NMS. Surgery

196

Part IV ♦ Gastrointestinal Disorders

Gallbladder

Common hepatic duct

Cystic duct

Common bile duct Pyloric sphincter

Accessory pancreatic duct

Pancreas

Pancreatic duct

Duodenal papilla

Duodenum

Ulcers caused by Zollinger–Ellison syndrome Figure 10-2: Biliary anatomy. (From Escott-Stump S. Nutrition and Diagnosis-Related Care , 7th ed. Baltimore: Lippincott Williams & Wilkins; 2011.)

Hepatobiliary Imaging I. Ultrasound: A. Detects parenchymal lesions and assesses hepatic vascular flow. B. Effective for imaging gallbladder and bile ducts. II. CT and MRI: A. Visualizes parenchyma well. B. Useful in the delineation of tumors and for resection planning. III. Hepatobiliary iminodiacetic acid (HIDA) scan: A. Technetium-99mm (99mTc) is excreted in bile. B. Useful for diagnosing acute cholecystitis, choledochal cyst, bile leaks, and obstruction. C. Can diagnose biliary dyskinesia. IV. Magnetic resonance cholangiopancreatography (MRCP): Provides the highest resolution of the hepatobiliary and pancreatic structures.