Ultrasonography( also referred to as echography) of the gallbladder is one of the highly informative, non-invasive and painless diagnostic techniques that allow you to assess the condition of both this organ and the ducts leading to it.
Given the close relationship of the gallbladder to the organs of the biliary system, the procedure can be complex, involving the simultaneous scanning of this organ, pancreas and liver.
Indications
The gallbladder echography can be appointed by a gastroenterologist with:
- permanent pain in the right hypochondrium, which can not be cured even by painkillers( as a rule, such pains are manifestations of acute or chronic cholecystitis);
- often arose bitterness in the mouth;
- discomfort and a feeling of heaviness in the region of the liver;
- marked jaundice of the mucous membranes and skin, observed in combination with nausea and vomiting, containing an admixture of bile;
- abdominal injuries;
- monitoring of a patient who underwent an operation to remove the gallbladder and its ducts;
- presence of significant deviations from the norm of some( the level of bilirubin, AST and ALT) of the laboratory blood test;
- biliary dyskinesia;
- of cholelithiasis;
- the appointment of hormonal contraceptive means( because in women prone to gallbladder disease, taking hormonal birth control pills can not only accelerate the occurrence of gallstones, but also cause inflammation);
- is too long taking some medications;
- the presence of obesity;
- all kinds of intoxications of the body, first of all - with the abuse of strong alcoholic beverages;
- monitoring of the functioning of the bile excretory system( if there is a suspicion of the presence of tumors or the onset of a malignant process);
- control over the effectiveness of the prescribed treatment;
- suspected of having congenital gallbladder disease.
The basis for the appointment of ultrasound examination of the gallbladder in young children is:
- yellowing of the eyes and skin proteins;
- frequent occurrence of diarrhea and vomiting;
- presence of abdominal pain blurred localization;
- lack of appetite;
- causeless weight loss.
Get a recommendation for the performance of ultrasound of the gallbladder can patients:
- often include in their daily diet too fatty, sharp, smoked and fried foods;
- excessively addicted to low-calorie diets;
- eating extremely irregular.
Contraindications
The undoubted advantage of echography is the complete absence of contraindications to its conduct. The only exception is cases of severe damage or breaches of the integrity of the skin in the study area( eg, infectious lesions, open wounds or burns).
Preparation for ultrasound of the gallbladder with the definition of the function
The complex of measures for the preparation of the patient for ultrasound examination of the gallbladder is absolutely identical to the program of preparation for ultrasound of all other internal organs localized in the abdominal cavity.
For three to five days prior to the procedure, the patient is required to follow a diet that completely excludes consumption:
- Too fatty foods.
- Any alcoholic beverages.
- Products provoking the process of enhanced gas formation in the intestine.
This category includes:
- products from yeast and dough;
- whole wheat bread;
- snacks;
- fresh berries and fruits;
- dishes from raw vegetables;
- leguminous crops;
- cabbage in any( stewed, pickled, pickled) kind;
- any sour-milk production;
- strongly brewed tea;
- any carbonated drinks;
- coffee.
The patient is allowed to use:
- porridges boiled on water;
- of white chicken meat;
- lean beef;
- fish( boiled or steamed);
- of low-fat cottage cheese;
- eggs boiled "soft".
On the eve of the scheduled study:
- The last meal should be taken no later than 19 hours. The food should be light enough, but satisfying. The ideal option for such a dinner can be porridge, cooked on the water( without the addition of sugar).
- It is advisable that the intestines be emptied naturally. In extreme cases, it can be emptied with microclysters, a glycerin suppository or a mild laxative( most often patients prone to constipation are prescribed lactulose).
- Newborn infants and toddlers under the age of one should not drink and feed for three to three and a half hours before the survey.
- The period of abstinence from food and drink of children under three years is four hours, and children who have reached the age of eight - six hours.
- The preparation for ultrasound and the procedure for the procedure itself for older children are carried out in exactly the same way as those designed for adult patients.
The morning of the day on which the ultrasound is scheduled:
- Breakfast should be abandoned if the procedure is to be performed in the morning.
- Allowed a light snack( for example, cracker and a cup of light tea), if the survey is scheduled for the second half of the day. The duration of the interval between breakfast and the diagnostic procedure should be at least six hours.
- It is forbidden to smoke and apply chewing gum.
- It is necessary to completely refrain from using any liquid for two to three hours before the study. Patients who take essential medicinal preparations that require water swill should always consult with the treating specialist.
Ultrasound examination of the gallbladder is always performed exclusively on an empty stomach.
Only if this condition is met, the organ, maximally filled with bile, will increase in size. With the use of even a small amount of liquid( and even more food), the process of bile secretion starts, leading to a squeezing of the gallbladder and significantly hampering the performance of the diagnostic examination.
Procedure for conducting
An ultrasound examination of the gallbladder may be:
- Simple. For this type of procedure, an ultrasonic outdoor sensor is used that receives information transabdominally( through the front wall of the abdomen).During the study, the patient assumes a supine position, releasing the upper abdomen from the clothing covering it. Before starting the procedure, the doctor lubricates the scanning head of the sensor with a water-soluble gel that improves the patency of ultrasonic waves by eliminating interference, which is the air gap between the skin and the sensor surface. Patients whose bottom of the gallbladder is covered with intestinal loops are asked to take a deep breath and hold their breath for a while. Some patients are offered to lie on their left side. If it is necessary to establish whether the gallbladder contains pathological inclusions( in the form of sand or stones), the doctor asks the patient to stand up and make several slopes of the body forward.
