Slide 2: This is a normal nuclear medicine biliary scan ...
Slide 2: This is a normal nuclear medicine biliary scan.
Normal uptake is noted in the liver at 5 minutes
consistent with normal hepatocellular function. The
common bile duct is visualized at 15 minutes and the
gall bladder is seen at 30 minutes. These findings rule
out acute cholecystitis with an accuracy of
Slide 3: This nuclear
medicine study shows
normal liver uptake at
5 minutes. The
common duct is
visualized at 15
minutes but no
visualized after 60
minutes. This study is
diagnostic for cystic
duct obstruction consistent with acute cholecystitis.
Slide 4: This nuclear medicine biliary scan
shows normal liver uptake but no
visualization of the common bile duct or the
gall bladder at 60 minutes. This study is
diagnostic of common duct obstruction.
Slide 5: The oral cholecystogram is
seldom used currently but still may
be helpful in diagnosing chronic
cholecystitis in patients with clinical
symptoms of chronic biliary colic in
the absence of stones in the
gallbladder on ultrasound. This study
represents a normal oral
cholecystogram with filling of the
gall bladder. An abnormal study
would fail to visualize the gall
bladder on two successive days after
the tablet has taken orally the
evening before. An oral
cholecystogram may also demonstrate filling of the gallbladder with filling defects
representive of stones.
Slide 6: This slide shows a transhepatic
cholangiogram demonstrating common duct
obstruction. A Chiba needle is introduced
percutaneously into a bile duct by
fleuroscopic guidance. The ductal system is
then filled with contrast material. Notice the
tapering obstruction of the distal common
duct suggestive of malignancy in the head of
the pancreas. The small marks on the common
duct demonstrate the usual caliber.
Slide 7: An alternative to transhepatic
of the common
bile duct is
retrograde cholangiopancreatography (ERCP). In this study,
a side viewing endoscope is passed through the stomach and
into the duodenum for visualization of the ampula of Vater.
A catheter is now passed through the ampula and dye
injected to fill both the pancreatic duct (PD) and the
common duct (CD). This study shows the typical
appearance of a stone obstructing the common duct. ERCP
is a frequent study in the evaluation of chronic pancreatic disease.
Slide 8: This slide
anatomy at the
abdomen at the
level of the
to this normal
Slide 9: This CT scan of the
abdomen with contrast shows the
typical appearance of acute
pancreatitis. The pancreas is
edematous with extrapancreatic
extension. The use of contrast
allows visualization of areas of
"unenhancement" diagnostic of
pancreatic necrosis. Such areas of
unenhancement may be aspirated
to determine the presence of
infected pancreatic necrosis.
Slide 10: This chest x-ray was taken of a patient four days after admission for severe
acute pancreatitis. Adult respiratory distress syndrome (ARDS) is demonstrated, a
complication of acute pancreatitis.
Slide 11: This slide demonstrates another
complication of acute pancreatitis, a
pancreatic pseudocyst. This 6 cm pseudocyst
is in the head of the pancreas and adherent to
the posterior wall of the stomach. These are
treated with either CT guided percutaneous
drainage or surgical drainage of the
pseudocyst into the stomach (internal
Slide 12: This abdominal CT
scan represents a large cancer in
the head of the pancreas. The
gallbladder is markedly dilated
secondary to common duct
obstruction. Such a gallbladder
would be palpable but not
nontender on physical
Slide 13: This CT scan of the abdomen shows
significant intrahepatic bile duct dilatation
secondary to obstruction. The cause of the
obstruction in this patient was a large cancer in
the head of the pancreas.
Slide 14: This CT scan of the abdomen
demonstrates the typical appearance of a
hepatoma or hepatocellular cancer.
Slide 16: This patient presented to the
surgical service with spiking fevers
quadrant abdominal pain. The CT scan
of the abdomen shows the typical appearance of a liver abscess.