Preparing the patient for oral cholecystography. Examination of the gallbladder. Cholecystography and cholangiography. Consequences and complications

Oral cholecystography is an X-ray examination of the gallbladder after taking a contrast agent. Nowadays, instead of oral cholecystography, 99mTc radioisotope scanning, ultrasound and CT are increasingly used. Indications for oral cholecystography are symptoms of impaired patency of the biliary tract (pain in the right hypochondrium, intolerance to fats, jaundice). The study, as a rule, is carried out to confirm the diagnosis of diseases of the gallbladder. After taking a radiopaque contrast agent, it is absorbed in the small intestine, enters the liver, from where it enters the bile and accumulates in the gallbladder. Its maximum filling is usually achieved 12-14 hours after ingestion; at this time, images of the bladder are taken in order to identify the features of its configuration. Additional data can be obtained after prescribing fatty foods that contribute to the contraction and emptying of the gallbladder, while bile enters the common bile duct and small intestine. The images taken at this time allow assessing the evacuation function of the gallbladder and the patency of the common bile duct.
Oral cholecystography is done to:
Identify gallstones.
Confirm inflammatory changes and neoplastic lesions of the gallbladder.

Preparing for the procedure

The patient can eat regular food until noon on the eve of the study, and only low fat in the afternoon. The first stimulates the emptying of the gallbladder and creates optimal conditions for the entry of bile containing a radiopaque substance into it. The second inhibits the contraction of the bladder and promotes the accumulation of bile. After dinner, the patient should refrain from eating (it is allowed to drink water). 2-3 hours after dinner, the patient takes 6 tablets (3 g) of iopanoic acid. There are other radiopaque contrast agents such as sodium ipodate. The drug is taken according to the scheme: 1 tablet every 5 minutes, washed down with 1-2 sips of water, while the total amount of liquid should not exceed 250 ml. Thereafter, until the end of the study, the patient should not drink, smoke or chew gum. If necessary, in the morning before the start of the study, the patient is given an enema. Failure to comply with the requirements for the preparation of the patient (restrictions in diet and diet) may affect the result of the study.
The patient should warn the doctor if he has an intolerance to iodine, seafood or radiopaque substances. Possible side effects from a radio-opaque substance: diarrhea (occurs quite often), nausea, vomiting, intestinal colic and dysuria. If they appear, immediately inform the doctor.
How is cholecystography

The procedure is carried out in the position of the patient on his stomach, and if radiopaque shadows are detected in the gallbladder, pictures are taken. Then, fluoroscopy is performed in a standing position and on the left side, when delamination of the contents of the gallbladder or mobile filling defects is detected, pictures are taken. After that, the patient is given a choleretic breakfast or syncalid.
Emptying the gallbladder is assessed radiographically. After 15 and 30 minutes, images are taken that allow visualization of the common bile duct. When emptying is slowed down or the evacuation function of the gallbladder is completely disturbed, an additional X-ray is taken after 60 minutes. In the absence of any abnormalities, the patient is allowed to return to his usual diet. If stones in the gallbladder are detected, the patient is recommended a special diet with restriction of fatty foods for the prevention of cholecystitis. With insufficient filling of the gallbladder and the need for repeated cholecystography, the patient should limit the intake of fatty foods until a final diagnosis is established.

Cholecystography is one of the popular methods for examining the bile ducts and gallbladder. It is carried out using a contrast agent. After absorption, it enters first into the bloodstream, and then into the examined organ.

The peculiarity of the procedure is that it can be carried out only with satisfactory liver function.

The technique makes it possible to establish:

the shape of the bubble, its size,
correct position,
relief of the inner wall,
the presence of additional inclusions,
contractility of the gallbladder.

Indications

Cholecystography reveals anatomical and functional features gallbladder in the presence of clinical manifestations of cholecystitis, the presence of a tumor or stones in the gallbladder, dyskinesia.

Contraindications

Bile is a secret that is synthesized in the liver. Therefore, cases of liver disease can become a contraindication, since the contrast agent can begin to have a negative effect on the organ itself.

Contraindications include:

jaundice,
cirrhosis of the liver,
acute cholangitis.

When the patient's condition changes, the procedure can be performed. There are also absolute contraindications. These include:

Acute liver disease, since the likelihood of developing liver failure is high,
Cardiovascular, liver failure,
Allergic reaction to iodine.

Study types

Cholecystography can be performed using different methods:

Oral. The patient drinks a contrast agent approximately 15 hours before the examination. Usually the contrast is taken on the evening before the study after dinner, the contrast medium is washed down with sweet water or tea. During the night, the contrast is absorbed from the small intestine into the blood. From the blood, the substance enters the liver, ducts, goes down to the gallbladder. Thanks to this, a clear image of the organ on the radiograph is obtained. X-rays are taken the next morning.
Intravenous. The method is based on the ability of the contrast to be absorbed in the first minutes after intravenous administration. Contrasting of the bile ducts occurs in 10-20 minutes and after about 1.5 hours of the gallbladder. Radiographs are taken at regular intervals after the introduction of contrast. Next, a person is given a choleretic breakfast, after which a study of the evacuation function of the gallbladder is carried out. This method allows you to get a clearer picture, detect calculi, determine the degree of narrowing, deformation of the walls.

Infusion. The drug is also administered intravenously, but very slowly. Thanks to this, there are no unwanted side reactions that may occur with the jet injection of the drug. It is possible to use the technique in case of functional liver failure.
Percutaneous. This method of contrasting is carried out in the presence of a pronounced dysfunction of the liver. It occurs by puncture injection of a contrast agent into the bile ducts and bladder. The method often leads to the development of complications. These include allergies, sepsis. Death is observed in 1% of cases. For this reason, percutaneous cholecystography has not been used in recent years.

The purpose of the diagnosis

The main goal is to establish the features of the shape and size, as well as the contractility of the gallbladder. Sometimes a study is carried out to confirm the presence of inflammatory changes and tumor lesions of the organ.

With its help, it is possible to contrast the bubble and its ducts in 80-90% of cases. Sometimes a negative result is possible.

Algorithm for preparing a patient for cholecystography

Approximately 2-3 days before the study, a slag-free diet is prescribed. You cannot eat coarse bread, cabbage and potatoes. The patient is warned that the study is carried out on an empty stomach in the morning. A light dinner is allowed the night before.

For 12-14 hours, a person should take a cholevid or bilitrast. The contrast medium dose is calculated based on weight.

After that, the person lies down on the right side for better absorption of the drug. In the evening before going to bed, a cleansing enema is given; on the day of the study, the procedure is repeated.

The patient is warned that while taking the medication, nausea and loose stools may occur.

A day before the start of the examination, a person is tested for sensitivity to iodine-containing drugs. For this, 1 ml of the drug is injected intravenously, which is dissolved in 10 ml of saline.

Technique

The study is carried out in the X-ray room. First, the doctor makes an overview X-ray in an upright position, and then proceeds to sighting images of the gallbladder.

X-rays are taken while lying on the stomach. If there are radiopaque shadows, pictures are taken. Then the person gets up, the procedure is repeated.

After that, a choleretic breakfast or a special medicine is given. This allows you to assess the rate of emptying of the gallbladder. After 15-30 minutes, images are taken to visualize the common bile duct.

With insufficient filling of the organ and the need to re-conduct the study, the use of fatty foods is limited until the final diagnosis is established.

What does this survey show?

This study allows you to identify the presence of stones in the gallbladder, determine their number and degree of mobility. If necessary, the method can be supplemented with a biopsy.

Shows the diagnosis and nature of inflammatory changes in the mucous membranes of the gallbladder and ducts, the adequacy of organ sanitation and the state of the large duodenal nipple.

