What Is a Cholangiogram Catheter?

The bile duct system includes the gallbladder and the bile ducts inside and outside the liver. It is a cavity organ with different shapes and different diameters. Clinically susceptible to diseases, cholangiography (X-ray examination) plays an important role in the diagnosis of biliary disorders. Angiography is a commonly used X-ray examination.

Cholangiography

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The bile duct system includes the gallbladder and the bile ducts inside and outside the liver. It is a cavity organ with different shapes and different diameters. Clinically susceptible to diseases, cholangiography (X-ray examination) plays an important role in the diagnosis of biliary disorders. Angiography is a commonly used X-ray examination.

Chinese name

Cholangiography

Definition

Cavity organs of varying diameters

method 1

Oral cholecystography

Method 2

Intravenous cholangiography

method

Non-destructive inspection and damage inspection

1. Oral cholecystography (oral cholecystography) before the examination steps: eat fat and meals at noon one day to empty the gallbladder, fat-free meals at dinner. Laxatives are contraindicated so as not to affect the absorption of contrast agents.

From half an hour after the meal (about 6h in the afternoon), take 0.5g tablet of the contrast agent Acidum lopanoicum (Telepague) every 5min. Adults take 6 tablets (3g). After that, they fasted and took the first film 12-14h the next day after taking the contrast medium. If the gallbladder is well developed, you can take a fat meal, wait for half an hour and 1 hour to observe the emptying of the bile ducts and gallbladder. If the gallbladder is unsatisfactory or undeveloped in the first picture, you can wait for another 2-3 hours. If it still does not develop, you do not need to eat a fat meal and end the inspection.

Oral angiography is a commonly used method for examining gallbladder diseases, and has important value in the diagnosis of chronic cholecystitis, gallbladder proliferative diseases and gallstone disease.

2. Intravenous cholecystograpy and cholangiography: Preparation before the test: Eat a fat meal for dinner the day before, fast after that, check in the morning the next day, and perform a contrast agent allergy test before intravenous injection.

Inspection steps: Intravenous injection of 50% Meglumine lodipamide (Biligrafin, Cholografin) 20ml, the injection rate should be slow, about 10-15 minutes, take a photo at 20, 40, 60 and 120 minutes. Depending on the development, the number of photos can be increased or decreased. The bile duct was visualized within 60 minutes, and the gallbladder was visualized within 120 minutes. If the gallbladder is well developed, you can eat a fat meal. The photos are the same as the oral method. Such as light development can delay the photo time; if the gallbladder is not developed, you can end the examination. The contrast agent used in the intravenous method is excreted into the bile ducts along with the bile sweat through the liver, and its concentration is high. The gallbladder can be developed without concentration, and it is not affected by gastrointestinal absorption. It is suitable for patients who have not developed the gallbladder by oral contrast.

3. Intravenous infusion cholangiography (Intravenous infusion cholangiography) is suitable for patients with poorly developed biliary tract or accompanied by mild jaundice. Prepare the same intravenous method before the test. The checking procedure is only different in the amount. Commonly used 40% 50% bile glucosamine, 60-80ml with 5% glucose solution, a total amount of 100-120ml for intravenous infusion, about 30min after the infusion is completed, then take a film to observe the bile duct, and then take a tablet every 30min to 120min Observation of the gallbladder can be delayed to 180min.

4 Percutaneous transhepatic cholangiography (PTC)

Applicable to patients with obstructive jaundice, especially suitable for those with intrahepatic bile duct dilatation. This method can show the location, extent, scope and nature of bile duct obstruction. However, complications such as bleeding, bile leakage, and biliary peritonitis can occur in this method. In the past ten years, fine needle aspiration has been used to reduce complications. Moreover, due to the development of interventional radiology, guidewires are inserted on the basis of PTC. The catheter with side holes is left in the common bile duct, and percutaneous transhepatic choledochus drainage (PTCD) is used for internal and external drainage to reduce the pressure of the bile duct, improve the degree of jaundice, and provide surgical opportunities, thereby expanding Application scope of PTC. The examination is performed in the radiology department. First, the location of the puncture needle is selected under the perspective. There are many ways, such as the midclavicular line, anterior axillary line, or right back. Avoid the right costal angle and point the needle point at the 12th thoracic spine. After the needle is inserted into the bile duct, the bile is aspirated first, and then 30-60% ubiquitamine glucosamine 40-60ml is injected, depending on the degree of bile duct filling. Immediately take a picture, remove the contrast medium as much as possible and then dial the needle.

5. Endoscopic retrograde cholangio-pancreatography (ERCP)

It is a new inspection technique developed in the 1970s, which expanded the examination methods for bile duct and pancreatic duct diseases. In recent years, endoscopic papillary surgery, lithotripsy of the common bile duct, and bile duct drainage have been developed. It is suitable for biliary tract disorders, pancreatic disorders, especially those with recurrence of symptoms after cholecystectomy, and patients with jaundice to be investigated. Inspections are also performed in the radiology department. The specific steps are to send the duodenal fiberscope to the descending duodenum. After finding the nipple, insert a thin plastic catheter through the nipple, and then inject 60% diatrizoate, then develop the pancreatic duct and take a picture. The bile duct was developed. After the bile duct was fully developed, the endoscope was removed and then the radiograph was taken. It was shown that the concentration of the bile duct contrast agent could be changed to 30%. Avoid too much concentration to cover up the stone shadow. The total amount of contrast agent is about 40-60ml. The imaging was performed under fluoroscopy. Complications include injectable pancreatitis and suppurative cholangitis.

6. Post-cholecystectomy cholangiography

Also called "T" shaped tube angiography. A T -shaped drainage tube was left after gallbladder surgery. Generally, the contrast medium was injected into the drainage tube to observe the condition of the bile duct within 1-2 weeks after the operation. Brine ducts should be flushed with saline before angiography, avoiding air bubbles. Contrast agents can be 12.5% sodium iodide aqueous solution, or aqueous solvents containing iodine-containing organic compounds, and photos are taken immediately after injection. This method shows that the bile duct is clear, and it can show the branch of the intrahepatic bile duct. It is used to observe the presence of residual stones in the bile duct, and to understand the dilatation, stenosis and patency of the bile duct.

7. Barium meal

In individual cases, biliary disorders must be checked with a barium meal. It is suitable for the differential diagnosis of biliary diseases and gastric and duodenal diseases; and in patients with biliary reconstruction after cholecystectomy, when the above examination methods are not effective, this method can be used to understand whether the bile duct is unobstructed and whether there are residual stones. . The specific steps are to fill the stomach and duodenum with a dilute barium agent, take the head low and high, force the barium agent to flow back to the bile duct, and take a photograph to observe the change in the shape of the bile duct.

8. Application of tomography in biliary angiography

Sometimes the biliary angiography of the gallbladder and bile duct is light, or the intestinal gas overlaps, or the bile duct stones are covered by high-contrast contrast agents, which can be added tomography to avoid overlapping structures and improve the resolution of the biliary image.

9. Choice of angiography method

The above methods use oral and intravenous methods as routine methods. Patients with suspected cholecystitis and gallstones are the preferred oral methods. If the gallbladder is lightly developed, an additional dose may be used. If the gallbladder is not improved, the intravenous method is used instead. For patients with jaundice, especially obstructive jaundice, use ERCP or PTC directly to shorten the examination time. For patients with T shaped tube after cholecystectomy, T shaped tube angiography can be used; if the T shaped tube has been removed and there are minor symptoms, the intravenous method or drip method can be tried; Heavy, can use ERCP directly.