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Endoscopic retrograde cholangiopancreatography ( ERCP ) is a process that diagnoses the pathology of the liver, saddle sore vesica, bile canal and the pancreas. Endoscopic retrograde cholangiopancreatography is normally performed by the doctor or sawbones instead than radiotherapist and it is assist with the radiographer. Endoscopic and fluoroscopic is use in this technique to obtain images.

This process diagnose and handle the pathology of the gall system such as saddle sore vesica rock, malignant neoplastic disease in the liver, stenosis in the bilious system, tumor, and ductal rock. The sawbones inserts a lighted range with camera which is flexible into the oral cavity of the patient, and reaches the patient ‘s tummy, and to the bilious tree. The sawbones will besides shoot contrast media in the bilious system so that the organ is seeable in the x-ray image, to let the sawbones to see the organ in inside informations and analyze pathologies in the system. This process can besides handle some disease, when the doctor found some unnatural growing ; a catheter is inserted in that peculiar part through the endoscope to roll up some tissue for farther diagnose.

In endoscopic retrograde cholangiopancreatography can besides handle certain disease on the topographic point such as saddle sore rock, during this process, if the sawbones found rock in the gall bladder, he will take the bilestone by infixing a device through the endoscopic. Furthermore, if a narrowed bile canal such as common bile canal is diagnose, so the sawbones will open the gall canal by infixing a plastic tubing to enlarge the gall canal through the endoscopic.

Endoscopic retrograde cholangiopancreatography is performed in a x-ray section. It requires minimal readying except fasting, and a depressant will be given to the patient and the process will get down. This ERCP has more advantages over transdermal transhepatic cholangiography ( PTC ) . Unlike ERCP, pancreatic canal can non be visualize and entree by transdermal cholangiography, but in ERCP all the bilious system is seeable. Besides, ERCP besides has the ability to visualise ampullary lesion, and besides obtain tissue ( biopsy ) for farther diagnosing. ERCP has besides greater curative potency. Furthermore, PTC can non undergoes endoscopic sphincterotomy.

Indication

Endoscopic retrograde cholangiography ( ERCP ) is used to look into bilious disease or pancreatic disease. There are many indicant that require to undergoes ERCP such as sclerosing cholangitis, cholangitis, cholecystitis, cirrhosis, Sphincter of Oddi disfunction, ascites, cholelith, cholelithiasis, choledocholithiasis, icterus, bile canal tumor, bile canal obstructor, acute pancreatitis, hepatitis, and hepatocarcinoma.

Sclerosing cholangitis is a disease refers to the puffiness of the gall canal inside or outside of the liver. In this instance, the gall canal is scarred and narrowed. It is normally appear in patient with redness intestine disease such as Crohn ‘s disease and ulcerative colititis. Cholangitis is the redness of the gall canal, it is normally caused by infection from bacteriums.

Cholecystitis is the redness of the gall bladder that is normally cause by the saddle sore rock in the vesica. Cholecystitis trapped the gall in the gall bladder and causes the builup in the gall bladder and lead to redness. Cirrhosis is the scarring of liver tissue and hapless liver map that may to chronic liver disease.

Sphincter of oddi dysfuntion is the failure of the sphincter muscular wall that controls the flows of the juices in the bilious system, it will do the keeping of the juice in the pancreatic canal and can non be deliver. Ascites is the inordinate accretion of the fluid in the peritoneal pit. Cholelithiasis refers to gallstone, it is a crystalline concrete that is form in the gall bladder, as the rock addition, it may blockade the flow of the bile canal to other portion of the bilious system.

Choledocholithiasis refers to the presence of the bilestone in the common gall canal, this may take to the obstructor of the common gall canal. Jaundice is xanthous febrility, the tegument of the patient look to be xanthous. It is normally caused by hyperbilirubinemia.

Cathether is inserted from the oral cavity to the duodenum and reaches the pancreatic canal.

