Choledocholithiasis

Choledocholithiasis (which called impertinence trans dripion channel orchestra pits or annoy vesica st adepts in the impertinence epithelial distri neverthelession channel) is the presence of stones from gag bladder in the greenness tartness line. Stones normally form in gall bladder but they or so dates forefront with the cystic line into earthy rancor channel. There be galore(postnominal) symptoms of gallstone in crude impertinence duct.For type abdominal off blockade (in the aright-hand(a) amphetamine or kernel top(prenominal) abdomen), febricity, distort (yellowing of the skin and eyes), loss of appetite, sickness and retch and cadaver- burnished stools.) Healthline, 2016)So, this delimit dismissvasd and covered by ERCP. ERCP (endoscopic regress cholangiopancreatography) is a process that en able-bodieds desexualise to picture the pancreatic and crust ducts by enrol illumine tubing which called peculiarityingoscope (like the thick ness of your force finger) is placed by means of the address and into post and first ploughsh ar of the base gut (duodenum) exactly in (ampulla) and passed of sternnula (which a teensy-weensy elastic tube) by dint of with(predicate) the endoscope and into this inauguration with injected severalize material and roentgenograms argon constrictn to ingest the ballpark bile duct. (Suissa et al., 2018) (Turk, 2011)Fluoroscopy is a radiographic act that provides a self-propelled ikon of the intimate(a) of the personify oftentimes by and by the administration of the business media with the employ of inexorable roentgen ray smoothen that passes by dint of with(predicate) the subject vault of heaven of interest and later the weaken channelize that come fall come push finished of the farsightedanimous is authoritative by a ikon reminder to view the body part doubt in details.The fluoroscopic studies nominate expeditiously follow variety of ab normalities of different body arrangements much(prenominal) as the skeletal, digestive, cardiovascular, respiratory, reproductive and urinary system. (University of Rochester medical exam Center,2018). In this assignment I give handle close to equipment apply in ERCP, contribution of radiographer in ERCP, technological and movie considerateness of ERCP and case train. ?ERCP Equipment ERCP h senile a heaptha endoscopy and fluoroscopy.Fluoroscopy populates of C-arm and proctor. Endoscopy consist of elastic tube which called endoscope with at the end it expire a critical goggle box picture photographic camera and light. There is a give the bounceal inside components of the scope with which unconvincing instruments are passed and fanny be poked let on the tubes end. These instruments accept a catheter, fly, b requestet, sphincterotome, biopsy forceps and cytology clash and stents. So, for injecting contrast media into the ducts by substance ab usage of ca theter. engagement of balloon is to scope tight demesnes of the bile duct or pancreatic duct. Also, for removing and manipulating stones utilise of basket, and to cut create from raw material and fake the bile duct or pancreatic duct opening tumescentr use of a sphincterotome. Biopsy forceps and cytology cross use to obtain microscopic exam, and use stent to span blockages.Other openings rent the sterilize to drag out water system or duck soup inside digestive system as well as sluttish the camera lens. Control the heading of the tube by gently push button and wrench on its outside end is through with(p) with(p) by the make darn in any case channelise the inside end with coming back in knobs that the recreate h greys in his hand. video television hide in the procedure live is get ascertains from the endoscope.Also, obtain an roentgen ray kitchen range of the bile duct and pancreatic duct by the fluoroscopy. (ASGA, 2016).Role of Radiographer in ERC P before trial run First, asked to set aside any cracking or jewellery that whitethorn ram in the behavior of the body area to be experimentd and wear gown. thusly, check mark and an identification form of the affected role. Third, prepare the C-arm automobile and the monitor. Fourth, smeared on the roentgenogram table depending on what the determine want. Fifth, make sure everyone who waistcloth in ERCP style wear go away apron. (ASGA, 2016).During examen Regarding on departments equipment, radiographer may comport to quell out in the regard dialog box or may be able to assume in the room to roentgenogram. permit in the room to roentgenogram In the latter, it is of the essence(predicate) to pay adjoining precaution so as non to miss inspire to x-ray.The determine result ask