Cholecystography allows you to get ahead of the shape and size of the organ. Normally, on the roentgenogram, the bubble should have a pear-shaped shape, smooth contours and thin walls. Sometimes the form may vary slightly depending on the constitutional characteristics of a person.

With properly organized work, the doctor determines the presence of a violation of patency, a decrease in the concentration capacity of the biliary tract, adhesions and scars.

Consequences

After the examination, the person may complain of dizziness and headache, intestinal upset, nausea and vomiting.

Under certain circumstances, you have to repeat the procedure. This should be done if the person moved during the study, did not follow the requirements for preparation, or an insufficient dose of contrast agent was administered.

Intravenous administration of drugs affects the work of various organs. Often after the injection, there is a feeling of heat, a metallic taste in the mouth. All complications are divided into two groups.

The first is associated with the general toxicity of contrast. Here nausea, bouts of biliary colic, a feeling of pressure may appear.

The second group is explained by increased sensitivity nervous system... There may be excitement, a feeling of fear, cerebral edema.

The literature describes 28 cases of death. All of them are associated with an allergic reaction to the injected substance or hypokalemia.

This study is indispensable and if necessary, surgical treatment of the liver. Then it is used as the main visualization method.

Preparation and conduct of cholecystography

Preparation for cholecystography is carried out the day before the procedure and includes the following steps:

After 14 hours the day before the examination, the patient is assigned a low-fat diet.
Abstaining from food is required after dinner. It is allowed to drink water.
Before going to bed, take 6 tablets of sodium ipodinate or iopanoic acid: 1 tablet every 5 minutes.
Smoking is excluded.
Immediately before the contrast x-ray of the gallbladder, a provocative test for sensitivity to bilithrast is performed.
To cleanse the intestines, some radiologists recommend doing an enema before the procedure.

Cholecystography takes about 30 minutes and delivers a minimum of painful sensations to the patient. Preparation is not accompanied by difficulties, therefore, it is available for people both in price range and in terms of time.

How to take x-rays of the bile ducts and bladder

An x-ray of the gallbladder is taken after provocative tests and a survey x-ray abdominal cavity... It eliminates the presence of free gas in the abdominal cavity, which indicates perforation (perforation) of the intestinal wall.

Cholecystography is performed after excluding contraindications:

intestinal obstruction;
perforation of the intestinal wall;
pregnancy and breastfeeding;
allergy to contrast;
renal, hepatic and cardiovascular failure.

After ingestion of 3 grams of bilitrast, pictures of the liver are taken. If acid is used as a contrast agent, the maximum accumulation of the substance in the gallbladder is observed after 15 hours.

Radiologists take pictures immediately after the contrast is injected and when the gallbladder is full. This is how the maximum efficiency from cholecystography is achieved.

What are the indications for X-ray contrast examination of the gallbladder (cholecystography)

Indications for contrast x-ray of the gallbladder:

biliary dyskinesia;
suspicion of gallstone disease;
study of the state of the biliary system with tumors;
frequent pains in the right hypochondrium, which are not eliminated by drugs;
violation of the digestion of fats in the intestine.

If the preparation is carried out efficiently, but in gastrointestinal tract there is an accumulation of gases, this is a relative contraindication to the procedure.

What does intravenous cholecystography show?

Oral or intravenous cholecystography shows the following anatomical structures of the gallbladder:

form;
position;
displacement;
magnitude;
stones;
polyps;
tumors.

Normally, on the roentgenogram, the bubble has a pear-shaped shape, smooth contours and thin walls. Its anatomical structure is individual, but depends on the constitutional characteristics of a person (asthenic, hypersthenic, normosthenic).

In a hypersthenic, the bladder has a round shape and a wide diameter, in an asthenic, it is extended upward.

What diseases does cholecystography show:

violation of patency;
decreased concentration of the biliary tract;
pathology motor function bile ducts;
adhesions and scars.

Concrements on the cholecystogram are determined by the presence of oval defects against the background of the bladder shadow. In 30 minutes after the introduction of contrast, the emptying of the bladder by ½ is observed. At the same time, in its cavity, you can notice an additional shadow with a large calculus.

If the contrast cholecystogram shows an organ contraction by more than a third, this indicates its hyperkinetic state. Such an x-ray picture can be with a blockage of the duct.

Consequences of X-ray of the gallbladder with contrast

After cholecystography, the following complications are observed:

Dizziness and headache.
Disorder of the intestines.
Nausea and vomiting.

In conclusion, we add that such a study as cholecystography is rarely done, since there is a more harmless procedure - ultrasound of the liver. It is not accompanied by radiation exposure, therefore it is more popular.

Each of these types of research has its own diagnostic value. Radiopaque stones are visible only on images, and echo-acoustic calculi - on ultrasound.

Research proves indispensable when needed surgical treatment liver diseases. It is used as the main method of visualization of the state of the bile ducts and duodenum 12 in case of suspected tumor formations.

The value of cholecystography is high, despite radiation exposure a person when performing it.

To perform the procedure, a highly qualified radiologist is required. This also requires practical training in vision. With fluoroscopy, after contrasting the common bile duct, the substance quickly flows out of the ducts and intestines. During this interval, you need to see the state of the walls, the shape and internal lumen of the organ.

The quality of diagnostics in this case justifies the costs, therefore cholecystography is actively developing. The method is gradually being improved and updated.

Cholecystography - the essence and objectives of the study

Diagnostic methods that use X-rays to obtain images of human internal organs began to be used in medicine in the first half of the 20th century. Thanks to the discovery of X-rays in 1895, the science of that time received a powerful tool for studying bone, muscle, connective and other types of tissues, as well as organs and the vascular system, without the use of surgical intervention.

X-ray of the gallbladder using contrast was first experimentally carried out in 1923-1924. Then the scientists intravenously injected the sodium salt of tetraiodophenolphthalein to dogs, after which they fixed the image of the organ in the pictures. A number of theorists and practitioners of medicine carried out the development of this method in the future, making every effort to ensure that the experiment conducted on animals became a full-fledged method for examining the bile ducts and the human bladder. Ya.G. Dillon, A.A. Lemberg, N.E. Stern, N.F. Mordvinkin, and other scientists worked towards exploring the possibilities contrast radiography gallbladder and bile ducts.

With the invention in 1946 of a special contrast agent - a diiodinated derivative of a-phenylpropionic acid - the procedure became a little safer for human health. Bilitrast, as well as the later synthesized vesipak, triodan, cystobil, telepak, can increase the percentage of positive cholecystograms: in about 50-70% of studies, it is possible to achieve a high-quality image of the intrahepatic bile ducts.

For what purposes can the attending physician prescribe the procedure? The survey is carried out for:

establishing the size and contours of the gallbladder;
assessing the contractility of the walls of the organ;
displaying the size and contours of the bile ducts;
identifying stones in the bladder and ducts;
confirmation of the presence of inflammatory or tumor processes.

Gallbladder and bile ducts: anatomy and function

The gallbladder looks like a small pear-shaped sac. Its main function is the accumulation of bile produced by the liver. Anatomically, in the bladder, the bottom, walls or middle part, and the neck are distinguished, while the bottom has a wider diameter, and then the walls and neck gradually narrow. The bladder is 8 to 12 centimeters long and 3-5 centimeters wide. The walls of the gallbladder are thin. The color of the organ is dark green or gray-green.

From the proximal narrow part - the neck of the bladder - the cystic duct departs, which looks like a hollow tube. Connecting with the hepatic duct, it forms a common bile duct.

