4. hepático común cístico colédoco pancreático común (Wirsung) ampolla de Vater esfínter de Oddi 2a porción del duodeno
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8. Fases de la motilidad de la vesícula biliar en ayunas (fase I en ayunas (fase II tras la ingesta en el estómago en el estómago 0.3 ml/min 0.6 ml/min 0.5 ml/min
Figure 9-2. A, This CT scan shows a hyperdense focus (arrow) in the distal common bile duct, with surrounding hypodense bile within an enormously dilated common bile duct. B, The magnetic resonance cholangiopancreatogram reveals multiple filling defects of varying size throughout the entire extrahepatic biliary tree within a tortuous and dilated common bile duct and prominent intrahepatic ducts. C, The corresponding cholangiogram obtained at endoscopic retrograde cholangiopancreatography is shown. (B, Courtesy of Robert Whitlock, New York, NY.)
Figure 9-3. Endoscopic retrograde cholangiopancreatography is the most accurate invasive diagnostic modality and can clearly demonstrate intraluminal filling defects as well as ductal dilatation (A). Other diagnostic modalities, depending on availability and local expertise, include percutaneous cholangiography, intraoperative cholangiography (obtained laparoscopically in panel B), and common bile duct exploration, performed laparoscopically or by an open approach. Surgical and endoscopic ductal clearance rates are usually reported to be greater than 95%. Mortality rates for surgical series range from 0% to 28%, depending on the patient populations selected, and recurrence rates range from 5% to 21%. In contrast, endoscopic ductal clearance has a published mortality rate ranging from 0% to 3% and a recurrence rate of less than 5%.
Figure 9-2. A, This CT scan shows a hyperdense focus (arrow) in the distal common bile duct, with surrounding hypodense bile within an enormously dilated common bile duct. B, The magnetic resonance cholangiopancreatogram reveals multiple filling defects of varying size throughout the entire extrahepatic biliary tree within a tortuous and dilated common bile duct and prominent intrahepatic ducts. C, The corresponding cholangiogram obtained at endoscopic retrograde cholangiopancreatography is shown. (B, Courtesy of Robert Whitlock, New York, NY.)
Figure 9-3. Endoscopic retrograde cholangiopancreatography is the most accurate invasive diagnostic modality and can clearly demonstrate intraluminal filling defects as well as ductal dilatation (A). Other diagnostic modalities, depending on availability and local expertise, include percutaneous cholangiography, intraoperative cholangiography (obtained laparoscopically in panel B), and common bile duct exploration, performed laparoscopically or by an open approach. Surgical and endoscopic ductal clearance rates are usually reported to be greater than 95%. Mortality rates for surgical series range from 0% to 28%, depending on the patient populations selected, and recurrence rates range from 5% to 21%. In contrast, endoscopic ductal clearance has a published mortality rate ranging from 0% to 3% and a recurrence rate of less than 5%.