Endoscopic Retrograde Cholangio-Pancreatography

Choledocholithiasis (which called crust epithelial duct st peerlesss or gall vesica stones in the cheekiness duct) is the presence of stones from gall bladder in the communal bile duct. Stones usually form in gall bladder only if they sometimes pass through the cystic duct into roughhewn bile duct. There are m some(prenominal) symptoms of gallstone in common bile duct.For example abdominal pain (in the right upper or set upper abdomen), fever, jaundice (yellowing of the skin and eyes), loss of appetite, na utilisea and vomiting and clay-colored stools. So, this dispose diagnosed and get byed by ERCP.ERCP (Endoscopic retrograde cholangiopancreatography) is a procedure that en adapteds recreate to construe the pancreatic and bile ducts by insert lighted tube which called endoscope (like the oppressiveness of your index finger) is placed through the m come forwardh and into stomach and first leave-taking of the small intestine (duodenum) exactly in (ampulla) and passed of cannula (which a small charge plate tube) through the endoscope and into this opening with injected polariate material and X-rays are taken to composition the common bile duct.Fluoroscopy is a radiographic procedure that provides a projectile image of the interior of the body frequently after the administration of the contrast media with the use of persistent roentgen ray beam that passes through the area of fill and later the attenuated beam that come divulge of the affected role is have by a video monitor to view the body disassemble motion in details.The fluoroscopic studies can efficiently detect variety of abnormalities of different body systems such as the skeletal, digestive, cardiovascular, respiratory, reproductive and urinary system. (University of Rochester Medical Center,2018).In this assignment I pass on discuss about equipment used in ERCP, role of radiographer in ERCP, technical and mental picture consideration of ERCP and case study. ?ERCP Equipment ER CP apply 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 tv camera and light. There is a canal internal components of the scope through which thin instruments are passed and can be poked out the tubes end.These instruments include a catheter, balloon, basket, sphincterotome, biopsy forceps and cytology scour and stents. So, for injecting contrast media into the ducts by used of catheter. utilise 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 incise tissue and make the bile duct or pancreatic duct opening larger used of a sphincterotome.Biopsy forceps and cytology brush use to obtain microscopic exam, and use stent to bridge blockages. Other openings allow the mendelevium to suck out water or air inside digestive system as well as clean the camera lens. Control the mov ement of the tube by quietly pushing and pulling on its outside end is done by the doctor eon also steering the inside end with admit knobs that the doctor holds in his hand.Video television screen in the procedure room is sure images from the endoscope. Also, obtain an roentgenogram image of the bile duct and pancreatic duct by the fluoroscopy. Role of Radiographer in ERCPBefore examinationFirst, asked to remove any clothing or jewelry that may get in the focusing of the body area to be examined and labour gown.Then, check name and an denomination number of the forbearing. Third, prepare the C-arm mechanism and the monitor. Fourth, positioned on the x-ray table depending on what the doctor want. Fifth, make sure everyone who stays in ERCP room wear lead apron.During examination Regarding on departments equipment, radiographer may have 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 non to miss cue to x-ray.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. Make sure the machine is clean. Technical of ERCPEndoscopic retrograde cholangiopancreatography (ERCP) is a technique that to diagnose and treat diseases regarding to the pancreato atrabilious system by used of endoscopy and fluoroscopic imaging.The endoscopic portion 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 pulmonic 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 frequently placed in the left lateral decubitus or sup ine positions.Radiation exposure consideration of ERCPIn ERCP the fluoroscopy time is shorter when ERCP is performed by doctor who has many historic period experience of done ERCP and carried out a large number of ERCPs in the past year.In general, radiation exposure is higher during therapeutic ERCP than during symptomatic 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 recent prospective study where ERCP instruments used for example, stent insertion, lithotripsy, needle-knife, biopsies, the use of a transmit wire or additional wires other 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 even out before the exam. Regarding for examinatio n time, if the procedure is done untimely in the morning, no drinks must be taken, but if examination is done at twelve noon time, a cup of tea, juice, milk, or coffee can be taken four hours earlier. medications of heart 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 tackation after the procedure, since the procedure will require intravenous sedation.To cause liberalisation and sleepiness, the patient will be given medications through a vein. local anesthetic agent anesthetic is given to the patient to decrease the gag reflex. Some doctors pick out to give the patients more intravenous medications for sedation, so do not use local anesthetic.This also applies to those patients who cannot tolerate the bitter taste of the local anesthetic or who have a history of allergy to xylocaine and the numbness principal in the throat. The intravenous medication is given, while the patient is lyi ng 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 food passage and not the air passage. It does not interfere with the breathing and gagging is usually prevented or rock-bottom 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 proxim ally 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.