Gallstones and Gallbladder Disease - Diagnosis

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Endoscopic Ultrasound. In an ultrasound variation called endoscopic ultrasound (EUS), the physician places an endoscope (a thin, flexible plastic tube containing a tiny camera) into the patient's mouth and down the esophagus, stomach, and then the first part of the small intestine. The tip of the endoscope contains a small ultrasound transducer, which provides "close-up" ultrasound images of the anatomy in the area. EUS is useful when the health care provider suspects common bile duct stones, but they are not seen on a regular ultrasound and the patient is not clearly ill. However, if common duct stones are detected, they cannot be removed using this method.

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X-Rays. Standard x-rays of the abdomen may detect calcified gallstones and gas. Variations include oral cholecystography or cholangiography.

• In oral cholecystography, the patient takes a tablet containing a dye the night before the test. The dye fills the gallbladder, and x-ray images are taken the next day. The test has largely been replaced by ultrasound; however, it may be useful in some cases for determining the structural and functional status of the gallbladder, often before nonsurgical procedures.
• In cholangiography, a dye is injected into the bile duct and x-rays are used to view the duct. It is typically used during operations to provide a clear image of the biliary tract.

Cholescintigraphy (Also Called Gallbladder Radionuclide Scan or HIDA scan). Cholescintigraphy, a nuclear imaging technique, is more sensitive than ultrasound for diagnosing acute cholecystitis. It is noninvasive but can take 1 - 2 hours or longer. The procedure involves the following steps:

• A tiny amount of a radioactive dye is injected intravenously. This material is excreted into bile.
• The patient lies on a table under a scanning camera, which detects gamma (radioactive) rays emitted by the dye as it passes from the liver into the gallbladder.
• The test can take up to 2 hours, because each image takes about a minute, and images are taken every 5 -15 minutes.