Gallstone disease other imaging findings: Difference between revisions
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[[Image:ercp.jpg|thumb|center|500px|Source:wikiwand<ref name="urlwww.wikiwand.com">{{cite web |url=http://www.wikiwand.com/en/Common_bile_duct_stone |title=www.wikiwand.com |format= |work= |accessdate=}}</ref> ]] | [[Image:ercp.jpg|thumb|center|500px|Source:wikiwand<ref name="urlwww.wikiwand.com">{{cite web |url=http://www.wikiwand.com/en/Common_bile_duct_stone |title=www.wikiwand.com |format= |work= |accessdate=}}</ref> ]] | ||
===Bile microscopy=== | |||
Patients whom exhibit symptoms of biliary colic where ultrasound fails to detect stones often turn to microscopic analysis of their bile as proof of microlithiasis. It has an overall sensitivity of 65 to 90 percent for identifying patients with gallstones.<ref name="pmid3943777">{{cite journal |vauthors=Delchier JC, Benfredj P, Preaux AM, Metreau JM, Dhumeaux D |title=The usefulness of microscopic bile examination in patients with suspected microlithiasis: a prospective evaluation |journal=Hepatology |volume=6 |issue=1 |pages=118–22 |year=1986 |pmid=3943777 |doi= |url=}}</ref><ref name="pmid3706246">{{cite journal |vauthors=Moskovitz M, Min TC, Gavaler JS |title=The microscopic examination of bile in patients with biliary pain and negative imaging tests |journal=Am. J. Gastroenterol. |volume=81 |issue=5 |pages=329–33 |year=1986 |pmid=3706246 |doi= |url=}}</ref> The test detects traces of cholesterol crystals or bilirubinate granules. A high number of patients whom had clear ultrasounds had positive results on microscopy, however, the high sensitivity of tranabdominal ultrasonography has made the need for microscopy rare. <ref name="pmid7366692">{{cite journal |vauthors=Sedaghat A, Grundy SM |title=Cholesterol crystals and the formation of cholesterol gallstones |journal=N. Engl. J. Med. |volume=302 |issue=23 |pages=1274–7 |year=1980 |pmid=7366692 |doi=10.1056/NEJM198006053022302 |url=}}</ref><ref name="pmid6884818">{{cite journal |vauthors=Gollish SH, Burnstein MJ, Ilson RG, Petrunka CN, Strasberg SM |title=Nucleation of cholesterol monohydrate crystals from hepatic and gall-bladder bile of patients with cholesterol gall stones |journal=Gut |volume=24 |issue=9 |pages=836–44 |year=1983 |pmid=6884818 |pmc=1420078 |doi= |url=}}</ref> | |||
===Oral cholecystography=== | |||
Tests that are rarely done | Tests that are rarely done | ||
Oral cholecystography can diagnose gallstones and assess gallbladder function, but it has largely been replaced by more sensitive and specific tests, such as transabdominal ultrasound [33,55]. It is still occasionally used in patients in whom a high-quality ultrasound examination cannot be obtained (such as in obese patients), to confirm the presence of adenomyomatosis of the gallbladder, and to evaluate patients who are being considered for medical dissolution therapy with ursodeoxycholic acid, in whom it is important to demonstrate stone number and size, relative density of the stones to bile, cystic duct patency, and the gallbladder's concentrating ability. (See "Patient selection for the nonsurgical treatment of gallstone disease".) | |||
An orally administered contrast agent (eg, iopanoic acid, sodium tyropanoate, or calcium ipodate) is given and is absorbed through the intestine, taken up by the liver, and secreted into bile. Gallstones appear as filling defects within the contrast on plain radiographs (image 5). Non-opacification of the gallbladder can occur due to poor absorption from the intestine, impaired liver function, or extrahepatic biliary obstruction. With the currently available oral contrast agents, it is unlikely that the gallbladder will be visualized if the serum bilirubin is greater than 2 to 3 mg/dL. | An orally administered contrast agent (eg, iopanoic acid, sodium tyropanoate, or calcium ipodate) is given and is absorbed through the intestine, taken up by the liver, and secreted into bile. Gallstones appear as filling defects within the contrast on plain radiographs (image 5). Non-opacification of the gallbladder can occur due to poor absorption from the intestine, impaired liver function, or extrahepatic biliary obstruction. With the currently available oral contrast agents, it is unlikely that the gallbladder will be visualized if the serum bilirubin is greater than 2 to 3 mg/dL. |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
There are other imaging modalities that can be useful in diagnosing gallstone disease, these include; endoscopic retrograde cholangiopancreatography (ERCP), bile microscopy and oral cholecystography. It should be noted however, that some of these have been replaced by non-invasive, more advanced and less expensive imaging techniques.
