Home > Encyclopedia of Nursing & Allied Health > Percutaneous Transhepatic Cholangiography

Definition

Percutaneous transhepatic cholangiography (PTHC) is used to identify obstructions that slow or stop the flow of bile from the liver to the digestive system.

Purpose

PTHC allows doctors to determine what is causing a patient's jaundice (an obstructed bile duct or liver disease) and why upper abdominal pain continues after gallbladder surgery. It is not a first line test due to its invasive nature. PTHC is usually done only after computed tomography or ultrasound tests have been performed, when those tests indicate the need for PTHC to further delineate biliary anatomy.

Precautions

Patients should report allergic reactions to:

• anesthetics
• contrast media (dyes) used in radiographic tests
• iodine
• shellfish

PTHC should not be performed on anyone who has:

• cholangitis (inflammation of the bile ducts)
• massive ascites
• a severe allergy to iodine
• a serious uncorrectable or uncontrollable bleeding disorder

Description

The patient lies on a movable x-ray table and is given a local anesthetic. A footrest and shoulder rest prevent the patient from sliding when the position of the table is changed. The patient will be told to hold his or her breath, and a doctor, usually a radiologist, will place a needle into the liver and then inject contrast medium into the liver as the patient exhales.

The patient may feel a twinge when the needle penetrates the liver, a pressure or fullness, or brief discomfort in the upper right side of the back. Hands and feet may become numb during the 30–60 minute procedure.

The x-ray table will be tilted several times during the test, and the patient helped to assume a variety of positions. A special x-ray machine called a fluoroscope will track the contrast medium's passage through the bile ducts and show whether the fluid is moving freely or how its passage is obstructed. After the x rays have been taken, the needle is removed.

PTHC costs about $1,600. The test may have to be repeated if the patient moves while x rays are being taken.

Preparation

An intravenous antibiotic may be given every four to six hours during the 24 hours before the test. The patient will be told to fast overnight and may be given a sedative a few minutes before the test begins.

Aftercare

A nurse will monitor the patient's vital signs until they return to normal and watch for:

• itching
• flushing
• nausea and vomiting
• sweating
• excessive flow of saliva
• occasional serious allergic reactions to contrast dye

The patient should stay in bed for at least six hours after the test, lying on the right side to prevent bleeding from the injection site. The patient may resume normal eating habits and gradually resume normal activities.

Complications

Septicemia (blood poisoning) and bile peritonitis (a potentially fatal infection or inflammation of the membrane covering the walls of the abdomen) are rare but serious complications of this procedure.

Contrast material occasionally leaks from the liver into the abdomen, and there is a slight risk of bleeding or infection.

Results

Normal x rays show contrast material evenly distributed throughout the bile ducts. Obesity, gas, and failure to fast can affect test results.

Enlargement of bile ducts may indicate:

• obstructive or non-obstructive jaundice
• cholelithiasis (gallstones)
• cancer of the bile ducts or pancreas
• hepatitis (inflammation of the liver)
• cirrhosis (chronic liver disease)
• granulomatous disease

Health care team roles

PTHC is performed in a hospital, doctor's office, or outpatient surgical or x-ray facility. The procedure is usually performed by a radiologist, with the assistance of a radiologic technologist.

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KEY TERMS

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Ascites—Abnormal accumulation of fluid in the abdomen.

Bile ducts—Tubes that carry bile, a thick yellowish green fluid that is made by the liver, stored in the gallbladder, and helps the body digest fats.

Fluoroscope—An x-ray machine that projects images of organs.

Granulomatous disease—Disease characterized by the growth of tiny blood vessels and connective tissue, which forms tissues known as granulomas.

Jaundice—Disease that causes bile to accumulate in the blood, causing the skin and whites of the eyes to turn yellow. Obstructive jaundice is caused by blockage of bile ducts. Non-obstructive jaundice is caused by disease or infection of the liver that causes liver dysfunction.

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Stephen John Hage, AAAS, RT-R, FAHRA