eMedicine Specialties > Gastroenterology > Biliary

Biliary Disease: Multimedia

Author: Annie T Chemmanur, MD, Attending Physician, Metrowest Medical Center and University of Massachusetts Memorial Hospital, Marlborough Campus
Coauthor(s): Jeanette G Smith, MD, Fellow, Department of Gastroenterology-Hepatology, University of Connecticut School of Medicine; George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine
Contributor Information and Disclosures

Updated: Aug 29, 2009

Multimedia

A normal postcholecystectomy cholangiogram.
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Media file 1: A normal postcholecystectomy cholangiogram.
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A normal postcholecystectomy cholangiogram.

A normal postcholecystectomy cholangiogram.

Biliary disease. In this patient with persistent ...
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Media file 2: Biliary disease. In this patient with persistent elevation of liver-associated enzymes, the contrast entering the biliary ductal system preferentially enters the cystic duct.
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Biliary disease. In this patient with persistent ...

Biliary disease. In this patient with persistent elevation of liver-associated enzymes, the contrast entering the biliary ductal system preferentially enters the cystic duct.

Biliary disease. Even when the catheter is advanc...
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Media file 3: Biliary disease. Even when the catheter is advanced to the proximal common hepatic duct, contrast dye preferentially fills the cystic duct and gallbladder rather than allowing visualization of the intrahepatic ductal system.
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Biliary disease. Even when the catheter is advanc...

Biliary disease. Even when the catheter is advanced to the proximal common hepatic duct, contrast dye preferentially fills the cystic duct and gallbladder rather than allowing visualization of the intrahepatic ductal system.

Biliary disease. In this image, the common bile d...
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Media file 4: Biliary disease. In this image, the common bile duct is occluded with a balloon-tipped catheter. Contrast fills the intrahepatic ductal system to reveal diffuse intrahepatic sclerosing cholangitis.
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Biliary disease. In this image, the common bile d...

Biliary disease. In this image, the common bile duct is occluded with a balloon-tipped catheter. Contrast fills the intrahepatic ductal system to reveal diffuse intrahepatic sclerosing cholangitis.

Biliary disease. Common bile duct stones are amon...
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Media file 5: Biliary disease. Common bile duct stones are among the most common problems occurring in the biliary system. In this cholangiogram, the stones line up like peas in a pod.
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Biliary disease. Common bile duct stones are amon...

Biliary disease. Common bile duct stones are among the most common problems occurring in the biliary system. In this cholangiogram, the stones line up like peas in a pod.

Biliary disease. After a biliary sphincterotomy, ...
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Media file 6: Biliary disease. After a biliary sphincterotomy, a balloon-tipped catheter is used to remove the stones one by one.
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Biliary disease. After a biliary sphincterotomy, ...

Biliary disease. After a biliary sphincterotomy, a balloon-tipped catheter is used to remove the stones one by one.

Biliary disease. This clearing cholangiogram show...
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Media file 7: Biliary disease. This clearing cholangiogram shows a common bile duct free of filling defects and good flow into the duodenum. The stones are visible as filling defects in the duodenal bulb.
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Biliary disease. This clearing cholangiogram show...

Biliary disease. This clearing cholangiogram shows a common bile duct free of filling defects and good flow into the duodenum. The stones are visible as filling defects in the duodenal bulb.

Biliary disease. This patient with pancreatic can...
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Media file 8: Biliary disease. This patient with pancreatic cancer has developed jaundice during his treatment. The cholangiogram shows a stricture in the distal common bile duct (see Image 9).
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Biliary disease. This patient with pancreatic can...

Biliary disease. This patient with pancreatic cancer has developed jaundice during his treatment. The cholangiogram shows a stricture in the distal common bile duct (see Image 9).

Biliary disease. A patient with pancreatic cancer...
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Media file 9: Biliary disease. A patient with pancreatic cancer has developed jaundice during his treatment. To palliate the jaundice, the biliary stricture is dilated and stented with a 10F plastic stent. Note the contrast flowing down the stent (see Image 8).
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Biliary disease. A patient with pancreatic cancer...