The bladder is located on the visceral side of the liver, it lies in a special fossa in the organ. This depression separates the anterior section of the right lobe of the liver and the square lobe. The bottom of the bladder is directed to the lower edge of the liver, the neck looks towards the hepatic gate. In the place where the body of the bladder passes into the neck, there is usually a functional bend, and the neck lies at some angle to the body.

The bladder adjoins the fossa with its anterior surface, where it connects with the fibrous membrane of the liver. Its surface, directed towards the abdominal cavity, is covered with a visceral peritoneum, which passes from the liver to the bladder.

The walls of the gallbladder are composed of three layers:

external serous;
muscular;
internal mucous.

In the area of the peritoneum, the wall is covered with a loose thin connective tissue layer - a sub-serous base.

There are three intrahepatic bile ducts:

common hepatic;
cystic;
common bile.

The first of them is located at the gate of the liver from the other two hepatic ducts - the left and right. Descending in the hepatic-duodenal ligament, the common hepatic duct passes into the cystic duct, emanating from the neck of the bladder, forming a common bile duct.

The main function of the gallbladder is to work in close connection with the liver. The bile produced by the liver accumulates in the sac until the moment when food enters the body. To process fatty and high-calorie foods, the bladder releases a supply of bile into the duodenum, which, together with pancreatic and intestinal enzymes, subjects the food lump to processing. In turn, the bile ducts carry the accumulated bile into the intestines.

Varieties of cholecystography

The main sign by which doctors differentiate the procedure of cholecystography or cholegraphy is the way the contrast medium enters the patient's body. By the way in which the contrast agent is injected, the following types of X-ray examination of the gallbladder are distinguished:

intravenous cholecystography, when the contrast is injected into the subject's body through vascular system jet with a syringe;
oral procedure: in this case, the subject drinks a special solution containing a contrast agent;
infusion cholegraphy: a contrast agent is injected intravenously, with a special catheter, very slowly;
percutaneous: the method is used if the patient has diagnosed liver dysfunctions, while the contrast is injected by puncture into the gallbladder and ducts.

It should be noted that the latter diagnostic method is practically not used now, since it often causes complications - sepsis, allergies, and in some cases - death.

Indications for the procedure, possible contraindications

Considering that cholecystography directly uses the properties of X-rays, and to obtain a picture, the patient must be injected with a contrast agent, there must be objective reasons for the appointment of such an examination - indications for conduct.

Among such indications, the need to confirm one of the possible diagnoses:

suspicion of the presence of cholecystitis;
tumor diseases of the organ;
dyskinesia;
stones in the ducts or gallbladder.

Also, diagnostics can be prescribed if the patient has some symptoms:

pain in the right hypochondrium;
bitterness in the mouth;
belching, nausea, vomiting, heaviness in the right side, especially after eating;
discoloration of feces, accompanied by a significant darkening of urine.

As for the prohibitions on the appointment of diagnostics, they are mainly associated with the introduction of contrast into the body. Contraindications can be absolute or relative. The former make the procedure completely impossible due to the level of risk for the subject. Cholecystography is contraindicated in patients with:

liver failure;
allergy to contrast agents;
cardiovascular insufficiency;
acute inflammatory liver diseases.

Relative contraindications require a decision by the attending physician in each specific case - if the need for diagnostics and the benefits from it exceed the potential harm, the doctor can prescribe cholecystography under his own responsibility.

Relative contraindications are:

acute cholangitis;
cirrhosis of the liver
pregnancy, breastfeeding;
jaundice.

How to prepare for the examination

Doctors, prescribing cholegraphy, focus on the fact that the quality of the diagnostic results directly depends on how responsibly the subject will react to observing the rules for preparing the patient.

The algorithm for preparing the patient includes a mandatory slag-free diet. Five days before the appointed date, it is necessary to exclude from the diet all foods that increase gas formation in the intestine:

bread, especially black bread, pastry baked goods;
legumes;
carbonated and alcoholic drinks;
milk and dairy products;
fatty meat and fish;
vegetables and fruits rich in coarse fiber.

During the day, the doctor can test a person for sensitivity to bilithrast. To do this, he is injected intravenously with 1 milliliter of the drug, diluted with 10 milliliters of saline.

On the day that precedes the examination, it is also necessary to comply with some menu requirements. In the morning, it is allowed to eat densely, regular food, with the exception of the above products. This is necessary so that the bile that has already accumulated in the bladder is released from it. Lunch, snacks and dinner should already be as light and fat-free as possible so as not to cause the bladder to contract.

Eating and drinking is prohibited in the morning before the procedure - cholecystography is performed strictly on an empty stomach.

In preparation for oral cholecystography, the patient should drink the drug with contrast in 12-14 hours. The dosage of the substance is calculated by the attending physician, focusing on the weight of the subject. After using the drug, a person needs to lie down on his right side so that the liquid is better absorbed. Before going to bed, a cleansing enema is given, and in the morning before cholecystography it can be repeated. The contrast agent may cause nausea and loose stools. After that, the subject is prohibited from drinking, chewing gum and smoking.

The procedure for diagnosing the gallbladder

Before the examination, the diagnostician may prescribe a general X-ray of the right hypochondrium to assess the degree of preparedness of the digestive system. Also, the taken picture will help to identify shadow formations, which may indicate the presence of stones, gas, lime deposits in the biliary tract.

The algorithm of the procedure consists of two stages: first, the image of the filled organ is recorded, then images of the bladder are obtained after emptying.

For taking pictures with contrast, the patient is placed on a special couch, first in the “prone” position. Next, the doctor asks the examinee to move to the left side, stand up straight, while paying attention to the delamination of the contents of the bladder or the presence of mobile filling defects.

The shadow of the contrasting gallbladder is displayed on the center of the screen, and in the absence of a contrasting image - on the area of its projection. The organ projection point is located at the intersection of the outer edge of the right rectus abdominis muscle and the rib arch. Given the differences in size and position of the gallbladder and liver, the projection site may differ.

In the pictures, the bladder can be reduced or enlarged, deformed, wrinkled, located in the upper part of the right hypochondrium, or extending into the pelvic cavity. Also, the organ can deviate to the left or right, while its shadow will be superimposed on the right kidney or vertebrae.

If the subject has a blockage of the gallbladder (obstruction of the cystic duct), his shadow will not be visualized in the image. In addition, the incompleteness of the organ with contrast can also be explained by functional disorders, for example, a deterioration in the excretory function of the liver.

The second stage of diagnosis begins after the patient is given choleretic food or medicine - this is how the phase of contraction and emptying of the bladder begins. During this stage, the doctor can assess the so-called evacuation function of the organ, and as the contrasting bile decreases from it, determine the size and location of stones, scars or neoplasms in the walls.

The common bile duct is shown by images taken after 15 and 30 minutes. If the emptying function is slowed down, the last image capture is made after 60 minutes.

Carrying out cholegraphy for children

The general requirements for the preparation of a child and the implementation of diagnostics in children are similar to the rules for adults.

The child should be put on a slag-free diet, gradually removing prohibited foods from his diet. To cleanse the intestines, the doctor may recommend doing an enema the day before the procedure.

A contrast agent for a child is prescribed at the rate of 0.1 - 0.3 grams per kilogram of body.

Features of the interpretation of research results

The image obtained in the process of diagnostics is examined by a doctor-radiologist. The interpretation of the results is drawn up in the form of a medical report.

Normally, in the images of the first stage of the study, the bladder is completely filled with contrasting bile. It has thin, smooth walls and is pear-shaped. Sizes may vary, but do not exceed 10-12 centimeters in length, 5 centimeters in width. At the same time, all parts of the organ should be clearly visualized in the picture - the bottom, neck, walls.

If, during normal filling of the gallbladder, there are mobile contrasting defects, this indicates the presence of stones in the organ cavity. Contrasting defects that are not mobile indicate the location of polyps or neoplasms.