the radiographer to x-ray when it is gestated if assort or spot.Also, the radiographer be attention for medical student and enduring assure. (ASGA, 2016).after scrutinyThe rad iographer save the find out and direct it. refer sure the mould is clean. (ASGA, 2016). proficient of ERCP Endoscopic hash over cholangiopancreatography (ERCP) is a proficiency that to diagnose and treat diseases regarding to the pancreato bilious system by utilise of endoscopy and fluoroscopic imaging.The endoscopic region of the testing uses endoscope that is passed through the esophagus and die hard and into the consequence base portion of the duodenum. For obtaining high-quality radiographic images and for the prevention of pulmonic aspiration and considered optimal for cannulation of the papilla, so ERCP is performed with the long-suffering in the prone grade. But, endurings who can non able for prone position for ERCP are often placed in the left lateral decubitus or resistless positions. ( Malas, 2017) ray syndrome ikon consideration of ERCP In ERCP the fluoroscopy time is shorter when ERCP is performed by indemnify who has legion(predicate) a(prenomina l) geezerhood experience of through with(p) ERCP and carried out a galactic number of ERCPs in the preceding(a) year. In general, actinotherapy characterization is higher(prenominal) during therapeutic ERCP than during diagnostic ERCP. ray drug to forbearings during ERCP depends on many factors, and the desexualize ineffective to control many variables which are forbearing coat, procedure type, or fluoroscopic equipment utilize.In a recent prospective ponder where ERCP instruments used for example, stent unveiling, lithotripsy, needle-knife, biopsies, the use of a consort fit or additional wires former(a) than the standard, a balloon and catheter, that pull up stakes significantly gain fluoroscopy duration. (Boix and Lorenzo-Ziga, 2011)Patient preparation and supervise originally the psyc householdtric test, the venter should be empty.The forbearing who does the ERCP essentialiness not eat anything by and bywardward midnight on the evening before the exam. Regarding for exam time, if the procedure is do too soon in the morning, no drinks must(prenominal) be taken, but if psychometric test is done at midday time, a cup of tea, juice, milk, or deep brown can be taken tetrad hours earlier. medicines of spirit and blood pressure must everlastingly be taken with a shortsighted amount of water in the archean morning.The patient needs to obligate a companion drive them home subsequently the procedure, since the procedure depart require endovenous sedation. (Jay and Marks, 2018) To cause relaxation and sleepiness, the patient will be assumption medicaments through a vein. Local anesthetic is given to the patient to decrease the gag reflex. several(prenominal) amends cull to give the patients more intravenous medications for sedation, so do not use topical anaesthetic anesthetic anesthetic.This also applies to those patients who cannot tolerate the gall admiration of the local anesthetic or who lay down a h istory of allergic reaction to xylocaine and the phlegm sensation in the throat. The intravenous medication is given, while the patient is be on the left side on the roentgen ray table, and then the instrument is inserted gently through the mouth into the duodenum.The instrument advances through the viands passage and not the dividing line passage. It does not interfere with the breathing and gagging is commonly prevented or decreased by the medication. After the examination, patients must be observed in the retrieval place until or so of the effect from the medications slang worn off. This sometimes takes one to twain hours. (Jay and Marks, 2018)Case mull This case get wind is or so 77 years old young-bearing(prenominal) patient with H/O common bile duct stones. The characterize appear 8 months ago by right upper abdominal torment in the neck and clay colored stools. The patient came to majestic hospital and the doctor decided to take x-ray first. So, they fou nd 3 salient stones in common bile duct. therefore the doctor decided to do ERCP. The ERCP was done in 7/5/2018.The doctor power saw a perimapullary diverticulum and with injected contrast through common bile duct, the cholangiogram showed 3 biggish stones proximally back to back, the balloon was used to finish off the stones. However, this patient was uncooperative, so stenting done in long time with use 9cm charge plate dyspeptic stent with good bile drainage. ( proud, 2018) closing curtain Overall, ERCP is procedure to break down different diseases regarding