Endoscopic retrograde cholangiopancreatography
Endoscopic retrograde cholangiopancreaticogram (ERCP) is an invasive procedure that requires technical expertise and often performed by inserting a tube into the common bile duct while the patient is sedated. Contrast material is then injected to allow visualization of the biliary tree. Traditionally, ERCP was not only diagnostic but is also therapeutic, so that if a stone was detected, it could be removed in the same sitting. The sensitivity of ERCP for choledocholithiasis is estimated to be 80 - 93%. ERCP has largely been replaced by MRCP and is now reserved for patients at a high risk of having a common bile duct stone, particularly with cholangitis.[1][2][3]
Bile microscopy
Patients whom exhibit symptoms of biliary colic where ultrasound fails to detect stones often turn to microscopic analysis of their bile as proof of microlithiasis. It has an overall sensitivity of 65 to 90 percent for identifying patients with gallstones.[5][6] The test detects traces of cholesterol crystals or bilirubinate granules. A high number of patients whom had clear ultrasounds had positive results on microscopy, however, the high sensitivity of tranabdominal ultrasonography has made the need for microscopy rare. [7][8]
Oral cholecystography
Tests that are rarely done Oral cholecystography can diagnose gallstones and assess gallbladder function, but it has largely been replaced by more sensitive and specific tests, such as transabdominal ultrasound [33,55]. It is still occasionally used in patients in whom a high-quality ultrasound examination cannot be obtained (such as in obese patients), to confirm the presence of adenomyomatosis of the gallbladder, and to evaluate patients who are being considered for medical dissolution therapy with ursodeoxycholic acid, in whom it is important to demonstrate stone number and size, relative density of the stones to bile, cystic duct patency, and the gallbladder's concentrating ability. (See "Patient selection for the nonsurgical treatment of gallstone disease".)
An orally administered contrast agent (eg, iopanoic acid, sodium tyropanoate, or calcium ipodate) is given and is absorbed through the intestine, taken up by the liver, and secreted into bile. Gallstones appear as filling defects within the contrast on plain radiographs (image 5). Non-opacification of the gallbladder can occur due to poor absorption from the intestine, impaired liver function, or extrahepatic biliary obstruction. With the currently available oral contrast agents, it is unlikely that the gallbladder will be visualized if the serum bilirubin is greater than 2 to 3 mg/dL.
An approximation of gallbladder motor function can also be obtained using oral cholecystography. The patient is given a fatty meal and serial radiographs are obtained. If the gallbladder is functioning normally, there will be a decrease in gallbladder size over time. Evaluation of the gallbladder motor function is not recommended in patients who have known gallbladder stones since it may induce biliary colic or complications of gallstone disease.
References
- ↑ Prat F, Amouyal G, Amouyal P, Pelletier G, Fritsch J, Choury AD, Buffet C, Etienne JP (1996). "Prospective controlled study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common-bileduct lithiasis". Lancet. 347 (8994): 75–9. PMID 8538344.
- ↑ Gurusamy KS, Giljaca V, Takwoingi Y, Higgie D, Poropat G, Štimac D, Davidson BR (2015). "Endoscopic retrograde cholangiopancreatography versus intraoperative cholangiography for diagnosis of common bile duct stones". Cochrane Database Syst Rev (2): CD010339. doi:10.1002/14651858.CD010339.pub2. PMID 25719222.
- ↑ Tse F, Liu L, Barkun AN, Armstrong D, Moayyedi P (2008). "EUS: a meta-analysis of test performance in suspected choledocholithiasis". Gastrointest. Endosc. 67 (2): 235–44. doi:10.1016/j.gie.2007.09.047. PMID 18226685.
- ↑ "www.wikiwand.com".
- ↑ Delchier JC, Benfredj P, Preaux AM, Metreau JM, Dhumeaux D (1986). "The usefulness of microscopic bile examination in patients with suspected microlithiasis: a prospective evaluation". Hepatology. 6 (1): 118–22. PMID 3943777.
- ↑ Moskovitz M, Min TC, Gavaler JS (1986). "The microscopic examination of bile in patients with biliary pain and negative imaging tests". Am. J. Gastroenterol. 81 (5): 329–33. PMID 3706246.
- ↑ Sedaghat A, Grundy SM (1980). "Cholesterol crystals and the formation of cholesterol gallstones". N. Engl. J. Med. 302 (23): 1274–7. doi:10.1056/NEJM198006053022302. PMID 7366692.
- ↑ Gollish SH, Burnstein MJ, Ilson RG, Petrunka CN, Strasberg SM (1983). "Nucleation of cholesterol monohydrate crystals from hepatic and gall-bladder bile of patients with cholesterol gall stones". Gut. 24 (9): 836–44. PMC 1420078. PMID 6884818.