gallbladder can be located by following the reflective main lobar fissure from the right portal vein to the gallbladder fossa
      • The gallbladder is scanned slowly along its long axis and transversely from the fundus to the neck, leading to the cystic duct
      • The gallbladder should then be rescanned in the left lateral decubitus or erect positions
      • Visualization of the neck and cystic ducts may be improved by head-down tilt
    • Normal gallbladder wall thickness

      Never more than 3-mm thick
    • Assessment of gallbladder function
      • Fasting gallbladder volume may be assessed by measuring longitudinal, transverse and antero-posterior (AP) diameters
      • Normal gallbladder contraction reduces the volume by more than 25%, 30 min after a standard fatty meal
    • Visualization of bile ducts
      • Intrahepatic bile ducts
      • Extrahepatic bile ducts
    • Dilated intrahepatic bile ducts
      Diameter is more than 40% of the accompanying portal vein branch
    • Normal common hepatic duct diameter
      4 mm or less in a normal adult
    • Normal common bile duct diameter
      6 mm or less
    • Postcholecystectomy
      Symptomatic patients and those with abnormal liver function tests should have further investigations if the common duct measures more than 4 mm age 40, plus 1 mm for each decade over 40, and 1 mm for the postcholecystectomy state.
    • Indications for ultrasound of the pancreas
      • Suspected pancreatic tumour
      • Pancreatitis or its complications
      • Epigastric mass
      • Epigastric pain
      • Jaundice
      • To facilitate guided biopsy and/or drainage
    • No contraindications for ultrasound of the pancreas
    • Patient Preparation
      Nil by mouth, preferably overnight.
    • Equipment
      3–5-MHz transducer and contact gel. Selection of the appropriate preset protocol and positioning of focal zone will depend upon the type of machine, manufacturer and patient habitus. A stand off may be required in thin patients.
    • Technique for ultrasound of the pancreas
      • The patient is supine
      • The body of the pancreas is located anterior to the splenic vein in a transverse epigastric scan
      • The transducer is angled transversely and obliquely to visualize the head and tail
      • The tail may be demonstrated from a left intercostal view using the spleen as an acoustic window
      • Longitudinal epigastric scans may be useful
      • Gastric or colonic gas may prevent complete visualization, which may be overcome by left and right oblique decubitus scans or by scanning with the patient erect
    • Normal pancreatic duct diameter
      Not more than 3 mm in the head or 2 mm in the body
    • Endoscopic US and intraoperative US
      Useful adjuncts to transabdominal US. EUS may be used to further characterize and biopsy pancreatic solid and cystic lesions. Intraoperative US is used to localize small lesions (e.g. islet cell tumours prior to resection).
    • Degassed water is preferable
    • Pancreatic duct
      Should not measure more than 3 mm in the head or 2 mm in the body
    • Endoscopic US and intraoperative US
      • Useful adjuncts to transabdominal US
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