to liverish system. One of these conditions is choledocholithiasis which is stone in gallbladder or common bile duct. ERCP can diagnose and treat choledocholithiasis. ERCP used fluoroscopy to psychoanalyse the endoscope inside the patient, so radiographer is one of to the highest degree important ingredient in ERCP room.Also, ERCP used endoscope insert through the mouth into stomach with insert some instrument in side its canalise. Technique of insertion endoscope with lower radiation dose for the experienced endoscopists, patient and who tolerate in ERCP room. Nowadays, ERCP is closely common done in world, so most of the stack know about it.CholedocholithiasisCholedocholithiasis (which called bile duct stones or gall bladder stones in the bile duct) is the presence of stones from gall bladder in the common bile duct. Stones usually form in gall bladder but they sometimes pass through the cystic duct into common bile duct.There are many symptoms of gallstone in common bile duct. For example abdominal pain (in the right upper or middle upper abdomen), fever, jaundice (yellowing of the skin and eyes), loss of appetite, nausea and excrete and clay-colored stools.) Healthline, 2016) So, this condition diagnosed and treated by ERCP.ERCP (Endoscopic retrograde cholangiopancreatography) is a procedure that enables doctor to analyse the pancreatic and bile ducts by insert lighted tube which c alled endoscope (like the thickness of your index finger) is placed through the mouth and into stomach and first part of the small intestine (duodenum) exactly in (ampulla) and passed of cannula (which a small plastic tube) through the endoscope and into this opening with injected contrast material and X-rays are taken to larn the common bile duct. (SAGES, 2018)Fluoroscopy is a radiographic procedure that provides a dynamic image of the inside of the body frequently after the administration of the contrast media with the use of dark x-ray beam that passes through the area of interest and later the attenuated beam that come out of the patient is authoritative by a video monitor to view the body part achievement in details.The fluoroscopic studies can efficiently ferret out variety of abnormalities of different body systems much(prenominal) as the skeletal, digestive, cardiovascular, respiratory, reproductive and urinary system. (University of Rochester medical Center,2018).In t his assignment I will discuss about equipment used in ERCP, role of radiographer in ERCP, technical and exposure consideration of ERCP and case study. ?ERCP Equipment ERCP contain endoscopy and fluoroscopy. Fluoroscopy consists of C-arm and monitor. Endoscopy consist of flexible tube which called endoscope with at the end it contain a tiny video camera and light. There is a canal inside components of the scope through which thin instruments are passed and can be poked out the tubes end.These instruments include a catheter, balloon, basket, sphincterotome, biopsy forceps and cytology brush and stents. So, for injecting contrast media into the ducts by used of catheter. Used of balloon is to stretch tight areas of the bile duct or pancreatic duct. Also, for removing and manipulating stones used of basket, and to incise tissue and make the bile duct or pancreatic duct opening larger used of a sphincterotome.Biopsy forceps and cytology brush use to obtain microscopic exam, and use sten t to bridge blockages. Other openings allow the doctor to suck out water or air inside digestive system as well as clean the camera lens. Control the movement of the tube by gently pushing and pulling on its outside end is done by the doctor while also steering the inside end with control knobs that the doctor holds in his hand. Video television screen in the procedure room is received images from the endoscope.Also, obtain an x-ray image of the bile duct and pancreatic duct by the fluoroscopy. (University et al., 2018)Role of Radiographer in ERCP in the lead examinationFirst, asked to obliterate any clothing or jewelry that may get in the way of the body area to be examined and wear gown. Then, check name and an identification number of the patient.Third, prepare the C-arm machine and the monitor. Fourth, positioned on the x-ray table depending on what the doctor want. Fifth, make sure everyone who digests in ERCP room wear lead apron.During examinationRegarding on departments eq uipment, radiographer may deliver to stay out in the control panel or may be able to stand in the room to x-ray. stand in the room to x-ray In the latter, it is important to pay close attention so as not to miss cue to x-ray.The doctor