DIAGNOSIS OF BILIARY TRACT OR GALL BLADDER DISEASES
There are many diagnostic studies which can evaluated the state of biliary tract and gall bladder diseases which facilitated to reach proper diagnosis these diagnostic measures can be classified as follow
Laboratory diagnostic study
When patients with suspected diseases of the gallbladder or the extrahepatic biliary tree are evaluated by
Complete blood count CBC
An elevated white blood cell (WBC) count may indicate or raise suspicion of cholecystitis
Liver function tests
. An elevation of bilirubin, alkaline phosphatase, and aminotransferase cholangitis should be suspected
Cholestasis: an obstruction to bile flow is characterized by an elevation of bilirubin (i.e , the conjugated form), and a rise in alkaline phosphatase
Serum aminotransferases may be normal or mildly elevated. in patients with biliary colic
Important for detection if there is urobiliurolgin or biliurbin
Radiological study
Abdominal ultrasonography
All ultrasound is the initial investigation of any patient suspected of disease of the biliary tree
It is noninvasive painless does not submit the patient to radiation, and can be performed on critically ill patients
It is dependent upon the skills and the experience of the operator and it is dynamic (i.e., static images do not give the same information as those obtained during the ultrasound investigation itself
Adjacent organs can frequently be examined at the same time. Obese patients, patients with ascites, and patients with distended bowel may be difficult to examine satisfactorily with an ultrasound.
All ultrasound will show stones in the gallbladder Stones are acoustically dense and reflect the ultrasound waves back to the ultrasonic transducer, Because stones block the passage of sound waves to the region behind them, they also produce an acoustic shadow
All ultrasound will show stones in the gallbladder Stones are acoustically dense and reflect the ultrasound waves back to the ultrasonic transducer, Because stones block the passage of sound waves to the region behind them, they also produce an acoustic shadow
Stones also move with changes in position
Polyps may be calcified and reflect shadows, but do not move with change in posture
Some stones form a layer in the gallbladder; others a sediment or sludge
A thickened gallbladder wall and local tenderness indicate cholecystitis
The patient has acute cholecystitis if a layer of edema is seen within the wall of the gallbladder or between the gallbladder and the liver
When a stone obstructed the neck of the gallbladder the gallbladder may become very large but thin walled
A contracted thick-walled gallbladder indicates chronic cholecystitis
The extrabepatic bile ducts are also well visualized by ultrasound, except for the retroduodenal portion
The extrabepatic bile ducts are also well visualized by ultrasound, except for the retroduodenal portion
Dilation of the ducts in a patient with jaundice establishes an extrahepatic obstruction as a cause for the jaundice
. Frequently the site, and sometimes the cause of obstruction, can be determined by ultrasound
Small stones in the common bile duct frequently get lodged at the distal end of it, behind the duodenum, and are therefore difficult to detect
A dilated common bile duct on Ultrasound small stones in the gallbladder, and the clinical presentation allow one to assume that a stone or stones are causing the obstruction
Periampullary tumors can be difficult to diagnose on ultrasound, but beyond the retroduodenal portion, the level of obstruction and the cause may be visualized quite well
Ultrasound can be helpful in evaluating tumor invasion and flow in the porta1 vein. an important guideline for resectability of periampullary tumors
Biliary Radionuclide Scanning HIDA Scan
Biliary scintigraphy provides a noninvasive evaluation of the liver. gallbladder, bile ducts, and duodenum with both anatomic and func tional information
99m-Technetium-labeled derivatives of dimethyl iminodiacetic acid (HIDA) are injected intravenously, cleared by the Kupffer cells in the liver, and excreted in the bile
Uptake by the liver is detected within 10 minutes, and the gallbladder, the bile ducts, and the duodenum are visualized within 60 minutes in fasting subjects
The primary use of biliary scintigraphy is in the diagnosis of acute cholecystitis, which appears as a nonvisualized gallbladder, with prompt filling of the common bile duct and duodenum
Evidence of cystic duct obstruction on biliary scintigraphy is highly diagnostic for acute cholecystitis
False-positive results nay seen in patients with gallbladder stasis, as in critically ill patients and in patients receiving parenteral nutrition
Filling of the gallbladder and common bile duct with delayed or absent filling of the duodenum indicates an obstruction at the ampulla
,Biliary leaks as a complication of surgery of the gallbladder or the biliary tree can be confirmed and frequently localized by biliary scintigraphy.