Endoscopic retrograde cholangiopancreatography ( ERCP ) Procedure

This process can name the job of the liver, pancreas, gall bladder and the bilious system

Care before, during and after the process

Before the process: Before the patient enters the room, the radiographers have to do certain the room is tidy, clean and is free of bacteriums. The radiographers besides have to look into the x-ray machine to do certain there is no escape in the x-ray tubing and it is in a good status. Besides, they are besides in charge of puting the right exposure, ready the cassette with movie and the marker.Always ask patients for 10days regulation and do certain patient is non pregnant. Radiographer besides has to do certain that the right sum and concentration of contrast media is administered to the patient. Furthermore, the radiographer must ever inform consent and do certain the patient understands, and inquire the patient to subscribe the consent signifier after he or she is to the full understood. Make certain the parient is non allergy to seafood ( patient who is allergy to seafood may besides allergy to contrast media )

During the process: do certain it is the right patient by inquiring their name, designation figure and enrollment number.Always assist patient during the process. Make certain patient is free from any electricity and mechanical beginning. Give radiation protection to the patient. Give comfort to the patient. Observe patient ‘s status during scrutiny. Explain the process and do certain patient understand the process and ever pass on with patient.

After the process: Assist patient to travel out of the x-ray room. For outpatient, inquire the day of the month for the following assignment or set up the following assignment. For inmate, inquire the nurse or staff in ward to come and take the patient. Nil orally until esthesis has returned to the throat. Check the pulsation, temperature and the blood force per unit area half-hourly for 6 hr. Keep antibiotics if there is bilious or pancreatic obstructor. Serum/urinary amylase if pancreatitis is suspected.

Patient readying: patients have to fast for approximately 4 hours prior the process, to maintain the tummy and the duodenum empty for accurate image position and safer. The radiographer must do certain the patient is free from allergic reaction of contrast media. Ask the patient to alter into hospital gown, take all the jewelleries. A preliminary movie is taken ( prone AP and LAO of the upper venters, to look into for opaque bilestone and pancreatic calcification/calculi ) . Patients are advise non to utilize any medicine before the scrutiny.

Positioning of patient and cassette: Patient lying supine, so he or she is given ataractic to maintain them asleep or loosen up. Then throat is anaesthetized with xylocaine spray. The patient is so moved to the left side and the endoscope is introduced. The ampulla of vater is located and the patient is turned prone. A polythene catheter prefilled with the contrast media is inserted into the ampulla, holding ensured that all the air bubbles are excluded to forestall any complication. A little trial injection of the contrast under fluoroscopic control is made to find the place of the cannula. It is of import to avoid over-filling of the pancreas. If it is desirable to opacify the bilious tree and pancreatic canal, so the latter should be cannulated foremost. A sample of the gall should be sent for civilization and sensitiveness if there is grounds of the bilious obstructor. If any bilestone happens to be in the gall bladder, the sawbones will instantly take the bilestone. The plastic tubing ( stent ) can besides be inserted into the endoscopic if a narrow stenosis is detected to enlarge it. Besides if a tumour is found, the tumor can be bypassed to forestall obstructor and besides biopsy can be done to undergoes farther diagnosing.

If gall rocks is found in the bilious system, a particular instrument in inserted via the endoscopic and take the bilestone.

Endoscope that is used in the endoscopic retrograde cholangiopancreatography.

Complication, side consequence and the hazard of endoscopic retrograde cholangiopancreatography ( ERCP )

ERCP requires tonss of accomplishment and technique which is really indispensable during this process. If the process is non done right certain complication may originate and may take to life threathening.There are many complications in this process such as allergy reaction. Endoscopic retrograde cholangiopancreatography utilizations contrast media to do the soft tissue in the bilious system to be seeable in the movie, it act as a dye that is administered in the patient organic structure by a catheters in the ampulla of vater. Contrast media allergic reaction are fundamentally really rare but it may besides hold possibility particularly iodine contrast media. Contrast media will besides do blushing esthesis and puke.

Besides, it may besides do ague pancreatitis after this trial, the secretory organ of pancreas become inflamed, the digestive juices is so release to the environing tissue and causes pancreatitis. It is more likely after big volume and high force per unit area injections. It may besides do hemorrhage in the pancreas because of the interpolation of the catheters, acerate leafs and tubing. Furthermore, respiratory apprehension may besides happen if there is an overdose of the depressants. If the depressant that is given to the patient is excessively heavy, the patient may experience excessively sleepy, and may take to stamp down of the lungs and causes respiratory apprehension. After this process, patient will besides experience discomfort because the sawbones inject dyes and blow air into the duodenum of the patient and the ataractic usage will do the patient feel lethargic.

