This document summarizes the anatomy and imaging techniques of the biliary apparatus. It describes the structures of the liver, gallbladder and bile ducts. Imaging methods like sonography, cholecystography, cholangiography and ERCP are used to examine the biliary tract and diagnose conditions like gallstones, bile duct stones, infections and cancers. Contrast agents are administered orally, intravenously, via percutaneous transhepatic cholangiography or during ERCP to visualize the biliary structures.

2. Dr. Mustafa Zuhair Mahmoud
B.Sc; SUST {Khartoum, Sudan}
M.Sc; AAU {Khartoum, Sudan} & JUREI {Philadelphia, USA}
Ph.D, Ludes {Lugano, Swiss}
Ph.D, SUST {Khartoum, Sudan}
2

3. Biliary
Apparatus
(Cholegraphy)

4. Quick Anatomical
Review

5. The Biliary Apparatus:
The bile is drained from the liver by two main ducts, the
Right& Left hepatic ducts.
The right &Left hepatic ducts leave the liver at the porta
hepatic& unites to form the Common Hepatic Duct.

6. The Common Hepatic Duct -about 3cm in length- joined the
cystic duct. (This is the duct from the Gall Bladder)
The Cystic Duct& the Common Hepatic Duct together form
the Common Bile Duct.

7. The Common Bile Duct which is about 7.5 cm in length
passes behind the 1st part of duodenum& then unites with
the pancreatic duct to enter the 2nd part of the duodenum,
on the surface of the duodenal papilla.
The opening through the duodenum is surrounded by a
sphincter muscles, the sphincter of Oddi.

8. The Gall Bladder:
The gall bladder is a pear-shaped sac which lies on
the under surface of the liver, to which it is attached by
connective tissue.
The gall bladder is divided for descriptive purposed
into:
Fundus.
Body.
Neck.

9. Structure of the Gall
Bladder:
The wall of the gall
bladder is composed of
three coats:
An outer Serous Coat.
A middle Fibrous tissue&
Smooth muscles coat.
An inner Mucous coat.

11. Biliary Tract& Gall Bladder Radiography
Several techniques can be used to examine the gall
bladder and the biliary tract.
In many institution, Sonography is the modality of
choice.
Terms:
¤ Cholegraphy: Is the general term for a radiographic
study of the biliary system.
¤ Cholecystography: Is the radiographic investigation of
the gall bladder.
¤ Cholangiography: Is the radiographic study of the biliary
ducts.
¤ Radiography of both the gall bladder& the biliary ducts is
Cholecystangiography or Cholecystocholangiography.
¤ Endoscopic Reterograde Cholangio-pancreatogrphy
(ERCP) is the procedure to diagnose biliary and pancreatic
pathological conditions.

12. Indications for imaging
- Gallstones, (cholelithiasis).
- Stones of the bile ducts, (choledocholithiasis).
- Cholangitis.
- Cholecystitis.
- Bile duct cancer.
- Infection of the pancreas, liver, or the bile ducts.

13. Patients Preparation
- On the day before the procedure you will likely be asked not to eat,
and to drink only clear liquids.
- Complete fasting in the morning of the examination.

14. Contrast Media administration Methods
Routes of administration are as follow:
1.
By Mouth __ Oral.
Contrast
Media
Biloptin

15. Oral Cholecystogram (OCG)
Route of
administration:
By Mouth __ Oral.

16. 2. By injection in a vein in a single bolus or by drip
infusion __ Intravenous.

17. Contrast Media
Urographin or Omnipaque

18. Intravenous Cholangiogram
Route of administration:
By injection in a
vein in a single bolus
or by drip infusion __
Intravenous.

19. 3. By direct injection into the ducts:
a. Percutaneous Transhepatic Cholangiography
(PTC).

20. Contrast Media
Urographin or Omnipaque

21. PTC Examination
Routes of administration:
By direct injection into
the ducts.

22. 3. By direct injection into the ducts:
b. During biliary tract surgery (operative or
immediate), through an indwelling drainage
tube, termed a T-Tube (postoperative or
delayed).

23. Contrast Media
Urographin or Omnipaque

24. Postoperative Cholangiogram,
performed with a T-tube
Routes of administration:
By direct injection into
the ducts.

25. Endoscopic Reterograde Cholangio-pancreatogrphy (ERCP)
is the procedure to diagnose biliary and pancreatic pathological
conditions.

26. Endoscopic Reterograde Cholangio-pancreatogrphy
(ERCP) is the procedure to diagnose biliary and pancreatic
pathological conditions.

27. Contrast Media
Urographin or Omnipaque

28. ERCP

29. THANKS