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In the name of God

In the name of God. 9/17/2014. 1. MRCP. Edited by : Dr. A. Forouzmehr Radiologist. 9/17/2014. 2. Anatomy & congenital variations. -50-60% of cases own normal anatomy -40-50% belongs to the normal variations, that is seen in the following:

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In the name of God

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  1. In the name of God 9/17/2014 1

  2. MRCP Edited by : Dr. A. Forouzmehr Radiologist 9/17/2014 2

  3. Anatomy & congenital variations -50-60% of cases own normal anatomy -40-50% belongs to the normal variations, that is seen in the following: 1.Right posterior duct , into left main hepatic duct : 13% 2.Trifurcation of biliary confluence . 3.Aberrant right hepatic duct, draining into CHD, or cystic duct, or CBD. 4.Low cystic duct insertion. 5.Proxymal cystic duct insertion. -congenital abnormalities of bile ducts: 1. 5 types of choledochal cysts. 9/17/2014 3

  4. Gallbladder diseases 1- location of GB and normal variant GB stone: Non-visible GB neck stone or cystic duct stones , by sonography 3 mirizzi syndrom : 1% in cholecystitis 4-cholecystitis . 9/17/2014 4

  5. Biliary obstruction A-choledocolithiasis . B-biliary stricture . C-cholangitis: 1.infectious . 2.recurrent pyogenic 3.primary sclerosing 9/17/2014 5

  6. choledocolithiasis -Sonographic detection: 21-63% -False positive MRCP: -pneumobilia -hemobilia -intra-ductal tumor -crossing hepatic artery -false negative MRCP: -small stones(3-5 mm) -impacted stones. 9/17/2014 8

  7. 1-Biliary stricture(focal narrowing of bile duct) A-Benign : smooth, concentric, short segments B-Malignant : abrupt, exentric, long segment -clinical symptoms: epigastric pain, chills, fever, jaundice 9/17/2014 6

  8. Biliary stricture-2 A- Iatrogenic: any procedure on bile ducts.=> 95% B-inflammatory: -Pancreatitis .10% -Radiation -TB , HIV . -Autoimmune(SLE,poliartritis nodosa). C-Cholangitis . 9/17/2014 7

  9. Cholangitis • Infectious cholangitis . Recurrent pyogenic chlangitis . Primary sclerosing colangitis (PSC).

  10. MRCP imaging in post operative patients -post cholecystectomy -biliary-entric . anastomosis -liver transplantation & partial hepatectomy 9/17/2014 9

  11. Post cholecystectomy complications A.Early complications: -retained CBD stones -clipped CBD or hepatic duct -transected CBD or hepatic duct -bile leak B.Late complications: -CBD stricture(usually after laparoscopic resection) -oddi’s dysfunction 9/17/2014 10

  12. A common feature of both the initial and late postoperative complications of cholecystectomy is , the biliary dilatation, measure maximally 13mm & taper slowly. 9/17/2014 11

  13. Complications of biliary-entricanastomosis & liver transplantation -obstruction -cholangitis -intra-hepatic stricture -bile leaks -intra-hepatic bile stones 9/17/2014 12

  14. Papillary disorders A-Papillitis : - causes are: -choledocolithiasis -cholangitis -pancreatitis B- Papillary stricture: C-oddi’s dysfunction : (in the absence of any mass or stricture, dilated CBD, pancreatic duct or both at the level of ampulla , cause of ODD’SDYSFUNCTION will be created). D- Papillary & ampullary adenoma.

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