Overview
This lecture reviewed key aspects of the hepatic and urological systems focusing on anatomy, imaging techniques, contrast flow, and positional effects for radiographic studies.
Hepatic System & Gallbladder Anatomy
- Know the anatomy of the ducts: cystic duct, hepatic duct, and common bile duct.
- Be able to identify ERCP studies and know that ERCP stands for Endoscopic Retrograde Cholangiopancreatography.
- Review differences between cholangiograms: surgical/operative cholangiogram is done in the operating room and demonstrates bile ducts.
- Understand how body habitus affects gallbladder location—hypersthenic (short/stout: up and out); asthenic (tall/thin: down and in).
Urological Imaging: Studies & Anatomy
- Differentiate between structural and functional urological studies.
- Voiding cystourethrogram (VCUG): assesses voiding function.
- Voiding positions: female—AP; male—30-degree RPO oblique to separate femurs.
- IVU (Intravenous Urography), formerly IVP (Intravenous Pyelogram), visualizes kidneys, ureters, bladder.
- Nephrogram focuses on kidney function.
- Kidney stones appear bright white on imaging.
- Review kidney and urinary anatomy, including ureters and bladder.
Radiographic Positioning & Contrast Flow
- "Slap the belly" and SI joint positioning are similar to kidney/ureter obliques: for SI joints, side up is best seen, but for kidneys/ureters, it is the opposite.
- RPO (Right Posterior Oblique): left kidney is parallel; right ureter is free of spine superimposition.
- Contrast delivery—Voiding cystogram: retrograde into bladder; retrograde urethrography: retrograde via catheter; IVU: intravenous (antigrade) flow.
- Differentiate antigrade (with flow) vs retrograde (against flow) contrast injections.
Key Terms & Definitions
- ERCP — Endoscopic Retrograde Cholangiopancreatography, an imaging study of the bile and pancreatic ducts.
- Cholangiogram — X-ray examination of the bile ducts, often with contrast.
- Hypersthenic — Body type: short and stout; gallbladder higher/up and out.
- Asthenic — Body type: tall and thin; gallbladder lower/down and in.
- VCUG (Voiding Cystourethrogram) — Imaging study assessing bladder and urethra during voiding.
- IVU (Intravenous Urography) — X-ray of urinary tract using injected contrast.
- Antigrade flow — Movement of contrast in the normal direction of urine flow.
- Retrograde flow — Movement of contrast opposite to normal urine flow.
- Nephrogram — Radiographic image showing kidney parenchyma after contrast.
Action Items / Next Steps
- Review hepatic system and bile duct anatomy.
- Study body habitus variations and their effects on gallbladder position.
- Go over kidney and urinary tract anatomy.
- Familiarize yourself with contrast flow terms (antigrade vs retrograde).
- Practice identifying imaging studies and correct radiographic positioning.