4. Liver is largest abdominal organ
major role in metabolism
Glycogen storage
Decomposition of red blood cells
Plasma protein synthesis
Hormone production
Detoxification
5. Liver is an irregular, wedge-
shaped organ Lies below the
diaphragm in the right upper
hypo quadrant of the abdomen
Closely related with the the
gallbladder, diaphragm,
stomach and covered by the
costal cartilages.
7. • Pancreas is a retroperitoneal
organ Has both endocrine and
exocrine functions.
• Production hormones(insulin,
somatostatin) glucagon.
• Digestion by its production
and secretion of pancreatic juice
Small intestine (duodenum)
ality: Investigate
8. ERCP is a technique that combines the use of
endoscopy and fluoroscopy to diagnose and
treat problems of the biliary or pancreatic
ductal system.
15. Nil orally for 4 h prior to procedure
Patients may be asked to temporarily stop
taking medications
Patient may asked to stop smoking
temporarily
Diazepam 4 hour before procedure
16. Sedation is given by using
midazolam, meperidine or
fentanlyl
Explain patient about
procedure
Written consent
Antibiotic cover
17. Prone AP and LAO of the
upper abdomen, to check for
opaque gallstones and
pancreatic
calcification/calculi
Prone AP
LAO
18. Pharynx is anaesthetized with
4% Xylocaine spray
Patient is given diazepam 5 mg
min-1 IV
Patient then lies on left side
and endoscope is introduced
19. Ampulla of Vater is located and
patient is turned prone.
Polythene catheter prefilled with
contrast medium - inserted into
ampulla, having ensured that all air
bubbles are excluded.
20. Small test injection of contrast
under fluoroscopic control is made
to determine position of cannula
If it is desirable to opacify both
biliary tree and pancreatic duct,
then latter should be cannulated
first
22. Bile ducts
Early filling films to show calculi
Prone - straight and posterior obliques
Supine - straight, both obliques;
Trendelenburg to fill intrahepatic
ducts
semi-erect to fill lower end of common
bile duct and gallbladder
23. Films following removal of
the endoscope, which may
obscure the duct.
Delayed films to assess the
gallbladder and emptying of
the common bile duct
24. Nil orally until sensation has returned to the pharynx
Pulse, temperature and blood pressure half-hourly for 6
h
Maintain antibiotics if there is biliary or pancreatic
obstruction
Serum/urinary amylase if pancreatitis is suspected
25. Due to contrast medium
Allergic reactions - rare
Acute pancreatitis - more likely with large volumes, high-pressure
injections
Due to the technique
Local
Damage by the endoscope, e.g. rupture of the oesophagus, damage to
the ampulla, proximal pancreatic duct and distal common duct
Distant
Bacteraemia, septicaemia, aspiration pneumonitis, hyperamylasaemia
(approx. 70%). Acute pancreatitis (0.7-7.4%)
Editor's Notes
physiological or medicinal removal of toxic substances from a living organism,
Postcholecystectomy syndrome describes the presence of abdominal symptoms, two years after a cholecystectomy
A pancreatic pseudocyst is a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue, typically located in the lesser sac of the abdomen. The most common cause of a pancreatic pseudocyst is inflammation of the pancreas, called pancreatitis
An anti-emetic,
e.g. Stemetil 12.5 mg, may be added
Antibiotic before and for at least 3 days following,
e.g. Cefuroxime 750 mg i.v. 6-hourly