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