Biliary disease. A patient with pancreatic cancer has developed jaundice during his treatment. To palliate the jaundice, the biliary stricture is dilated and stented with a 10F plastic stent. Note the contrast flowing down the stent (see Image 8).

Biliary disease. The CT scan of the abdomen shows...
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Media file 10: Biliary disease. The CT scan of the abdomen shows a large tumor mass in the head of the pancreas. The brightly colored object within the mass is the biliary stent placed by endoscopic retrograde cholangiopancreatography (ERCP).
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Biliary disease. The CT scan of the abdomen shows...

Biliary disease. The CT scan of the abdomen shows a large tumor mass in the head of the pancreas. The brightly colored object within the mass is the biliary stent placed by endoscopic retrograde cholangiopancreatography (ERCP).

Biliary disease. This abdominal CT scan shows mil...
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Media file 11: Biliary disease. This abdominal CT scan shows mild intrahepatic biliary ductal dilation.
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Biliary disease. This abdominal CT scan shows mil...

Biliary disease. This abdominal CT scan shows mild intrahepatic biliary ductal dilation.

Biliary disease. This patient with jaundice has p...
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Media file 12: Biliary disease. This patient with jaundice has polycystic liver disease on abdominal CT scan.
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Biliary disease. This patient with jaundice has p...

Biliary disease. This patient with jaundice has polycystic liver disease on abdominal CT scan.

Biliary disease. Findings on an endoscopic retrog...
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Media file 13: Biliary disease. Findings on an endoscopic retrograde cholangiopancreatography (ERCP) exclude extrahepatic biliary obstruction but demonstrate that the intrahepatic biliary ductal system is splayed by multiple hepatic cysts.
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Biliary disease. Findings on an endoscopic retrog...

Biliary disease. Findings on an endoscopic retrograde cholangiopancreatography (ERCP) exclude extrahepatic biliary obstruction but demonstrate that the intrahepatic biliary ductal system is splayed by multiple hepatic cysts.

Biliary disease. This cholangiogram shows a chole...
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Media file 14: Biliary disease. This cholangiogram shows a choledochal cyst. Fusiform dilation of the entire extrahepatic bile duct is present.
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Biliary disease. This cholangiogram shows a chole...

Biliary disease. This cholangiogram shows a choledochal cyst. Fusiform dilation of the entire extrahepatic bile duct is present.

This 92-year-old woman had recurrent abdominal pa...
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Media file 15: This 92-year-old woman had recurrent abdominal pain and jaundice. A right upper quadrant ultrasound showed a dilated biliary duct with no stones. She had a previous Roux-en-Y surgery that made endoscopic retrograde cholangiopancreatography (ERCP) impossible. Critical aortic stenosis that increased the risk of most interventions. This percutaneous cholangiogram, performed under conscious sedation in the operating room, revealed a large stone missed by the ultrasound. It was removed successfully with percutaneous choledochoscopy and electrohydraulic lithotripsy.
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This 92-year-old woman had recurrent abdominal pa...

This 92-year-old woman had recurrent abdominal pain and jaundice. A right upper quadrant ultrasound showed a dilated biliary duct with no stones. She had a previous Roux-en-Y surgery that made endoscopic retrograde cholangiopancreatography (ERCP) impossible. Critical aortic stenosis that increased the risk of most interventions. This percutaneous cholangiogram, performed under conscious sedation in the operating room, revealed a large stone missed by the ultrasound. It was removed successfully with percutaneous choledochoscopy and electrohydraulic lithotripsy.

Biliary disease. This cholangiogram shows a stone...
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Media file 16: Biliary disease. This cholangiogram shows a stone too large to deliver through a standard biliary sphincterotomy (see Image 17).
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Biliary disease. This cholangiogram shows a stone...

Biliary disease. This cholangiogram shows a stone too large to deliver through a standard biliary sphincterotomy (see Image 17).

Biliary disease. Here, a mechanical lithotripter ...
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Media file 17: Biliary disease. Here, a mechanical lithotripter is used to grab a stone too large to deliver through a standard biliary sphincterotomy and crush it into small pieces. The smaller pieces then are removed with a balloon-tipped catheter (see Image 16).
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Biliary disease. Here, a mechanical lithotripter ...