Incomplete filling of the organ with contrast bile is also a deviation from the norm. Usually, the cause of such a violation is inflammatory pathologies (calculous or acalculous cholecystitis). Due to inflammation, the patency of the bile ducts is disturbed, and bile cannot normally enter the organ.

If the subject has a violation of the contractile activity of the bladder after taking choleretic food, this may indicate cholecystitis or mechanical impairment of the patency of the ducts.

When carrying out the decoding process, the doctor must take into account that the accuracy of the results may be influenced by some factors, for example, the patient's movement during the picture, insufficient contrast dose, improper or incomplete preparation, insufficient absorption of contrast medium in the small intestine, as well as liver dysfunction, which is directly affects the flow of contrast into bile.

Cholegraphy, along with ultrasound of the gallbladder, is one of the most frequently prescribed methods of examining patients with pathologies of this organ. Thanks to the introduction of a contrast agent, it is possible to detect stagnant processes in the gallbladder, polyps, neoplasms, stones in the ducts and gallbladder on X-rays.

The data obtained after the procedure allows the attending physician to determine the position anatomical structure, size, functional ability and activity of the gallbladder. They can also indicate the presence of various pathologies of this organ.

What is cholecystography?

Cholecystography is an X-ray method for examining the state of the gallbladder. The bottom line is the introduction into the body of a special contrast agent, which, due to physiological metabolic processes, appears in the cavity of the gallbladder after a while. During this period, a series of X-ray images are taken, which constitute an informative picture of the state of the organ.

To study the bile ducts, another, more informative X-ray examination method is used - intravenous cholegraphy. Its essence is based on the slow parenteral administration of a special contrast agent, which, after 5-15 minutes, provides a clear visualization of the intra- and extrahepatic bile ducts. Intravenous cholegraphy with a high proportion of informational content demonstrates the state of not only the bile ducts, but also the gallbladder itself.

The main purpose of cholegraphy is to provide the most complete and detailed morpho-functional picture of the present state of the biliary system.

Indications for

There are a number of conditions (including inhibition of the concentration function of the biliary tract) that may raise suspicion in the attending physician. In this case, one of the cholecystography methods is prescribed to make the correct diagnosis or clarify the existing one. IN different situations the specialist selects the most rational way X-ray examination of the gallbladder and bile ducts.

Let's consider the most common indications for cholecystography.

Biliary dyskinesia

This disease is characterized by a disorder of the motor function of the gallbladder and biliary tract. This contributes to the disruption of the natural outflow of bile into the duodenum, which is accompanied by an incorrect digestion process and is manifested by characteristic symptoms.

There are two types of biliary dyskinesia:

hyperkinetic - there is an accelerated release of bile from the gallbladder into the duodenum;

hypokinetic - slowing down the outflow of bile.

The method of cholegraphy allows you to assess the motor function of the biliary system and determine the severity and, possibly, the cause of the pathology.

Suspected gallstone disease

In situations where there are characteristic symptoms of cholecystitis and the specialist has good reasons to suspect gallstone disease, cholecystography (what it is, described above) may be prescribed to determine the presence or absence of calculi.

Study of the state of the biliary system with tumors

Tumors of various origins, localized near the organs of the biliary system, can rapidly progress and rapidly increase in size. Over time, this can lead to partial or complete compression of the bile ducts and a slowdown or complete cessation of the flow of bile. This condition is fraught with the development of serious complications, the fight against which is not always favorable.

Frequent pain in the right hypochondrium, which is not eliminated by drugs

Frequent periodic pain in the right hypochondrium may indicate the presence of a variety of pathologies of the biliary system. It should be noted that the localization of pain in this area is due to the projection of the gallbladder and outflow ducts into the right hypochondrium.

Impaired digestion of fats in the intestine

A symptom characteristic of the pathology of the organs of the biliary system, tk. bile causes the digestion of fats in the digestive tract cavity.

What does it show?

These methods of X-ray diagnostics are highly informative in nature and can provide the necessary information for the correct diagnosis. Below are some of the data that can be obtained after cholecystography or intravenous cholegraphy.

Bubble shape, size

The shape and size of the bubble reflects its functional ability. Their deviation from normal indicators may be a sign of the development of pathologies.

Correct position

The correct anatomical position of these structures and nearby organs prevents pathological compression of the excretory ducts.

Inner wall relief

Sometimes it is possible to determine various deviations in the state of the inner wall of the organ: the growth and development of polyps, etc.

The presence of additional inclusions

On the X-ray it is possible to reveal the presence of additional inclusions - calcifications. This may indicate the development of gallstone disease.

Gallbladder contractility

This function affects the intensity of bile excretion and further processing of the food lump.

Preparation for conducting

Preparation for cholecystography is integral and important.

The day before, 1 day before the study, the last meal should not be later than 19:00.

1 day before the procedure and directly on the day of manipulation, preparation for the study (cholecystography) implies the rejection of drugs that affect the motility and intensity of bile secretion (only after consultation and appointment of a specialist). This can distort the received data.

Before the cholecystography, the doctor prescribes a special meal that will stimulate the secretion of bile.

Proper preparation of the patient for cholecystography will provide reliable data that will help to find out the cause of the complaint and establish a diagnosis.

How is the x-ray of the bile ducts and bladder done?

The procedure is carried out in a specially equipped X-ray room. Depending on the X-ray method, a contrast agent is administered orally or parenterally over a certain period of time to the patient. Then a series of shots is taken. After their manifestation, it remains to wait for the decoding and analysis of the results obtained.

Contraindications

Let's consider the main contraindications for cholecystography.

Jaundice

Jaundice is often a symptom pathological processes developing in the liver. This organ plays one of the most important roles - detoxification. The introduction of a contrast agent can only aggravate the situation.

Cirrhosis of the liver

Cirrhosis of the liver, in which there is a persistent and serious dysfunction of this organ, is also a contraindication to the examination. The essence is similar to the previous contraindication: violation of the detoxification function of the liver after the administration of contrast.

Acute cholangitis

This pathological condition characterized by the development of inflammatory processes in the bile ducts of the liver due to the action of various infectious agents.

For the diagnosis of diseases gallbladder and bile ducts along with biochemical research liver function and the study of duodenal contents, described in detail in the course of internal diseases, are widely used X-ray examinations... These include: plain radiography, cholecystography, cholegraphy and cholangiography. With plain radiography in the gallbladder, theine of radiopaque stones can be found, calcification of its walls, which, however, is rare. At the same time, diseases of adjacent organs can be detected, proceeding under the guise of cholecystitis (kidney stones to the ureters, calculous pancreatitis, deforming spondyloarthrosis, etc.). The methods of cholecystography and cholegraphy are based on the ability of the liver cells to secrete iodine-containing substances with bile, which, getting into the bile pugs, make it possible to obtain their image on radiographs.