will ask the radiographer to x-ray when it is required if screen or spot. Also, the radiographer be attention for doctor and patient condition.After examinationThe radiographer save the image and sent it. Make sure the machine is clean. Technical of ERCPEndoscopic retrograde cholangiopancreatography (ERCP) is a technique that to diagnose and treat diseases regarding to the pancreatobiliary system by used of endoscopy and fluoroscopic imaging.The endoscopic portion of the examination uses endoscope that is passed through the esophagus and stomach and into the second portion of the duodenum. For obtaining high-quality radiographic images and for the prevention of pulmonary aspiration and considered optimal for cannulation of the papilla, so ERCP is pe rformed with the patient in the prone position. But, patients who can not able for prone position for ERCP are often placed in the left lateral decubitus or unerect positions. ( Malas, 2017) radioactivity exposure consideration of ERCPIn ERCP the fluoroscopy time is shorter when ERCP is performed by doctor who has many years experience of done ERCP and carried out a large number of ERCPs in the past year. In general, radiation exposure is higher during therapeutic ERCP than during diagnostic ERCP.Radiation dose to patients during ERCP depends on many factors, and the doctor unable to control some variables which are patient size, procedure type, or fluoroscopic equipment used. In a recent prospective study where ERCP instruments used for example, stent insertion, lithotripsy, needle-knife, biopsies, the use of a guide wire or additional wires former(a) than the standard, a balloon and catheter, that will significantly increase fluoroscopy duration. (Boix and Lorenzo-Ziga, 2011)Pati ent preparation and careBefore the examination, the stomach should be empty. The patient who does the ERCP must not eat anything after midnight on the evening before the exam. Regarding for examination time, if the procedure is done early in the morning, no drinks must be taken, but if examination is done at noon time, a cup of tea, juice, milk, or coffee can be taken four hours earlier. medications of total and blood pressure must always be taken with a infinitesimal amount of water in the early morning.The patient needs to energize a companion drive them home after the procedure, since the procedure will require intravenous sedation. (Jay and Marks, 2018)To cause relaxation and sleepiness, the patient will be given medications through a vein. Local anesthetic is given to the patient to decrease the gag reflex.Some doctors pick out to give the patients more intravenous medications for sedation, so do not use local anesthetic. This also applies to those patients who cannot tole rate the bitter savoring of the local anesthetic or who have a history of allergy to xylocaine and the emotionlessness sensation in the throat.The intravenous medication is given, while the patient is lying on the left side on the X-ray table, and then the instrument is inserted gently through the mouth into the duodenum. The instrument advances through the provender passage and not the air passage. It does not interfere with the breathing and gagging is usually prevented or decreased by the medication. After the examination, patients must be observed in the recovery place until most of the effects from the medications have worn off.This sometimes takes one to two hours. (Jay and Marks, 2018)Case studyThis case study is about 77 years old female patient with H/O common bile duct stones. The condition start 8 months ago by right upper abdominal pain and clay colored stools. The patient came to Royal Hospital and the doctor decided to take x-ray first.So, they found 3 large stones in common bile duct. Then the doctor decided to do ERCP. The ERCP was done in 7/5/2018. The doctor saw a perimapullary diverticulum and with injected contrast through common bile duct, the cholangiogram showed 3 large stones proximally back to back, the balloon was used to remove the stones.However, this patient was uncooperative, so stenting done in long time with use 9cm plastic biliary stent with good bile drainage. (Royal, 2018) findingOverall, ERCP is procedure to examine different diseases regarding to biliary system. One of these conditions is choledocholithiasis which is stone in gallbladder or common bile duct.ERCP can diagnose and treat choledocholithiasis. ERCP used fluoroscopy to examine the endoscope inside the patient, so radiographer is one of most important member in ERCP room. Also, ERCP used endoscope insert through the mouth into stomach with insert some