Biliary disease. Here, a mechanical lithotripter is used to grab a stone too large to deliver through a standard biliary sphincterotomy and crush it into small pieces. The smaller pieces then are removed with a balloon-tipped catheter (see Image 16).

Biliary disease. This patient had malignant stric...
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Media file 18: Biliary disease. This patient had malignant strictures of the biliary system that were palliated with metal mesh stents. Unfortunately, the tumor has grown through the metal mesh to reobstruct the biliary system (see Images 19-20).
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Biliary disease. This patient had malignant stric...

Biliary disease. This patient had malignant strictures of the biliary system that were palliated with metal mesh stents. Unfortunately, the tumor has grown through the metal mesh to reobstruct the biliary system (see Images 19-20).

Biliary disease. This patient had malignant stric...
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Media file 19: Biliary disease. This patient had malignant strictures of the biliary system that were palliated with metal mesh stents. Unfortunately, the tumor has grown through the metal mesh to reobstruct the biliary system. After a wire is passed through the lumen, a balloon-dilating catheter is passed into the metal mesh stents and inflated to enlarge the lumen (see Image 18 and Image 20).
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Biliary disease. This patient had malignant stric...

Biliary disease. This patient had malignant strictures of the biliary system that were palliated with metal mesh stents. Unfortunately, the tumor has grown through the metal mesh to reobstruct the biliary system. After a wire is passed through the lumen, a balloon-dilating catheter is passed into the metal mesh stents and inflated to enlarge the lumen (see Image 18 and Image 20).

Biliary disease. This patient had malignant stric...
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Media file 20: Biliary disease. This patient had malignant strictures of the biliary system that were palliated with metal mesh stents. The tumor has grown through the metal mesh to reobstruct the biliary system (see Image 18). After a wire was passed through the lumen, a balloon-dilating catheter was passed into the metal mesh stents and inflated to enlarge the lumen (see Image 19). In this image, 2 plastic stents were passed into the intrahepatic ductal system to again palliate the obstruction.
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Biliary disease. This patient had malignant stric...

Biliary disease. This patient had malignant strictures of the biliary system that were palliated with metal mesh stents. The tumor has grown through the metal mesh to reobstruct the biliary system (see Image 18). After a wire was passed through the lumen, a balloon-dilating catheter was passed into the metal mesh stents and inflated to enlarge the lumen (see Image 19). In this image, 2 plastic stents were passed into the intrahepatic ductal system to again palliate the obstruction.

More on Biliary Disease

Overview: Biliary Disease
Differential Diagnoses & Workup: Biliary Disease
Treatment & Medication: Biliary Disease
Follow-up: Biliary Disease
Multimedia: Biliary Disease
References
Further Reading
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Further Reading

Related eMedicine Topics

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Keywords

biliary disease, abnormal bile composition, abnormal biliary anatomy, abnormal biliary function, gallstones, gall stones, gallbladder disease, cirrhosis, primary biliary cirrhosis, PBC, liver disease, primary sclerosing cholangitis, PSC, acute cholecystitis, cholecystectomy, cholestasis, steatorrhea, cholelithiasis, papillary stenosis, pancreatitis, cholangiocarcinoma, postcholecystectomy syndrome, sphincter of Oddi dyskinesia, vanishing bile duct syndrome

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Contributor Information and Disclosures

Author

Annie T Chemmanur, MD, Attending Physician, Metrowest Medical Center and University of Massachusetts Memorial Hospital, Marlborough Campus
Annie T Chemmanur, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Medical Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Jeanette G Smith, MD, Fellow, Department of Gastroenterology-Hepatology, University of Connecticut School of Medicine
Jeanette G Smith, MD is a member of the following medical societies: American College of Physicians, American Gastroenterological Association, and American Public Health Association
Disclosure: Nothing to disclose.

George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine
George Y Wu, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Medical Association, American Society for Clinical Investigation, and Association of American Physicians
Disclosure: Humana Press Consulting fee Consulting; Novartis Consulting fee Review panel membership

Medical Editor

Ronnie Fass, MD, Director of GI Motility Laboratory, Tucson VA Medical Center, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, University of Arizona School of Medicine
Ronnie Fass, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Motility Society, American Society for Gastrointestinal Endoscopy, and Israel Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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