Gallbladder and Biliary System Radiography

The Gallstone Elimination Report

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The gallbladder and biliary system consists of the gallbladder and cystic duct; right and left hepatic ducts, which come together as the common hepatic duct; and the common bile duct, which is formed when the cystic duct and the common hepatic duct join. The common bile duct empties into the duodenum. Figure 10-3 reviews the anatomy of the bile duct system.

Several radiography studies, all using contrast media, are available for the examination of the gallbladder and biliary tree. Cholecystography, percutaneous transhepatic cholangiography, and T-tube cholangiography are presented in this section.

Cholecystography

Cholecystography, also known as a gallbladder (GB) series, is the radiographic visualization of the gallbladder using a radiopaque, iodinated contrast medium. The contrast medium can be ingested in the form of pills, oral cholecystography, or it can be administered via intravenous injection.

Indications for the test include suspected gallstones, gallbladder inflammation, and cystic duct obstruction. Contraindications are allergies to iodine contrast media and diseases of the digestive tract that may interfere with the absorption of orally ingested contrast media.

Normal Findings. Normal gallbladder anatomy and absence of pathology.

Variations from Normal. Various gallbladder disorders can be diagnosed via cholecystography. These include gallstones, polyps, and chronic

How The Gallbladder Tested
Figure 70-3. Structures of the biliary system

cholecystitis. Tliis examination can identify cystic duct obstruction and gallbladder cancer. Biopsy is necessary to confirm any cancer diagnosis.

Interfering Circumstances. Vomiting and diarrhea affect the absorption of orally ingested contrast media. Residual barium, usually the result of an upper GI series or barium enema, and an incomplete bowel prep interfere with gallbladder visualization. Any tests that require barium should be scheduled after the cholecystography exam.

Percutaneous Transhepatic Cholangiography (PTC, PTHC)

Percutaneous transhepatic cholangiography (PTC, PTHC), a radiographic examination of the biliary system and sometimes the gallbladder, uses an io-

dinated contrast medium that is injected through the liver into an intrahepatic bile duct. Visualization of the intra- and extrahepatic bile ducts, and occasionally the gallbladder, is then accomplished. Suspected duct obstruction and unexplained jaundice are the major indications for this procedure. Contraindications include allergies to the contrast media.

Normal Findings. Normal biliary duct anatomy and absence of pathology. If the gallbladder is visualized, normal gallbladder anatomy and absence of pathology.

Variations from Normal. Abnormal results include a variety of bile duct disorders such as tumors, strictures, or presence of gallstones. Sclerosis of the biliary tree and cysts of the common bile duct may also be identified.

T-Tube Cholangiography

T-tube cholangiography, a postoperative examination of the hepatic and common bile ducts, is accomplished by injecting an iodine contrast medium into the common bile duct via a T-tube. This test is usually done within ten days after cholecystectomy. During gallbladder surgery a self-retaining T-tube is often placed in the common bile duct. The tube is left in position until the patency of the hepatic and common bile ducts can be confirmed postoperatively. Indications for this examination include detection of postoperative common bile duct stones and evaluation of bile flow into the duodenum. Figure 10-4 shows the placement of the T-tube during this examination.

Normal Findings. Normal hepatic and common bile duct anatomy and absence of hepatic and common bile duct pathology.

Variations from Normal. T-tube cholangiography is able to identify common bile duct stones, stricture or tumors causing obstruction, bile duct cysts, and anatomic variations.

Interfering Circumstances. Residual barium interferes with bile duct visualization. Any tests that require barium should be scheduled after the T-tube cholangiography.

Cystic duct

Gallbladder

Liver

T-Tube

Duodenum

Pancrease

Figure 10-4. Placement of a T-tube for T-tube cholangiography

Gallbladder

Liver

T-Tube

Duodenum

Cystic duct

Pancrease

Figure 10-4. Placement of a T-tube for T-tube cholangiography

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