Computed Tomography CT scanning
Abdominal CT scans are inferior to ultrasonography in diagnosing gallstones
The major application of CT scans is to define the course and status of the extrahepatic biliary tree and adjacent structures
It is the test of choice in evaluating the patient with suspected malignancy of the gallbladder, the extrahepatic biliary system, or nearby organs, in particular the head of the pancreas
Use of CT scan is an integral part of the differential diagnosis of obstructive jaundice
Spiral CT scanning provides additional staging
information, including vascular involvement in patients with peri
ampullary tumors
Percutaneous Transhepatic Cholangiography PTC
An intrahepatic bile duct is accessed percutaneously with a small needle under fluoroscopic guidance
Once the position in a bile duct has been confirmed, a guidewire is passed and subsequently a catheter passed over the wire
Through the catheter, a cholangiogram can be performed and therapeutic interventions done, such as biliary drain insertions and stent placements
Percutaneous transhepatic cholangiography (PTC) has little role in the management of patients with uncomplicated gallstone disease, but is particularly useful in patients with bile duct strictures and tumors, as it defines the anatomy of the biliary tree proximal to the affected segment
As with any invasive procedure, there are potential risks for PTC these are mainly bleeding, cholangitis, bile leak, and other catheter related problems
Magnetic Resonance Imaging MRI scanning
MRI provides anatomic details of the liver, gallbladder, and pancreas similar to those obtained from CT
Using MRI with newer techniques and contrast materials, accurate anatomic images can be obtained of the bile ducts and the pancreatic duct
It has a sensitivity and specificity of 95 and 89%, respectively, at detecting choledocholithiasis
MRI with magnetic resonance cholangiopancreatography (MRCP) offers a single non invasive test for the diagnosis of biliary tract and pancreatic disease
Endoscopic Retrograde Cholangiopancreatography (ERCP
Using a side-viewing endoscope, the common bile duct can be
canulated and a cholangiogram performed using fluoroscopy
The procedure requires intravenous-sedation for the patient
The advantages of endoscopic retrograde cholangiography (ERC) include direct visualization of the ampullary region and direct access to the distal common bile duct, with the possibility of therapeutic intervention
The test is rarely needed for uncomplicated gallstone disease, but for stones in the common bile duct, in particular when associated with obstructive jaundice, cholangitis, or gallstone pancreatitis
ERC is the diagnostic and often therapeutic procedure of choice. Once the endoscopic cholangiogram has shown ductal stones. sphincterotomy and stone extraction can be performed, and the common bile duct cleared of stones
Complications of diagnostic ERC include pancreatitis and cholangitis. and occur in up to % of patients
Endoscopic Ultrasound
requires a special endoscope with an ultrasound transducer at its tip
The results are operator dependent, but offer noninvasive imaging of the bile ducts and adjacent structures
It is of particular value in the evaluation of tumors and their resectability
The ultrasound endoscope has a biopsy channel, allowing needle biopsies of a tumor under ultrasonic guidance
Endoscopic ultrasound also has been used to identify bile duct stones, and although it is less sensitive than ERC, the technique is less invasive
Oral Cholecystography
Oral cholecystography has largely been replaced by ultrasonography
It involves oral administration of a radiopaque compound that is absorbed, excreted by the liver, and passed into the gallbladder. Stones are noted on a film as filling defects in a visualized, opacified gall bladder
Oral cholecystography is of no value in patients with intestinal malabsorption, vomiting. obstructive jaundice, and hepatic failure
You can also see
tags:biliary,gall,diagnosis,bladder,diseases,tract
Small stones in the common bile duct frequently get lodged at the distal end of it, behind the duodenum, and are therefore difficult to detect
A dilated common bile duct on Ultrasound small stones in the gallbladder, and the clinical presentation allow one to assume that a stone or stones are causing the obstruction
Periampullary tumors can be difficult to diagnose on ultrasound, but beyond the retroduodenal portion, the level of obstruction and the cause may be visualized quite well
Ultrasound can be helpful in evaluating tumor invasion and flow in the porta1 vein. an important guideline for resectability of periampullary tumors
Biliary Radionuclide Scanning HIDA Scan
Biliary scintigraphy provides a noninvasive evaluation of the liver. gallbladder, bile ducts, and duodenum with both anatomic and func tional information
99m-Technetium-labeled derivatives of dimethyl iminodiacetic acid (HIDA) are injected intravenously, cleared by the Kupffer cells in the liver, and excreted in the bile
Uptake by the liver is detected within 10 minutes, and the gallbladder, the bile ducts, and the duodenum are visualized within 60 minutes in fasting subjects
The primary use of biliary scintigraphy is in the diagnosis of acute cholecystitis, which appears as a nonvisualized gallbladder, with prompt filling of the common bile duct and duodenum
Evidence of cystic duct obstruction on biliary scintigraphy is highly diagnostic for acute cholecystitis
False-positive results nay seen in patients with gallbladder stasis, as in critically ill patients and in patients receiving parenteral nutrition
Filling of the gallbladder and common bile duct with delayed or absent filling of the duodenum indicates an obstruction at the ampulla
,Biliary leaks as a complication of surgery of the gallbladder or the biliary tree can be confirmed and frequently localized by biliary scintigraphy.
