Endoscopic Retrograde Cholangio-Pancreatography

Choledocholithiasis (which called bile communication channel stones or gall bladder stones in the bile duct) is the presence of stones from gall bladder in the parking lot bile duct. Stones usually form in gall bladder but they some beats pass by means of the cystic duct into harsh bile duct. There are numerous symptoms of gallstone in common bile duct.For example abdominal pain (in the right upper or middle upper abdomen), fever, bitterness (yellowing of the skin and eyes), loss of appetite, nausea and vomiting and clay- drab stools. So, this considerateness diagnosed and treated by ERCP.ERCP (Endoscopic retrograde cholangiopancreatography) is a cognitive process that enables prepare to examine the pancreatic and bile ducts by insert lighted tube which called endoscope (like the thickness of your baron finger) is placed through the m tabuh and into stomach and first part of the small intestine (duodenum) exactly in (ampulla) and passed of cannula (which a small plastic tub e) through the endoscope and into this opening with injected contrast material and X-rays are taken to rent the common bile duct.Fluoroscopy is a radiographic mathematical operation that provides a dynamic image of the within of the dust frequently by and by the administration of the contrast media with the use of persistent x-ray beam that passes through the land 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 line up variety of abnormalities of different body strategys such as the skeletal, digestive, cardiovascular, respiratory, reproductive and urinary system. (University of Rochester Medical Center,2018).In this appointee I will discuss about equipment employ in ERCP, role of radiographer in ERCP, technical and picture con billetration 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 sparse 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 use 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 cut tissue and make the bile duct or pancreatic duct opening vaingloriousr used of a sphincterotome.Biopsy forceps and cytology brush use to obtain microscopic exam, and use stent to bridge blockages. Other openings allow the animate to suck out irrigate or air inside digestive system as nearly as clean the camera lens. Control the movement of the tube by gently pushing and drag on its outsid e end is done by the doctor while also steering the inside end with control knobs that the doctor holds in his hand.Video television top in the procedure style is received images from the endoscope. Also, obtain an x-ray image of the bile duct and pancreatic duct by the fluoroscopy. voice of Radiographer in ERCPBefore examinationFirst, asked to remove any clothing or jewelry that may demoralise in the way of the body area to be examined and wear gown.Then, check name and an identification telephone 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 waistcloth in ERCP elbow room wear lead apron.During examination Regarding on departments equipment, radiographer may own 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-r ay.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. puff 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 designate 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 performed with the patient in the addicted position.But, patients who can not able for prone position for ERCP are often placed in the leftover lateral decubitus or supine positions.Radiation exposure consideration of ER CPIn ERCP the fluoroscopy time is shorter when ERCP is performed by doctor who has many years experience of done ERCP and carried out a declamatory 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 new-made prospective study where ERCP instruments used for example, stent insertion, lithotripsy, needle-knife, biopsies, the use of a guide wire or additional wires another(prenominal) than the standard, a balloon and catheter, that will significantly increase fluoroscopy duration.Patient 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 stock ticker 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.To cause relaxation and sleepiness, the patient will be presumption medications through a vein. Local anesthetic is given to the patient to decrease the gag reflex. Some doctors like to give the patients more intravenous medications for sedation, so do not use local anesthetic.This also applies to those patients who cannot rest the bitter taste of the local anesthetic or who have a history of allergy to xylocaine and the nonchalance 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 pabulum 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.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 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.