China
Africa
Explore chapters and articles related to this topic
Gastrointestinal system
Published in David A Lisle, Imaging for Students, 2012
US is the first imaging investigation of choice for the jaundiced patient. Common bile duct diameter measurements are graded as follows: normal <6 mm; equivocal 6–8 mm; dilated >8 mm (Fig. 4.42). The site and cause of obstruction are defined on US in only 25 per cent of cases as overlying duodenal gas often obscures the lower end of the common bile duct (Fig. 4.43). Associated dilatation of the main pancreatic duct suggests obstruction at the level of the pancreatic head or ampulla of Vater. Depending on the results of US, further investigation may be directed as follows:Bile ducts not dilated: hepatocellular jaundice is considered and liver biopsy may be indicatedBile ducts dilated due to biliary calculus: endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy or surgeryBile ducts dilated due to soft tissue mass: CT for further characterizationBile ducts dilated without an obvious cause: CT may be performed as this has a higher rate of diagnosis of the cause of biliary obstruction than US (Fig. 4.44).
Liver and biliary system, pancreas and spleen
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The pancreas lies retroperitoneally and is situated in the epigastric and left hypochondriac regions of the abdomen. It is between 12 and 15 cm long and comprises a broad head that lies in the curve of the duodenum, a body behind the stomach and a tail that reaches the spleen. Its posterior relations include the aorta and IVC (Figs 6.20a,b). The gland is divided into lobules, the walls of which are lined with secretory cells. These drain by a series of ducts into the main pancreatic duct, which extends the length of the pancreas before joining with the bile duct at the ampulla of Vater. This opens into the second stage of the duodenum through a small papilla controlled by the sphincter of Oddie.
Physiology of the Human Biliary System
Published in Wenguang Li, Biliary Tract and Gallbladder Biomechanical Modelling with Physiological and Clinical Elements, 2021
The common duct is about 10–15 cm long and 5–15 mm wide, in which the CHD is ~4 cm long (Dodds et al. 1989). The CBD penetrates the wall of the duodenum to meet pancreatic duct at the duodenal ampulla. Early measurements illustrated normal CBD outer diameter was in a range of 4–17 mm with a mean of 8.85 mm (Ferris and Vibert 1959), and a slightly late examination indicated the CBD outer diameter was in a range of 4–12 mm with a mean of 7.39 mm and the CBD wall thickness varied from 0.8 to 1.5 mm with an average of 1.1 mm (Mahour et al. 1967). A histogram of CDB length versus the number of CBDs observed is illustrated in Figure 1.3.
Bioburden and transmission of pathogenic bacteria through elevator channel during endoscopic retrograde cholangiopancreatography: application of multiple-locus variable-number tandem-repeat analysis for characterization of clonal strains
Published in Expert Review of Medical Devices, 2019
Masoumeh Azimirad, Masoud Alebouyeh, Amir Sadeghi, Elham Khodamoradi, Hamid Asadzadeh Aghdaei, Amir Houshang Mohammad Alizadeh, Mohammad Reza Zali
Endoscopic retrograde cholangiopancreatography (ERCP) is used increasingly for diagnosis and treatment of pancreatobiliary diseases, including choledocholithiasis, gallstone pancreatitis, and bile duct or pancreatic duct stenosis [1]. Bacterial infection is the most morbid complications of ERCP, which can cause ERCP-related death through septic cholangitis, liver abscess, acute cholecystitis, and pancreatic pseudocyst [2]. During the procedure, bacteria can enter the biliary tract and colonize this tissue via contaminated device and its related instruments [3]. Difficulty in reprocessing, cleaning and disinfection of duodenoscopes, such as elevator mechanism, converted this medical device as a reservoir for life-threatening infections. The infection in this organ causes more frequently through enteric bacterial flora [4]. Several outbreaks were reported in association to used contaminated endoscopes during ERCP procedure in recent years [5–11]. Although these outbreaks were mainly related to Pseudomonas aeruginosa, Klebsiella spp., Enterococcus spp., Escherichia coli, and Staphylococci, sources of these bacteria and their transmission routes were not well characterized.
A comprehensive review of endoscopic ultrasound core biopsy needles
Published in Expert Review of Medical Devices, 2018
Theodore W. James, Todd H. Baron
In order to address these shortcomings and to enable passage and actuation using a standard echoendoscope, Cook Medical (Winston-Salem, NC) introduced the first flexible biopsy needle in 2003, the Quick-Core® Biopsy Needle, adapted from the Tru-Cut design [31]. The Quick-Core was composed of a cannula, a tissue penetrating stylet that can be disposed within the cannula, and a handle mechanism to advance the cannula over the stylet, which can retain the ability for the cannula to move smoothly and freely over the stylet, even when bent (Figure 3). While the Quick-Core represented a major advance in technology, technical issues inhibited widespread adoption. These issues included challenges in deploying the spring-loaded tray, especially when in torqued positions within the duodenum, as well as loss of specimen when the needle was withdrawn [32,33]. A minimal track length within the pancreas was required to safely deploy the needle and obtain tissue without traversing the pancreatic duct, which can lead to postprocedural pancreatitis and pancreatic duct leakage.
Device profile of the EXALT Model D single-use duodenoscope for endoscopic retrograde cholangiopancreatography: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2021
Dean Ehrlich, V. Raman Muthusamy
The management of pancreaticobiliary pathology has evolved significantly over the past several decades with the increasing utilization of endoscopic retrograde cholangiopancreatography (ERCP). At least 660,000 ERCPs are performed in the United States annually, with many more performed across the globe [1–3]. Unlike routine upper endoscopy or colonoscopy, ERCP is performed with a side-viewing duodenoscope that facilitates access to the duodenal papilla for entry into the common bile duct and pancreatic duct. The machinery within the distal end of the duodenoscope that allows precise control of devices passed through the duodenoscope working channel is much more complex than that of a standard endoscope. This complexity, among other factors (see below), increases the risk for device contamination or colonization by infectious organisms. Furthermore, these infectious organisms can be multi-drug resistant bacteria such as carbapenem-resistant enterobacteraciae [1,4,5]. In a post-market surveillance study of reprocessed duodenoscopes, the FDA found that approximately 5% were culture positive for high-concern organisms, more than tenfold higher than expected [6]. The precise incidence of duodenoscope-related infections is unknown, but in the past decade, several major infectious outbreaks have been identified and linked to duodenoscopes [7–9], prompting the FDA to issue a recommendation in 2019 that device manufacturers modify duodenoscope design to reduce or eliminate the risk of device transmitted infection [10]. In response to the ongoing infectious outbreaks and the FDA call to action, the EXALT Model D single-use duodenoscope (EXALT) (Boston Scientific Corporation, Marlborough, MA) was created to completely eliminate the risk of duodenoscope-transmitted infections.