I get asked about imaging the common bile duct often since I teach it at day 1 of the SDEP protocol in the downloadable video(https://sonopath.com/products/downloadable) and at our CE events TBA soon for 2016 (6-8 dates coming) (https://sonopath.com/products/ce-events) CBD imaging is an essential part of the clinical abdominal sonogram. Lots of occult disease lives there and I want no one here at sonopath to be the first sonographer with a missed dx on a second opinion case… which is one of the reasons we are here to help:) If you arent imaging the CBD on every scan I assure you that you are missing the primary problem on many anorexia or “GI cases” as the vast majority of CBD pathology cases lack elevated bilirubin clinically and only 25% of dogs are visibly icteric according to our studies of surgical biliary disease in dogs. Moreover, off the top of my head I think cats are even more occult in this process. So a member emailed us at info@sonopath.com and asked for some help on imaging the common bile duct to the duodenal papilla. So I made a sonopod cast from one of my lectures on the subject and put it up on youtube for anyone to review.
https://www.youtube.com/watch?v=NLloFGb7H80
Also I added a couple of exemplary stills of the cbd and a video as well as a vet tech (Amanda Lacey of Aninal Sounds Eugene, Oregon) that I instructed a couple of months ago sending in a routine case to Dr Ondreka using the SDEP protocol… thats the splashy color flow video with body movement but the CBD is at 3 o’clock above the PV with color flow and seen clearly in the right of the screen. Amanda has been imaging this portal hilus like this from day one. Why the CBD isn’t taught day one of scanning or at least day 2 in traditional US courses I’m not sure but traditionally that’s the case where its an “advanced abdomen” subject. That may be changing I’m not sure but we teach it on day one just like the pelvic urethra… another essential view for the 1st vs 2nd or even 3rd opinion sonographer battle.
You don’t have to see the CBD every time from day one you just have to image it for someone to review (no image …no discussion) and if you can see the GB pylorus and portal vein I assure you the CBD is right there with the panc duct to the right in position 11, 13 or 14 of the SDEP protocol. But if its not imaged its missed forever and that CBD mucous plug, biliary carcinoma, post hepatic obstruction, or irritating stone case just waxes and wanes or circles the drain… see where Im goin here? Well here is something to refer to on youtube and some homework on your next couple of spay surgery practice cases if you don’t see this every time:)
Feel free to post your own still image of the CBD here on this thread and happy scanning:)
Comments
Thank you very much for this.
Thank you very much for this. It is very helpful. I see I am improving a lot in understanding this area so it’s great to have more info for settling this particular aspect. Very much appreciated.
U bet ! Glad to be of
U bet ! Glad to be of assistance:)