By Ronald S. Chamberlain
Albert Einstein university of medication, manhattan urban, big apple. Pocket technical guide offers a method via combining services, event, and opinion on operative strategies and interventions. comprises halftone illustrations and photographs. for college kids, citizens, surgeons, and gastroenterologists. Wire-spiral binding. DNLM:Liver Diseases--surgery.
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Interpretation CTAP demonstrates areas of diminished portal perfusion very well. While it is quite sensitive for identifying tumor, it is far less specific. The initial images are the most sensitive for demonstrating areas of decreased portal perfusion. The later images, in particular the delayed, or hepatic excretion phase images, are then used to differentiate tumor from perfusion artifact. In general, tumors are visible on each of the three sets of images while perfusion artifacts will disappear over time.
Larger stones, in general, require fragmentation prior to removal. The common endoscopic methods for stone fragmentation are mechanical lithotripsy and intracorporeal lithotripsy using either laser or electrohydraulic probes to cause stone fragmentation. Mechanical Lithotripsy Mechanical lithotripsy is often the best initial option for fragmentation and removal of large stones that cannot be removed by the standard techniques. This procedure can be utilized safely and effectively during the initial endoscopic procedure.
The more common type of each of the anomalies will be described in detail below. Anomalous Sectoral Biliary Anatomy Although the union of the right and left hepatic duct typically occurs at the hilum, a triple confluence of the right posterior and anterior sectoral ducts with the left hepatic duct may exist in up to ~15% of cases. (Fig. 12) In 20% of cases one of the right sectoral ducts, more commonly the anterior sectoral duct, may enter the common hepatic duct distal to the confluence. If this situation is not recognized it can be very dangerous, and represents a common cause of injury during laparoscopic cholecystectomy.