Cholecystography it is carried out after ingestion of 3-3.5 g of bilitrast or 4-6 g of ponanosic acid (cholevid). Being absorbed in the kneshechinka, the contrast agent with the blood flow enters the liver, where almost 70% of it is gradually excreted in the bile. Accumulating in the gallbladder, it concentrates, reaching a maximum after 14-16 hours. gall bladder... Concrements in it are defined as rounded or oval defects against the background of the bubble shadow (Fig. 125). After a choleretic breakfast (2 yolks), the motor function of the gallbladder is studied. Normally, after 30-40 minutes, it is emptied by half. If the gallbladder contracts by 2/3 or more, this indicates its hyperkinetic state. A contraction of 7s or less indicates a violation of his motor function. Lack of contrasting gallbladder can be observed when the cystic duct is blocked by a stone ("excluded" gallbladder) or weak concentration capacity of its mucous membrane. A negative result of the study may also be due to impaired absorption of the contrast by the intestinal mucosa or the lack of absorption by liver cells (hepatitis, jaundice, cirrhosis), as a result of which the contrast is completely excreted by the kidneys. For cholegraphy, a contrast agent (bilignost, biligraphy) is administered intravenously. Almost 90% of it is absorbed by the liver and excreted in the bile, rapidly creating a high concentration of the drug in the bile ducts. At the same time, they become clearly visible on radiographs, in contrast to cholecnetography, in which the ducts are poorly contoured. Cholegraphy is more often used when the gallbladder is "disconnected", as well as in patients who have undergone cholecystectomy. The advantage of this method is also independence from the state of the intestine and the function of the gallbladder. Negative results are observed only with diffuse damage to the parenchyma in the liver, when the excretory function of hepatocytes is impaired, in particular when the concentration of bilirubin in the blood is above 17 μmol / l (1 mg%). For a better image of the bile ducts, infusion cholegraphy has recently been widely used. in which a contrast agent is injected intravenously with drops (40-50 drops per minute) in 200 ml of 5% glucose solution. In some cases, it is combined with oral cholecystography.

At cholangiography a radiopaque contrast agent is injected directly into the bile ducts. This can be achieved by percutaneous puncture of the intrahepatic ducts, administration of a contrast agent through an existing external biliary fistula, or during surgery. Percutaneous transhepatic cholangiography is usually used in patients with obstructive jaundice to identify the underlying cause (duct tumor, calculus, pancreatic head tumor), as well as the level of occlusion. Successful puncture of the intrahepatic bile ducts can be carried out only with their significant expansion, which arose as a result of high biliary hypertension due to obstruction of the bile ducts. Due to the danger of leakage of bile and blood from the puncture hole into the free abdominal cavity and the occurrence of peritonitis, the study is performed immediately before surgery. Less dangerous and more expedient in these cases is laparoscopic cholangiography, in which the puncture is performed under the control of the eye and, in addition, the puncture opening is sealed by filling the canal with glue. If an inoperable tumor is found this method avoids unnecessary surgical intervention.

a - Radiography of the right upper quadrant of the liver revealed many calcified small (2-3 mm) multifaceted stones in the gallbladder.
b - Radiography of the right upper quadrant of the liver revealed 11 large (5-10 mm) calcified stones in the gallbladder.
c - Gallbladder filled with 20 polygonal radiolucent stones, 3-5 mm in diameter, detected by oral cholecystography.

Fistulocholangiography performed by injecting a contrast agent (cardiotrast, triyotrast) through an external biliary fistula or through a drainage left in the hepaticoholedochus after surgery on the biliary tract. This study allows you to determine the state of the bile ducts, to establish the presence of calculi, cicatricial strictures and other changes in them.

Operating cholangiography carried out during surgery. The contrast agent using special needles, metal or polyethylene cannulas, depending on the conditions, is introduced into the gallbladder, cystic duct or its stump, directly into the hepaticoledochus or intrahepatic ducts. Pictures are taken using a mobile x-ray machine. To do this, a special tunnel box is placed under the patient, which allows you to quickly change cassettes with film. As a valuable diagnostic method for studying the state of the biliary tract, operating cholangiography should now be performed in all operations undertaken for the pathology of the latter. A more advanced method of contrast study of the biliary tract during surgery is X-ray television cholangioscopy using an electro-optical amplifier or converter (EOP). Its main advantage is the ability to observe on the TV screen all phases of the passage of the contrast medium through the bile ducts, which makes it possible to more accurately determine pathological changes, for example, small stones, which, as the contrast agent arrives, are filled with it and become invisible on conventional radiographs. In addition, with this method, it is possible to investigate the functional state of the bile ducts, in particular the sphincter of Oddi, which is very important in resolving issues of surgical tactics. Dose X-ray irradiation the patient and the staff in the operating room, when using the image intensifier, is much lower.

During biliary tract surgery the surgeon often has to deal with a number of issues, for the solution of which it is necessary to resort to other studies of the bile ducts. Probing with plastic probes of different diameters (2-5 mm) is used to determine the stricture of the Vater papilla. Normally, the papilla easily passes a probe with a diameter of 3 mm. The use of metal probes is dangerous due to the possibility of damage to the walls of the duct and duodenum... For the diagnosis of calculi, transillumination of the ducts with cold light is used - the method of transillumination. In this case, calculi are defined in the form of different sizes of dark dots on a red background, sometimes moving. For the same purpose, there are special metal probes connected to the "Fon-1" apparatus. A beep will sound when the end of the probe touches a stone. With the help of an elastic probe with an inflatable cuff at the end (such as a Fogarty probe), not only the ducts are revised in order to establish calculi, but also their extraction.

Choledochoscopy- examination of the bile ducts from their lumen is carried out with the help of special endoscopic devices - choledochoscopes and fibrocholedochoscopes. This study allows you to assess the state of the mucous membrane, to see and remove the smallest calculi and "putty" under the control of vision, to assess the state of the mouth of a large duodenal papilla... However, the complexity of this method, the need for expensive equipment and special experience limit its application.

Cholangiomanometry and debitmetry(measuring the pressure in the bile ducts and the amount of fluid flowing in them per unit of time under constant pressure) make it possible to judge the patency of the bile duct and the functional capacity of the bile ducts. Unfortunately, the performance of these methods is significantly influenced by the surgical trauma. especially manipulations in the area of the Vater papilla, as well as various medicines used to prepare for surgery and during anesthesia (morphine, fsntannl, etc.). In addition, these studies take a significant amount of time. In this regard, in recent years, they are almost never used.

The contrast agent for performing the study contains 2 atoms of iodine, therefore it reflects X-rays well. The drug is administered orally at a dosage of 1 gram per 20 kg of body weight.

The essence of the study is the intravenous administration of contrast. From the blood, bilitrast enters the liver and ducts, which makes it possible to obtain a clear image of the organ on an x-ray.

Preparation and conduct of cholecystography

Preparation for cholecystography is carried out the day before the procedure and includes the following steps:

After 14 hours the day before the examination, the patient is assigned a low-fat diet.
Abstaining from food is required after dinner. It is allowed to drink water.
Before going to bed, take 6 tablets of sodium ipodinate or iopanoic acid: 1 tablet every 5 minutes.
Smoking is excluded.
Immediately before the contrast x-ray of the gallbladder, a provocative test for sensitivity to bilithrast is performed.
To cleanse the intestines, some radiologists recommend doing an enema before the procedure.

How to take x-rays of the bile ducts and bladder

An x-ray of the gallbladder is made after provocative tests and a survey x-ray of the abdominal cavity. It eliminates the presence of free gas in the abdominal cavity, which indicates perforation (perforation) of the intestinal wall.

Cholecystography is performed after excluding contraindications:

intestinal obstruction;
perforation of the intestinal wall;
pregnancy and breastfeeding;
allergy to contrast;
renal, hepatic and cardiovascular failure.

After ingestion of 3 grams of bilitrast, pictures of the liver are taken. If acid is used as a contrast agent, the maximum accumulation of the substance in the gallbladder is observed after 15 hours.

Radiologists take pictures immediately after the contrast is injected and when the gallbladder is full. This is how the maximum efficiency from cholecystography is achieved.

What are the indications for X-ray contrast examination of the gallbladder (cholecystography)

Indications for contrast x-ray of the gallbladder:

biliary dyskinesia;
suspicion of gallstone disease;
study of the state of the biliary system with tumors;
frequent pains in the right hypochondrium, which are not eliminated by drugs;
violation of the digestion of fats in the intestine.

