Percutaneous
Transhepatic Cholangiography (PTCA)
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What is the
test?
Percutaneous transhepatic cholangiography is
an x-ray test that can help show whether there
is a blockage in the liver or the bile ducts
that drain it. Since the liver and its drainage
system do not normally show up on x-rays, the
doctor doing the x-ray needs to inject a special
dye directly into the drainage system of the
liver. This dye, which is visible on x-rays,
should then spread out to fill the whole drainage
system. If it does not, that means there is a
blockage. This type of blockage might result
from a gallstone or a cancer in the liver.
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How
do I prepare for the test?
Tell your doctor if you have ever had an allergic
reaction to lidocaine or the numbing medicine
used at the dentist's office. Also tell your
doctor if you could be pregnant. If you have
diabetes and take insulin, discuss this with
your doctor before the test.
Most people need to have a blood test done some
time before the procedure, to make sure they
are not at high risk for bleeding complications.
If you take aspirin, nonsteroidal anti-inflammatory
drugs, or other medicines that affect blood clotting,
talk with your doctor. It may be necessary to
stop or adjust the dose of these medicines before
your test.
You will be told not to eat anything on the
morning of the test so that your stomach is empty.
This is a safety measure in the unlikely case
you have a complication, such as bleeding, that
might require repair surgery.
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What
happens when the test is performed?
You lie on a table wearing a hospital gown.
An IV (intravenous) line is inserted into a vein
in case you need medicines or fluid during the
procedure. An area over your right ribcage is
cleaned with an antibacterial soap. Then the
radiologist may take a picture of your abdomen
with an overhead camera. Medicine is injected
through a small needle to numb the skin and the
tissue underneath the skin in the area where
the dye is to be injected. You may feel some
brief stinging from the numbing medicine.
A separate needle is then inserted between two
of your ribs on your right side. A small amount
of xray dye is injected, and some pictures are
taken that are visible on a video screen. Your
doctor adjusts the placement of the needle until
it is clear that the dye is flowing easily through
the ducts (drainage tubes) inside your liver.
Because taking the x-ray pictures sometimes
requires a significant amount of time, the doctor
replaces the needle with a softer plastic tube.
First, the syringe holding the dye is detached
from the top of the needle, leaving the needle
in place. The doctor then gently pushes a thin
wire through the needle and into the duct where
the needle has been sitting. Next the needle
is pulled out, sliding over the outside end of
the wire. The wire is left with one end inside
the liver to hold the position where the needle
had been. A thin plastic tube similar to an IV
line is slid along the wire, like a long bead
on a string, until it is in the same place where
the needle was. The wire is then pulled out,
and the dye syringe is attached to the tube.
More dye is injected through the plastic tube,
and pictures are taken with the video camera
as the dye spreads inside the liver. If there
is no blockage, the dye drains out of the liver
through the bile ducts and begins to show up
on the x-ray in the area of your small intestine.
Once all of the needed pictures have been taken,
the plastic tube is pulled out, and a small bandage
is placed over your side. The whole test usually
takes less than an hour.
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What
risks are there from the test?
It is possible to have serious bleeding from
this test. In some cases, blood leaks to the
outside surface of the liver and causes a buildup
of blood there. In other cases, blood can leak
directly into the liver's drainage system, in
which case it might start showing up in your
intestine, causing a bloody bowel movement. It
is less likely that you could develop an infection
after the test. The only soreness you are likely
to have is at the skin surface where the needle
went in. This should last for only a day or two.
In rare cases, the dye used in the test can
damage your kidneys. This kidney effect is almost
always temporary, but some people have permanent
damage.
As with all x-rays, there is a small exposure
to radiation. In large amounts, exposure to radiation
can cause cancers or (in pregnant women) birth
defects. The amount of radiation from the video
x-ray in this test is very small-too small to
be likely to cause any harm. (The people performing
the test on you will wear lead shields, since
they would otherwise be exposed to this radiation
over and over, which could be more of a danger.)
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Must
I do anything special after the test is over?
Call your doctor right away if you have pain
in your right abdomen or shoulder, fever, dizziness,
or a change in your stool color to black or red.
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How
long is it before the result of the test is
known?
You may be told a few early results of your
test as soon as the test is done. It takes a
day or two for the radiologist to review the
x-rays more thoroughly and to give your doctor
a full report.
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