Other complication such as, the flexible thin range can sometimes damage the internal organ of patient, by brushing the surface of the duodenum. The liner of the digestive system may happen and if serious it will do a hole in the bilious system and will take to internal hemorrhage. Patients are advice non to eat or imbibe 8 hours before the surgery ; this is to avoid tummy choking after the interpolation of the catheters.

Patient will besides experience numb in the pharynx and bitter in the same clip because of the anaesthesia spray during the surgery. Patient will besides experience bloated and nausea due to the technique ( air is blown into the duodenum ) . Besides, patient will hold abdominal cramping when the catheter is pulled out.

Patient must reach the physician if symptoms like, purging blood, hurting in the abdominal, fever or chill, dizzy or lethargic after few yearss of the process, and shortness of breath. Patient with history of bosom disease will besides see cardiac apprehension and irregular pulse. The contrast media being used in this process may advance bleary vision, urtications ( ruddy athleticss on the surface of the tegument, itchy ) , throat cramp, urine keeping.

Consequences of endoscopic retrograde cholangiopancreatography ( ERCP )

Normal consequences: the x-ray image will demo normal construction of the bilious system. The bile canal, pancreas, gall bladder, and pancreatic canal look to be in normal size. The digestive system such as, duodenum, eosophagus, tummy, pancreas looks normal with no stenosis, unnatural growing, calcification or rocks.

Abnormal consequences: the x-ray radiographer may demo unnatural size of the gall bladder which may do by crystalline of rock in the vesica, obstructor of the common gall canal, bilious stenosis, cholangitis, cholelithiasis, chronic pancreatitis, cirrhosis, expansion of the pancreas, pancreatitis, pancreatic divisum, narrowed of the common gall canal and pancreas carcinoma, tumour, malignant neoplastic disease.

Endoscopic radiogram demoing rock in the gall canal

ERCP demoing dilated bile canal with rocks

Normal ERCP image

Decision

Endoscopic retrograde cholangiopancreatography ( ERCP ) is a process that diagnoses the pathology of the liver, saddle sore vesica, bile canal and the pancreas. Endoscopic retrograde cholangiopancreatography is normally performed by the doctor or sawbones instead than radiotherapist and it is assist with the radiographer. Endoscopic and fluoroscopic is use in this technique to obtain images. ERCP is performed utilizing depressant without general anesthetic. It is besides a less invasive process and fundamentally safe with really rare side effects. Besides, it is a really uncomfortable scrutiny but it is non painful with really low hazard.

This process diagnose and handle the pathology of the gall system such as saddle sore vesica rock, malignant neoplastic disease in the liver, stenosis in the bilious system, tumor, and ductal rock, which can non be obtain in other scrutiny such as computed imaging scan ( CT scans ) , magnetic resonance imagination ( MRI ) , general x-rays, or ultrasound.The sawbones inserts a lighted range with camera which is flexible into the oral cavity of the patient, and reaches the patient ‘s tummy, and to the bilious tree. The sawbones will besides shoot contrast media in the bilious system so that the organ is seeable in the x-ray image, to let the sawbones to see the organ in inside informations and analyze pathologies in the system. This process can besides handle some disease, when the doctor found some unnatural growing ; a catheter is inserted in that peculiar part through the endoscope to roll up some tissue for farther diagnose.

In endoscopic retrograde cholangiopancreatography can besides handle certain disease on the athletics such as saddle sore rock, during this process, if the sawbones found rock in the gall bladder, he will take the bilestone by infixing a device through the endoscopic. Furthermore, if a narrowed bile canal such as common bile canal is diagnose, so the sawbones will open the gall canal by infixing a plastic tubing to enlarge the gall canal through the endoscopic.

Endoscopic retrograde cholangiopancreatography is performed in a x-ray section. It requires minimal readying except fasting, and a depressant will be given to the patient and the process will get down. This ERCP has more advantages over transdermal transhepatic cholangiography ( PTC ) . Unlike ERCP, pancreatic canal can non be visualize and entree by transdermal cholangiography, but in ERCP all the bilious system is seeable. Besides, ERCP besides has the ability to visualise ampullary lesion, and besides obtain tissue ( biopsy ) for farther diagnosing. ERCP has besides greater curative potency. Furthermore, PTC can non undergoes endoscopic sphincterotomy.

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