If the preparation is carried out efficiently, but there is an accumulation of gases in the gastrointestinal tract, this is a relative contraindication to the procedure.

What does intravenous cholecystography show?

Photo. The system of extrahepatic ducts filled with calculi

Oral or intravenous cholecystography shows the following anatomical structures of the gallbladder:

In a hypersthenic, the bladder has a round shape and a wide diameter, in an asthenic, it is extended upward.

What diseases does cholecystography show:

violation of patency;
decreased concentration of the biliary tract;
pathology of the motor function of the bile ducts;
adhesions and scars.

If the contrast cholecystogram shows an organ contraction by more than a third, this indicates its hyperkinetic state. Such an x-ray picture can be with a blockage of the duct.

Consequences of X-ray of the gallbladder with contrast

After cholecystography, the following complications are observed:

Dizziness and headache.
Disorder of the intestines.
Nausea and vomiting.

Each of these types of research has its own diagnostic value. Radiopaque stones are visible only on images, and echo-acoustic calculi - on ultrasound.

Photo. Retrograde endoscopic cholangiography (REC) (bile and pancreatic ducts are contrasted, many stones are noted)

The study turns out to be indispensable in the need for surgical treatment of liver diseases. It is used as the main method of visualization of the state of the bile ducts and duodenum 12 in case of suspected tumor formations.

The value of cholecystography is high, despite the radiation exposure of a person during its performance.

The quality of diagnostics in this case justifies the costs, therefore cholecystography is actively developing. The method is gradually being improved and updated.

Cholecystoscopy preparation

1049 universities, 2214 subjects.

Indications: diseases of the biliary tract.

Contraindications: individual sensitivity to iodine-containing drugs.

1. Holevid, bilitrast or bilimin (1g per 15-20kg of body weight).

2. Two egg yolks or 20 g of sorbitol.

3. Instrumentation for a cleansing enema.

4. Sterile gloves.

1. 2-3 days before the study, the patient is prescribed a slag-free diet (exclude coarse bread, legumes, cabbage, potatoes).

2. Warn the patient that the study is carried out in the morning on an empty stomach.

3. Light supper on the eve at 18 o'clock.

4. Give oral bilitrast or cholevid one hour before the examination (in an amount taking into account the patient's weight). The drug should be taken with a glass of sweet tea. After taking a contrast agent, the patient lies on his right side for better absorption of the drug.

5. At 22 o'clock put a cleansing enema, on the day of the study - a second cleansing enema.

1. Give the patient a choleretic breakfast:

2 raw eggs or 20g sorbitol (this causes the gallbladder to contract and empty).

2. Take the patient to the X-ray room (hours after taking the contrast agent.)

3. To warn the patient about the possibility of nausea and loose stools after taking X-ray contrast drugs.

1. Observation of the patient.

1. Cholecystography is performed by an X-ray doctor.

2. First, a general X-ray is usually done in an upright position, then - sighting images of the gallbladder. The pictures evaluate the position, shape, size, contours, intensity and structure of the gallbladder shadow. 3. The motor function of the gallbladder can be assessed using a series of images before and after taking a choleretic breakfast.

4. The method is indicated in all cases when it is necessary to find out the state of the patient's gallbladder, while various pathological changes can be found in it: developmental anomalies, calculi, inflammatory process, tumor, polyps, etc.

Explain to the patient that the study is necessary for a more accurate diagnosis and control over the effectiveness of treatment.

Asking the patient if they tolerate iodine-containing drugs

Explain the purpose of the contrast medium intake. Explain that the manipulation is painless.

Reassure the patient, tell the course of the manipulation, during the procedure, ask about the patient's condition, about unpleasant sensations... Closely observe the patient's response. Do not leave the patient alone.

Ask the patient how they are feeling.

Encourage the patient to have a favorable outcome.

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Preparation and execution of cholecystography

The need to study the gallbladder and ducts is relevant for dozens of diseases, sets of symptoms. Cholecystography is the most popular procedure in this direction, it can be performed using contrast agents. When absorbed, they are transferred to bloodstream, into the investigated organ, allowing you to observe its state, dynamics. The condition for the implementation of the procedure is a satisfactory condition of the liver.

The use of the technique provides clarification:

Sizes, detailed dimensions of the bubble, location;
The inner wall is a relief;
Reduction rates;
Present inclusions.

Indications for the procedure

The study is prescribed in the presence of acute, sluggish clinical manifestations of a number of gallbladder diseases, suspicions, and concomitant symptoms. It is advisable to study the gallbladder, anatomical, functional indicators of the organ if there is a suspicion of cholecystitis, probable tumors, stones, and other pathologies. Dyskinesia belongs to this list.

Contraindications

Choosing this method, take into account the state of the liver. It synthesizes bile, the effect of the drug used in the study negatively affects the organ - functioning, condition. Liver diseases before the procedure are excluded by preliminary diagnostics. Liver cirrhosis, jaundice are the main contraindications.

When the patient is in a satisfactory condition, a cholecystogram can be obtained, but there are absolute contraindications that exclude the possibility of performing the procedure completely, unconditionally. Liver failure of any form, heart disease of arbitrary origin, acute conditions associated with the liver, allergy to iodine preparations exclude the possibility of implementing the approach.

Varieties of techniques

Medicine distinguishes four methods of carrying out the procedure. The approach is not exclusively oral, the optimal solution is selected on a case-by-case basis from the four available. The form is selected by the doctor, based on the list of relevant factors.

Oral

The oral option involves taking a contrast fluid by drinking. Reception is made 15 hours before the start of the scheduled study. It is taken in the evening, after having had dinner, the drug is washed down with tea, sweetened with liquid. The agent enters the blood through small intestine, from the blood goes to the liver, through the ducts it turns into the gallbladder. In the morning, it is possible to perform X-ray images, having seen in detail the organ of interest, condition, features.

Intravenous route

The contrast agent is able to be absorbed by the body in minutes, the intravenous technique is associated with this feature. The bile ducts are contrasted after 15 minutes of presence in the patient's blood, 1.5 hours is enough to contrast the gallbladder. A concentration drug is introduced, after a specified period of time, the study procedure begins. X-ray examination method gives accurate results. Before starting the patient receives choleretic products, eats. It is possible to investigate the evacuation work of the gallbladder, to obtain detailed images, relief, calculi, narrowing, and its degree.

Infusion regimen

The drug is delivered intravenously, slowly, eliminating the risk of adverse reactions the patient's body. Intravenous jetting creates risks for the liver, infusional administration eliminates them.

Percutaneous

The substance is administered percutaneously in the presence of severe liver problems. Reception is not entirely safe, the substance is injected into the ducts, the bladder is punctured, there is a risk of complications. Sepsis, allergies - not a complete list of complications and risks. The lethal outcome is about 1 percent of cases. Today practice is excluded, no appointment is made - it is inappropriate.

Purpose and algorithms

The purpose of the procedure is to study the gallbladder, size, features, location. Allows to establish contractility, presence - absence of tumors, inflammations, traces of diseases. It is possible to depict the bubble in detail in 90 percent of cases, the negative result is individual, depending on the preparation, the procedure, the patient's behavior.

Successful implementation depends on the preparation carried out. The patient is prepared for the procedure in 2-3 days, transferring to a slag-free diet. Potatoes, flour from wholemeal flour, vegetables - cabbage are excluded. In the evening before the procedure, a light dinner is given, an examination is performed on an empty stomach. With the first method of research, bilithrast is taken, a synonym - holevit, for hours. Optimal absorption is achieved with the patient on the right side, it is recommended to stay in this position. Before going to bed in the evening, it is recommended to put an enema that cleans the intestines, repeat the event in the morning before the examination. Nausea, loose stools are the norm, a reaction to the drug is often observed.

