<p begin="00:00:15.561" end="00:00:18.444" style="s2">- The more advanced area<br />that you may want to look at</p>
<p begin="00:00:18.444" end="00:00:19.811" style="s2">is actually measuring the bile duct.</p>
<p begin="00:00:19.811" end="00:00:22.201" style="s2">That's a pretty straight<br />forward procedure.</p>
<p begin="00:00:22.201" end="00:00:24.748" style="s2">First thing you do is again<br />find that exclamation sign.</p>
<p begin="00:00:24.748" end="00:00:27.474" style="s2">And again we see it here with<br />the gallbladder in length</p>
<p begin="00:00:27.474" end="00:00:28.671" style="s2">we see the portal vein,</p>
<p begin="00:00:28.671" end="00:00:31.988" style="s2">and just above the portal<br />vein lies the bile duct.</p>
<p begin="00:00:31.988" end="00:00:35.821" style="s2">So when we carefully<br />scan you can see an area.</p>
<p begin="00:00:37.717" end="00:00:41.612" style="s2">Just above the portal<br />vein which is anechoic.</p>
<p begin="00:00:41.612" end="00:00:43.775" style="s2">I'm going to freeze this here in a moment.</p>
<p begin="00:00:43.775" end="00:00:47.989" style="s2">And you should be able<br />to see a very tiny duct.</p>
<p begin="00:00:47.989" end="00:00:50.190" style="s2">If you are squinting<br />at the screen like I am</p>
<p begin="00:00:50.190" end="00:00:51.927" style="s2">trying to see where the duct is.</p>
<p begin="00:00:51.927" end="00:00:54.494" style="s2">You are dealing with a<br />patient with a normal duct.</p>
<p begin="00:00:54.494" end="00:00:57.745" style="s2">Usually if the duct is enlarged<br />it will be quite evident,</p>
<p begin="00:00:57.745" end="00:01:01.439" style="s2">and it can be as large as<br />the portal vein itself.</p>
<p begin="00:01:01.439" end="00:01:04.189" style="s2">So I'm going to freeze this here.</p>
<p begin="00:01:05.943" end="00:01:08.948" style="s2">So on the screen right now I<br />have a reasonably good image</p>
<p begin="00:01:08.948" end="00:01:10.104" style="s2">of the portal vein,</p>
<p begin="00:01:10.104" end="00:01:12.343" style="s2">and the associated structures around it.</p>
<p begin="00:01:12.343" end="00:01:16.100" style="s2">Right above it we see a<br />very tiny anechoic stripe,</p>
<p begin="00:01:16.100" end="00:01:17.589" style="s2">that is the bile duct.</p>
<p begin="00:01:17.589" end="00:01:20.786" style="s2">In addition, we also note a<br />very small area which is the</p>
<p begin="00:01:20.786" end="00:01:24.920" style="s2">hepatic artery which I'll<br />point out in a moment.</p>
<p begin="00:01:24.920" end="00:01:27.288" style="s2">So what we are going to do now is go ahead</p>
<p begin="00:01:27.288" end="00:01:29.305" style="s2">and do the measurement of the bile duct.</p>
<p begin="00:01:29.305" end="00:01:31.340" style="s2">A normal bile duct measurement<br />is about four millimeters</p>
<p begin="00:01:31.340" end="00:01:34.488" style="s2">or less or about one<br />millimeter per decade of life.</p>
<p begin="00:01:34.488" end="00:01:37.740" style="s2">So I'm going to go ahead and hit caliper.</p>
<p begin="00:01:37.740" end="00:01:41.544" style="s2">And I'm going to drag one end<br />of this to the inter aspect</p>
<p begin="00:01:41.544" end="00:01:42.961" style="s2">of the bile duct.</p>
<p begin="00:01:45.333" end="00:01:48.164" style="s2">Once I have found that<br />I'm going to hit select,</p>
<p begin="00:01:48.164" end="00:01:50.831" style="s2">and I'm going to drag this down.</p>
<p begin="00:01:53.848" end="00:01:56.672" style="s2">Just adjacent to it and<br />you can see we are getting</p>
<p begin="00:01:56.672" end="00:02:01.045" style="s2">a measurement here of .14<br />centimeters or 1.4 millimeters,</p>
<p begin="00:02:01.045" end="00:02:03.712" style="s2">so well within the normal limits.</p>
<p begin="00:02:03.712" end="00:02:06.054" style="s2">Okay I'm going to illustrate to you where</p>
<p begin="00:02:06.054" end="00:02:07.527" style="s2">the hepatic artery is.</p>
<p begin="00:02:07.527" end="00:02:11.153" style="s2">We can see first this is<br />the portal vein right here.</p>
<p begin="00:02:11.153" end="00:02:13.926" style="s2">Right above it is that<br />little anechoic stripe,</p>
<p begin="00:02:13.926" end="00:02:15.903" style="s2">which is very tiny and difficult to see,</p>
<p begin="00:02:15.903" end="00:02:17.683" style="s2">because this bile duct is normal.</p>
<p begin="00:02:17.683" end="00:02:19.324" style="s2">This is the common bile duct.</p>
<p begin="00:02:19.324" end="00:02:23.238" style="s2">But right adjacent to here is<br />another anechoic structure,</p>
<p begin="00:02:23.238" end="00:02:24.700" style="s2">which is an hepatic artery.</p>
<p begin="00:02:24.700" end="00:02:27.462" style="s2">If there is ever any confusion<br />of what you're measuring</p>
<p begin="00:02:27.462" end="00:02:29.308" style="s2">you can easily turn the color flow on</p>
<p begin="00:02:29.308" end="00:02:31.391" style="s2">to differentiate the two.</p>