Computed Tomography CT scanning
Abdominal CT scans are inferior to ultrasonography in diagnosing gallstones
The major application of CT scans is to define the course and status of the extrahepatic biliary tree and adjacent structures
It is the test of choice in evaluating the patient with suspected malignancy of the gallbladder, the extrahepatic biliary system, or nearby organs, in particular the head of the pancreas
Use of CT scan is an integral part of the differential diagnosis of obstructive jaundice
Spiral CT scanning provides additional staging
information, including vascular involvement in patients with peri
ampullary tumors
Percutaneous Transhepatic Cholangiography PTC
An intrahepatic bile duct is accessed percutaneously with a small needle under fluoroscopic guidance
Once the position in a bile duct has been confirmed, a guidewire is passed and subsequently a catheter passed over the wire
Through the catheter, a cholangiogram can be performed and therapeutic interventions done, such as biliary drain insertions and stent placements
Percutaneous transhepatic cholangiography (PTC) has little role in the management of patients with uncomplicated gallstone disease, but is particularly useful in patients with bile duct strictures and tumors, as it defines the anatomy of the biliary tree proximal to the affected segment
As with any invasive procedure, there are potential risks for PTC these are mainly bleeding, cholangitis, bile leak, and other catheter related problems
Magnetic Resonance Imaging MRI scanning
MRI provides anatomic details of the liver, gallbladder, and pancreas similar to those obtained from CT
Using MRI with newer techniques and contrast materials, accurate anatomic images can be obtained of the bile ducts and the pancreatic duct
It has a sensitivity and specificity of 95 and 89%, respectively, at detecting choledocholithiasis
MRI with magnetic resonance cholangiopancreatography (MRCP) offers a single non invasive test for the diagnosis of biliary tract and pancreatic disease
Endoscopic Retrograde Cholangiopancreatography (ERCP
Using a side-viewing endoscope, the common bile duct can be
canulated and a cholangiogram performed using fluoroscopy
The procedure requires intravenous-sedation for the patient
The advantages of endoscopic retrograde cholangiography (ERC) include direct visualization of the ampullary region and direct access to the distal common bile duct, with the possibility of therapeutic intervention
The test is rarely needed for uncomplicated gallstone disease, but for stones in the common bile duct, in particular when associated with obstructive jaundice, cholangitis, or gallstone pancreatitis
ERC is the diagnostic and often therapeutic procedure of choice. Once the endoscopic cholangiogram has shown ductal stones. sphincterotomy and stone extraction can be performed, and the common bile duct cleared of stones
Complications of diagnostic ERC include pancreatitis and cholangitis. and occur in up to % of patients
Endoscopic Ultrasound
requires a special endoscope with an ultrasound transducer at its tip
The results are operator dependent, but offer noninvasive imaging of the bile ducts and adjacent structures
It is of particular value in the evaluation of tumors and their resectability
The ultrasound endoscope has a biopsy channel, allowing needle biopsies of a tumor under ultrasonic guidance
Endoscopic ultrasound also has been used to identify bile duct stones, and although it is less sensitive than ERC, the technique is less invasive
Oral Cholecystography
Oral cholecystography has largely been replaced by ultrasonography
It involves oral administration of a radiopaque compound that is absorbed, excreted by the liver, and passed into the gallbladder. Stones are noted on a film as filling defects in a visualized, opacified gall bladder
Oral cholecystography is of no value in patients with intestinal malabsorption, vomiting. obstructive jaundice, and hepatic failure
You can also see
- Gallbladder anatomy
- Biliary duct anatomy including the common bile duct common hepatic duct and its branches and cystic duct anatomy
- Diagnosis or investigations of biliary channels
- Gallbladder function
- Gallbladder stones causes types diagnosis and treatment
- Acute cholecystitis causes types diagnosis and treatment
- Chronic cholecystitis causes types diagnosis and treatment
- Acaclular or non calcular cholecystitis causes diagnosis and treatment
- Ascending cholangitis causes diagnosis and treatment
- Sclerosing cholangitis types causes diagnosis and treatment
- Gallbladder cancer causes diagnosis and treatment
- Bile duct cancer or cholangiocarcinoma causes diagnosis and treatment
- Bile duct cysts or choledochal cysts causes types diagnosis and treatment
- Bile ducts injury or strictures causes types diagnosis and treatment
- Problems after gall bladder removal or postcholecystectomy complications
tags:biliary,gall,diagnosis,bladder,diseases,tract
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