The test for sensitivity to the drug with iodine in the composition is carried out per day, 1 ml in 10 ml of saline is injected intravenously, with a normal reaction, the procedure is feasible. Contraindications, forcing to refuse, are symptoms of hypersensitivity, allergies - lacrimation, runny nose, cough. The rise in body temperature is the reason for refusing the procedure.

How is it done?

Carrying out is feasible in the X-ray room, the doctor conducts a panoramic X-ray examination vertically, switches to the study of the bladder, removing the ducts, organ. Filming takes place when the patient is moved to his stomach, in a prone position. X-ray contrast shadows allow you to print images, the procedure continues while standing.

The next step is to provide products with choleretic properties, a similar medicine - it is possible to assess the quality, speed, and features of getting rid of the bladder from bile. A waiting period of minutes will provide an image of the bile duct. In a situation of insufficient filling of the bladder, it is necessary to carry out the procedure again, a diet with restriction of fats is prescribed, until the moment of establishing, concretizing the diagnosis.

The results of the study are detection - non-detection of stones in the organ, their mobility, number, size. Insufficient information content of the result, the need for additional research can be compensated for by biopsy, if necessary.

It is possible to diagnose inflammation, study the characteristic changes, examine the membranes, mucous membranes, consider the feasibility of sanitation. Sizes and geometry are easy to set - a healthy organ has thin walls, an elongated rounded shape. Has physiological characteristics within the normal range according to the human constitution. The presence of scars is easily detected, the presence of adhesions, patency problems, concentration is diagnosed.

Possible consequences

Taking the drug causes vomiting, nausea, diarrhea, and indigestion in a number of patients. Headache, dizziness - possible consequences. Failure to comply with the requirements of the doctor conducting the procedure, movement, low dose, poor preparation, the result runs the risk of being unsatisfactory, re-implementation is required. Intravenous use of the drug causes a sensation of heat, a metal taste is felt in the mouth, the reception is reflected in the work of human organs.

Complications can be associated with chemical composition necessary for the introduction of the drug, the toxic effect causes colic, headache, dizziness. Serious complications are fraught with increased sensitivity of the nervous system to the drug - fear, agitation, cerebral edema. In practice, 28 fatal situations have been registered - allergies, hypoglycemia.

Failure to detect pathology, the health of the organ allows you to return to the usual diet, the presence of pathology requires adherence to the rules of nutrition, treatment, observation by a doctor. The procedure is indispensable as a study before operations on the relevant organs, to determine the appropriateness of the intervention, forecasting, and the selection of an approach. The feasibility of the study is high with appropriate symptoms, requiring clarification of the state of the gallbladder, exclusion of inflammation, formation of stones, obstructions. The results of the study allow doctors to quickly make the optimal decision for the situation, provide accurate diagnosis, adequate treatment, taking into account individual characteristics organ, the course of the disease, the state of health of the patient.

Cholecystoscopy preparation

The purpose of cholecystography is to study the shape, size, position and contractility of the gallbladder and to detect the presence of stones. The goal of preparation for cholecystography is to prevent gas formation and bowel emptying.

Indications. Diseases of the gallbladder.

Contraindications Allergy to iodine-containing drugs (detected by history and application test).

Equipment. Radiopaque iodine-containing substance: iopagnost, bilignost, cholevid; choleretic breakfast (two egg yolks or 20 g of sorbitol).

Technique for performing preparation for cholecystography:

1. They go to bed before examining the patient, they are warned about excluding foods that contribute to gas formation from the diet: rye bread, legumes, fruits, milk.

2. Dinner the night before must be no later than 20.00.

3. For 12 hours before the study, within 1 hour, the patient is given tablets of a contrast agent (1-2 tablets every 10 minutes). The dose is determined based on the calculation of 1 g nkg of the patient's body weight.

4. The night before and 2 hours before the examination, the patient is given a cleansing enema.

5. On the evening before, the patient is warned that the study is being carried out on an empty stomach (on the day of the study, he also should not drink, take medications, or smoke).

6. On the day of the study, in the morning, the case history must be delivered to the X-ray room, the patient must be indicated the location of the room and the time of the study, or taken to the room.

7. The patient takes a choleretic breakfast as directed by a radiologist.

8. Breakfast is left to the patient in the department.

9. The medical history with the results of the research is returned to the medical department.

Preparing for intravenous cholegraphy

The aim of the study is the same as for cholecystography. Intravenous cholegraphy is performed in the absence of the desired result from cholecystography. The goals of preparation are to prevent flatulence and bowel movements.

Indications. Gallbladder disease; no result from cholecystography.

Contraindications Allergy to iodine-containing drugs.

Equipment. Choleretic breakfast; 20% solution of bilignost or endographite; anti-shock set.

Technique for preparing for intravenous cholegraphy:

1. For 2 days before the study begin bowel preparation, as before cholecystography (diet, enemas).

2. The day before the patient is warned that the study will be carried out in the morning on an empty stomach.

3. Before the introduction, bilignost is warmed up in a water bath to +37 ° C.

4. In the X-ray room, the procedural nurse the department slowly injects a contrast agent intravenously with the patient in a horizontal position. After the injection of 1-2 ml, a pause is made for 3 minutes to detect the patient's response to the drug. With the appearance of itching, sneezing, runny nose and other manifestations of the reaction, the administration of the drug is stopped. This is reported to the doctor.

5. In the absence of reaction, slowly (within 5 minutes) inject the entire drug.

6. The patient is left with breakfast in the department. The medical history is returned to the department.

Basic rules for preparing a patient for cholecystography

Cholecystography or X-ray examination of the gallbladder (GB) is performed after oral (oral) or intravenous administration of contrast medium. The contrast accumulates in the cavity of the organ and visualizes it on the radiograph. The indications for such a diagnosis are cholecystitis, cholelithiasis, biliary dyskinesia. But before visiting the diagnostic room, preliminary preparation of the patient for cholecystography is required. This is necessary to identify calculi, accurately check the filling of the bladder, and the main functions.

Types of cholecystography

The diagnostic method is based on the ability of the liver to absorb iodine compounds and secrete them together with bile - the gallbladder actively concentrates these microelements. As a contrast, bilimin, cholevid, yopagnost, bilitrast are used.

Cholecystography is of several types:

The oral technique is performed by taking contrast pills. The preparations are low-toxic, contain 65–75% iodine and stain the gallbladder well. The concentration becomes maximum 12 hours after the capsules are consumed.

Intravenous cholecystography is performed after slow injection of contrast. Bilitrast with blood quickly enters the liver, bile ducts. They are visualized, and the doctor gets a clear image: he can detect stones, blockages of the outflow tract, assess the size, contours, degree of contraction and other basic functions of organs.

Cholangiography is the invasive injection of contrast directly into the bile ducts. It is carried out by the method of percutaneous puncture, through an external fistula, or during surgical operation... Such a study helps to identify a tumor of the excretory canals, the head of the pancreas, calculi, the degree of occlusion.

Infusion cholangiography examines the functioning of the biliary system in patients after cholecystectomy. The contrast with the glucose solution is injected intravenously, slowly, dropwise over 30 minutes - this provides a longer staining of the ducts. The procedure can be combined with an oral diagnostic method.

The advantage of intravenous cholecystography is the ability to conduct a study regardless of the state of the intestine, if the patient had previously undergone cholecystectomy, and when bile acids do not enter the gallbladder cavity (“disabled” gallbladder).

Contraindications

Intravenous and oral cholecystography is contraindicated

severe damage to the renal and hepatic parenchyma;
thyrotoxicosis;
iodine intolerance;
allergy to seafood;
perforation of the walls in the gallbladder.