- With function definition. This version of the echography has several synonymous names. It is also called dynamic echolocationcintigraphy or ultrasound diagnostics with a choleretic breakfast. With the help of this study, a doctor in real time can evaluate the contractile function of the gallbladder. The procedure consists of two stages. First perform a primary examination of the body under examination on an empty stomach, after which the patient should have breakfast with the products brought with him( this is mandatory for the doctor on the eve of the examination).
Choleretic breakfast can consist of:
- 250 ml of creamy fat or sour cream( fat content of at least 25%);
- of the same amount of cottage cheese;
- several pieces of bitter chocolate and banana;
- two yolks of chicken eggs( raw or cooked);
- slices of bread with butter( this variant of breakfast is considered not very successful, since the gallbladder after it is reduced insufficiently actively, which affects the results of the study);
- solution of sorbitol.
Ten minutes after the end of breakfast, the echography is performed three times( the intervals between sessions are five, ten and fifteen minutes). The readings take place in two patient positions:
- lying on the back;
- lying on the left side.
Having received the results of the study( the physician of functional diagnostics decrypts them immediately), the patient can leave the office.
Transcript of the study with and without
During the procedure, a specialist evaluates:
- localization( relative to nearby tissues and organs) and gallbladder mobility;
- biliary tract diameter;
- dimensions, shape and thickness of the walls of the organ under examination;
- severity of its contractile function;
- presence of pathological inclusions( neoplasms, sand, polyps and stones).
Normal gallbladder( the range of parameters is determined by the dependence on the patient's age and general health condition) has:
- length from 7 to 10 cm;
- width from 3 to 5 cm;
- size in the cross-section from 3 to 3.5 cm;
- volume from 35 to 70 cm3;
- wall thickness - about 4 mm;
- diameter of the common bile duct from 6 to 8 mm;
- bile ducts with internal diameter not exceeding 3 mm.
A healthy organ has an oval or pear-shaped shape and distinct outlines. It is perfectly permissible if its bottom protrudes 1.5 cm from under the lower edge of the liver.
The normal size of the gallbladder in infants and children under the age of eight is set, based on their height and body weight.
The method of ultrasound examination of the gallbladder with a load makes it possible to assess not only the presence of structural abnormalities and changes, but also the operability of this organ.
The norm is to reduce it to 70% of the volume measured on an empty stomach, fifteen minutes after taking the cholagogue breakfast. The results of measurements, corresponding to this indicator, indicate normal motor activity of the gallbladder.
What does the examination show?
Gallbladder echography is able to detect the presence of:
- of Acute cholecystitis, as evidenced by:
- thickening of the walls of the test organ more than 4 mm;
- presence of multiple internal partitions;
- increased external parameters of the gallbladder;
- increased blood flow in the vesicle artery;
- pain experienced by the patient when the sensor is pressed on the area of localization of the organ being examined.
- Gangrenous cholecystitis , claiming an uneven increase in the thickness of the vesicle wall. The echogram shows the exfoliated particles of the mucous membranes, clearly visible in the lumen of the organ.
- Chronic cholecystitis , the clinical course of which is characterized by alternation of periods of exacerbations and remissions, according to:
- a significant reduction in the size of the gallbladder;
- presence of small inclusions, visible in the lumen of the bladder;
- presence of fuzzy blurred contours;
- sealing, thickening and deformation of the walls.
- Chololithiasis( cholelithiasis), the signs of which are the presence:
- of stones( small light formations) in the body cavity, displacing both with deep inspiration, and with each change of position of the body;
- of a dark patch( echoes) behind the stones, resulting from the impermeability of these formations for ultrasonic waves;
- uneven contours and thickened walls;
- of biliary sludge( a precipitate formed by bilirubin crystals), which should be differentiated from pus accumulation or hemorrhage, using similar signs.
- Choledocholithiasis is a variety of cholelithiasis, characterized by localization of stones not inside the bladder, but in the common bile duct( choledocha).Echography reveals an expansion of the diameter of not only choledocha, but also intrahepatic bile ducts, as well as the presence of stones in their visible areas. Because of the localization( part of the common bile duct is located behind the intestine) the diagnosis of this disease with ultrasound is not always successful. In such cases, a procedure is performed with changing the patient's poses.
- Dyskinesia of the gallbladder, manifested:
- by the bend of this organ;
- by increasing the tone of the vesicle walls and sealing them.
- Tumors whose signs on the echogram are availability:
- formations with dimensions exceeding 10-15 mm;
- significant wall thickening;
- essential deformation of the external contours of the organ under investigation.
- The gallbladder , showing a significant increase in its size, triggered by blockage of the cystic duct, the culprit can become a stone.
- Adenomyomatosis of the gallbladder - benign wall proliferation, in which all its layers are involved in the process. The ultrasound will show the presence of thickening of the vesicle wall, reaching 10 mm and making an insignificant internal lumen of the organ. Pathology can be spread either on a separate section of the wall, or diffusely - throughout the bladder.
- Polyps, looking on the echogram as rounded neoplasms, localized on the walls of the gallbladder. Polyps, whose diameter exceeds 10 mm, are very often malignant. If repeated procedures indicate a rapid growth of the polyp, the doctor will conclude that malignancy begins.
- Congenital pathologies, such as:
- presence of diverticulum - protrusions of the vesicles;
- agenesis - complete absence of the gallbladder;
- ectopic - atypical - localization( for example, between the right lobe of the liver and the diaphragm or behind the peritoneum) of the gallbladder;
- presence of a double gallbladder.
Price
The cost of the gallbladder echography, as a rule, depends on the class of the medical institution and on the region in which it is located.
In specialized gastroenterological centers in Moscow:
- , the cost of a simple ultrasound examination of the gall bladder ranges from 500 to 1200 rubles;
- for the procedure of ultrasound examination of the gallbladder with the load of the patient will have to pay from 700 to 1800 rubles.