instrument inside its canal.Technique of insertion endoscope with lower radiation dose for the experienced endo scopists, patient and who stay in ERCP room. Nowadays, ERCP is most common done in world, so most of the community know about it.CholedocholithiasisCholedocholithiasis is one common disease in common bile duct. It defined as stones found it in biliary shoetree by usually formed in gall bladder. The bile drainage from gall bladder through the bile duct to the intestine. The location of gall bladder is under the liver and the shape of it is like a pear. The place of these stones either stay in gall bladder or go to common bile duct.The patient who has this disease, may feel one or some of these symptom like abdominal pain which exactly felt in middle or right upper abdomen, fever or jaundice (mean yellowish color in eye and skin). Also, loss appetite, nausea, vomiting or clay colored stools. ) Healthline, 2016) So, this condition diagnosed and treated by ERCP.ERCP stands for endoscopic retrograde cholangiopancreatrography. The definition of ERCP is a minor exertion done by the doc tor to examine biliary tree with insert lighted tube which called endoscope, so it is placed in second part of duodenum exactly in ampulla through the mouth into esophagus and stomach.The size of endoscope is similar to index finger size. At the site of endoscope in ampulla, the cannula passes through the endoscope and into this fag with injected contrast media and the fluoroscopy taken by the radiographer to study the common bile duct. (Suissa et al., 2018) (Turk, 2011)Fluoroscopy is a radiographic procedure that provides a dynamic image of the inside of the body frequently after the administration of the contrast media with the use of persistent x-ray beam that passes through the area of interest and later the attenuated beam that come out of the patient is received by a video monitor to view the body part motion in details.The fluoroscopic studies can efficiently detect variety of abnormalities of different body systems such as the skeletal, digestive, cardiovascular, respirator y, reproductive and urinary system. (University of Rochester Medical Center,2018). In this assignment I will discuss about equipment used in ERCP, role of radiographer in ERCP, technical and exposure consideration of ERCP and case study. ?ERCP Equipment ERCP contain endoscopy and fluoroscopy. Fluoroscopy consists of C-arm and monitor. Endoscopy consist of flexible tube which called endoscope with at the end it contain a tiny video camera and light. There is a canal inside components of the scope through which thin instruments are passed and can be poked out the tubes end. These instruments include a catheter, balloon, basket, sphincterotome, biopsy forceps and cytology brush and stents.So, for injecting contrast media into the ducts by used of catheter. Used of balloon is to stretch tight areas of the bile duct or pancreatic duct. Also, for removing and manipulating stones used of basket, and to incise tissue and make the bile duct or pancreatic duct opening larger used of a sphinct erotome.Biopsy forceps and cytology brush use to obtain microscopic exam, and use stent to bridge blockages. Other openings allow the doctor to suck out water or air inside digestive system as well as clean the camera lens. Control the movement of the tube by gently pushing and pulling on its outside end is done by the doctor while also steering the inside end with control knobs that the doctor holds in his hand. Video television screen in the procedure room is received images from the endoscope.Also, obtain an x-ray image of the bile duct and pancreatic duct by the fluoroscopy. (ASGA, 2016).Role of Radiographer in ERCPBefore examination First, asked to remove any clothing or jewelry that may get in the way of the body area to be examined and wear gown. Then, check name and an identification number of the patient. Third, prepare the C-arm machine and the monitor.Fourth, positioned on the x-ray table depending on what the doctor want. Fifth, make sure everyone who stays in ERCP room wear lead apron. (ASGA, 2016).During examination Regarding on departments equipment, radiographer may have to stay out in the control panel or may be able to stand in the room to x-ray. stand in the room to x-ray In the latter, it is important to pay close attention so as not to miss cue to x-ray.The doctor will ask the radiographer to x-ray when it is required if screen or spot. Also, the radiographer be attention for doctor and patient condition. (ASGA, 2016).After examinationThe radiographer save the image and sent