Contrast radiography of the gallbladder is contraindicated in pregnant women, as there is a risk negative impact on the intrauterine development of the fetus.

Preparation rules

On the eve of the study (2 days in advance), the patient must follow a special diet. Do not eat fatty foods, fresh vegetables, fruits, legumes, milk, rye bread. The last dinner must be no later than 20.00.

12-16 hours before visiting the clinic, the patient takes pills with contrast at the rate of 1 g of active ingredient per 15 kg of body weight, the interval between each capsule should be 5-10 minutes. The medicine should be taken with a little water. In the evening and a few hours before the study, a cleansing enema is given.

Cholecystography and cholangiography are performed in the morning on an empty stomach; on this day, it is also forbidden to drink alcohol, smoke, take any medications, or chew chewing gum.

Preparation for cholecystography by the intravenous method is carried out in the same way, with the exception of taking pills with bilitrast. The contrast is injected immediately before the study by injection.

Cholecystography technique

X-rays of the gallbladder are performed in a specialized office. The patient lies on his stomach, on his left side, then the position is changed and pictures are taken in a standing position in the front, direct projection with and without compression. After that, the person is given 2 raw eggs to drink and the motor-evacuation capacity of the bladder is examined again after 15, 30 and 60 minutes.

If there is no organ shadow in the photographs, a two-time evening reception of contrast is needed. The same preparation method is recommended for overweight patients.

Normally, the gallbladder is pear-shaped, has clear contours, is completely filled with bile, the neck, funnel, body and bottom are clearly visible, its shadow is uniform. Oral cholecystography has disadvantages: poor visibility or absence of an image of the excretory canals, a long preparation period, and the inability to assess the concentration function of the bladder. For dyskinesia, tumors, an intravenous method is used or infusion cholangiography is performed.

Intravenous cholecystography is performed on an empty stomach after a cleansing enema. First, a survey x-ray of the gallbladder is done, this helps to assess the preparation of the patient. The contrast agent heated in a steam bath is injected into the cubital vein. Dripping slowly, at least 4-5 minutes. For each kilogram of body weight - 0.6 ml of contrast.

The first pictures are taken within an hour. While the patient is lying on his back, the bile ducts are stained. After 90 and 120 minutes, pictures are taken already in a standing position, the gallbladder is completely contrasted, which makes it possible to assess its motor and concentration functions.

Adverse reactions

Adverse reactions are not uncommon with cholecystography, but they are not pronounced. Patients may have the following symptoms:

When allergic to a contrast agent, patients complain of itching, rhinitis, weakness, urticaria, redness of the skin after injection.

Causes of errors

Improper preparation can distort the results of the study. With jaundice, degenerative processes in the liver, cancerous tumors, echinococcus cholecystography, cholangiography gives a negative answer, even if the gallbladder is absolutely healthy. Changes in the images are also noted in congenital organ pathologies.

Nervous system disorders can lead to a spasm of the bladder neck or paresis of the muscle walls. Such symptoms can create a clinical picture identical to cholelithiasis.

Cholecystography is rarely used, since ultrasound procedure, CT scan, magnetic resonance therapy give a more accurate result, do not have a large number contraindications and complications.

How to prepare for oral or intravenous cholecystography

The frequency of liver and gallbladder diseases increases every year, therefore, to identify pathology, it is necessary to use all possible methods diagnostics. Do not forget cholecystography as a clarifying method for visualizing the gallbladder and intrahepatic bile ducts.

What is cholecystography?

Cholecystography (cholegraphy) belongs to an extensive group of methods based on X-ray radiation. This X-ray method involves taking multiple images of the gallbladder varying degrees fullness.

For its better visualization, it is necessary to introduce an X-ray contrast agent, depending on the route of contrast intake, cholegraphy is divided into:

After the procedure, you can determine:

the shape of the bubble, its size;
bubble position;
the relief of its inner wall;
the presence of additional inclusions, such as polyps, stones;
contractility of the gallbladder;
patency of the bile ducts (an intravenous study is done).

Given the possibilities of cholecystography, the main indication for a diagnostic procedure is the presence of pathology of the gallbladder.

A series of cholecystograms is normal

Contraindications to cholecystography

Bile is a secretion synthesized in the liver and necessary for digestion processes. Therefore, relative contraindications include conditions associated with liver pathology due to the fact that the contrast agent will be excreted through the liver and exert a significant functional load on this organ. These include:

parenchymal jaundice, that is, an increase in the level of bilirubin in the blood due to damage to liver cells;
cirrhosis of the liver, because with this disease the function of the organ is significantly affected;
Acute cholangitis is an inflammatory disease of the intrahepatic bile ducts.

Absolute contraindications are associated with both liver pathology and other organs and systems:

acute liver disease, as the likelihood of acute liver failure increases;
renal failure, since about 10% of the contrast is excreted by the kidneys;
severe cardiovascular insufficiency;
allergic reactions to iodine.

Oral cholecystography

This method was named because of the way the contrast medium enters the body - orally, that is, through the mouth. Therefore, the form of release of the contrast agent is a tablet.

Preparation and implementation

Preparation for the study begins in a few days:

in 3 days, the transition to food that excludes foods that increase gas formation;
the day before, you should cleanse the intestines with an enema;
in the evening before the study, do not eat after 20.00;
method of a single dose of contrast: 12 hours before the appointed time of cholecystography, the patient within 1 hour needs to drink several tablets of a contrast agent at the rate of 1 tablet of nkg body weight;
the technique of double intake of contrast: the required dose of the drug is divided into two equal parts, taken in the interval of hours and hours, and between each tablet you need to do at least a 10-minute interval;
in the morning repeat the cleansing enema.

Oral cholecystography is performed on an empty stomach, that is, you cannot eat or drink, smoking is also prohibited due to the ability of nicotine to cause contraction of the gallbladder.

In the X-ray diagnostic room, images of the right hypochondrium are taken in frontal projection, after which the patient takes a choleretic breakfast, most often consisting of two raw yolks, and the doctor makes a repeated series of images.

Complications

Various side effects during the study occur quite often, but their severity is insignificant and they do not pose a threat to life:

loose stools;
nausea, vomiting;
feeling of heaviness in the hypochondrium;
rashes on the skin.

Intravenous cholecystography

Oral cholecystography differs from intravenous in that with the latter, the contrast is injected into a vein and a procedure is prescribed if the former is ineffective.

Preparation and implementation

The algorithms for preparing for cholecystography are almost identical and somewhat simplified:

2-3 days before cholegraphy, it is necessary to abandon or reduce the amount of gas-forming products;
on the evening before, you can not eat after 20.00;
also in the evening it is necessary to cleanse the intestines;
the study is carried out on an empty stomach, that is, you cannot eat or drink.

Before the introduction of the X-ray contrast agent, a general picture of the abdominal organs is taken in the X-ray room to determine the quality of the patient's preparation for the procedure.

In the horizontal position of the patient, a series of images of the right hypochondrium are taken for an hour at 15-minute intervals. As a result, the state of the intrahepatic bile ducts is assessed.

After 1.5-2 hours, images are taken to visualize the gallbladder, after which the patient takes a choleretic agent, and the series of images is repeated.

Complications

Almost all possible consequences are associated with the introduction of a contrast agent, which can cause a feeling of heat, chills, abdominal pain, chest, dry cough, shortness of breath - these are signs of an adverse reaction of the body to the contrast, the occurrence of which must be reported to the medical staff.

Methods of oral and intravenous cholecystography are very informative, however, they are difficult to perform and time-consuming, therefore they are rarely performed.