Cholangiogram

http://info.med.yale.edu/surgery/anatomy/radiology/cholangiogram_content.php

SLIDE 1
Goals:
1. Relate the hepatoduodenal ligament and second portion of the duodenum to bony landmarks
2. Relate the pancreas to bony landmarks and the duodenum

SLIDE 2
- The gallbladder was removed
- To examine the integrity of the biliary system during surgery, a catheter was inserted in the ampulla of the duodenum.
Question 1. Besides the biliary tree, what other structure should be filed with contrast dye?
- the pancreatic duct, because it empties into the ampulla along with the bile duct.

SLIDE 3
Identify the following landmarks
- 12th rib
- L1 vertebrae
- L2 vertebrae
- catheter
- common bile duct and gallbladder
- pancreatic duct
- hepatoduodenal ligament
- 3rd portion of the duodenum (filled with contrast)
- infer the 2nd portion of the duodenum

SLIDE 4
SUMMARY
- The pancreatic and common bile ducts empty into the middle of the 2nd portion of the duodenum
- This portion of the duodenum is to the right of midline between L1 and L3; the 3rd portion crosses the midline at L3
- The body of the pancreas crosses the midline at L2
- The hepatoduodenal ligament begins near the midline near the L1/L2 disc (transpyloric plane) and angles towards the liver

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