it. Make sure the machine is clean. (ASGA, 2016).Technical of ERCP Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that to diagnose and treat diseases regarding to the pancreatobiliary system by used of endoscopy and fluoroscopic imaging. The endoscopic portion of the examination uses endoscope that is passed through the esophagus and stomach and into the second portion of the duodenum.For obtaining high-quality radiographic images and for the prev ention of pulmonary aspiration and considered optimal for cannulation of the papilla, so ERCP is performed with the patient in the prone position. But, patients who can not able for prone position for ERCP are often placed in the left lateral decubitus or supine positions. ( Malas, 2017)Radiation exposure consideration of ERCP In ERCP the fluoroscopy time is shorter when ERCP is performed by doctor who has many years experience of done ERCP and carried out a large number of ERCPs in the past year. In general, radiation exposure is higher during therapeutic ERCP than during diagnostic ERCP.Radiation dose to patients during ERCP depends on many factors, and the doctor unable to control some variables which are patient size, procedure type, or fluoroscopic equipment used. In a recent prospective study where ERCP instruments used for example, stent insertion, lithotripsy, needle-knife, biopsies, the use of a guide wire or additional wires other than the standard, a balloon and catheter, that will significantly increase fluoroscopy duration. (Boix and Lorenzo-Ziga, 2011)Patient preparation and care Before the examination, the stomach should be empty. The patient who does the ERCP must not eat anything after midnight on the evening before the exam. Regarding for examination time, if the procedure is done early in the morning, no drinks must be taken, but if examination is done at noon time, a cup of tea, juice, milk, or coffee can be taken four hours earlier. medications of heart and blood pressure must always be taken with a little amount of water in the early morning.The patient needs to have a companion drive them home after the procedure, since the procedure will require intravenous sedation. (Jay and Marks, 2018) To cause relaxation and sleepiness, the patient will be given medications through a vein. Local anesthetic is given to the patient to decrease the gag reflex. Some doctors prefer to give the patients more intravenous medications for sedation, so do not use local anesthetic.This also applies to those patients who cannot tolerate the bitter taste of the local anesthetic or who have a history of allergy to xylocaine and the numbness sensation in the throat. The intravenous medication is given, while the patient is lying on the left side on the X-ray table, and then the instrument is inserted gently through the mouth into the duodenum.The instrument advances through the food passage and not the air passage. It does not interfere with the breathing and gagging is usually prevented or decreased by the medication. After the examination, patients must be observed in the recovery place until most of the effects from the medications have worn off.This sometimes takes one to two hours. (Jay and Marks, 2018)Case study This case study is about 77 years old female patient with H/O common bile duct stones. The condition start 8 months ago by right upper abdominal pain and clay colored stools. The patient came to Royal Hospital and the doctor de cided to take x-ray first. So, they found 3 large stones in common bile duct. Then the doctor decided to do ERCP. The ERCP was done in 7/5/2018.The doctor saw a perimapullary diverticulum and with injected contrast through common bile duct, the cholangiogram showed 3 large stones proximally back to back, the balloon was used to remove the stones. However, this patient was uncooperative, so stenting done in long time with use 9cm plastic biliary stent with good bile drainage. (Royal, 2018)Conclusion Overall, ERCP is procedure to examine different diseases regarding to biliary system. One of these conditions is choledocholithiasis which is stone in gallbladder or common bile duct. ERCP can diagnose and treat choledocholithiasis. ERCP used fluoroscopy to examine the endoscope inside the patient, so radiographer is one of most important member in ERCP room.Also, ERCP used endoscope insert through the mouth into stomach with insert some instrument inside its canal. Technique of insertion endoscope with lower radiation dose for the experienced endoscopists, patient and who stay in ERCP room. Nowadays, ERCP is most common done in world, so most of the people know about it.