Diagnostic Tests

• Abdominal X-ray

An abdominal x-ray may be obtained if gallbladder disease is suggested to

exclude other causes of symptoms. However, only 15% to 20% of

gallstones are calcified sufficiently to be visible on such x-ray studies.

• ULTRASONOGRAPHY

Ultrasonography is rapid and accurate and can be used in patients with

liver dysfunction and jaundice. The procedure is most accurate if the

patient fasts overnight so that the gallbladder is distended.

Ultrasonography can detect calculi in the gallbladder or a dilated common

bile duct. It is reported to detect gallstones with 95% accuracy.

• RADIONUCLIDE IMAGING OR CHOLESCINTIGRAPHY

Cholescintigraphy is used successfully in the diagnosis of acute

cholecystitis. In this procedure, a radioactive agent is administered

intravenously. It is taken up by the hepatocytes and excreted rapidly

through the biliary tract. The biliary tract is then scanned, and images of

the gallbladder and biliary tract are obtained.

• CHOLECYSTOGRAPHY

Although it has been replaced by ultrasonography as the test of choice,

cholecystography is still used if ultrasound equipment is not available or if

the ultrasound results are inconclusive. Oral cholangiography may be

performed to detect gallstones and to assess the ability of the gallbladder

to fill, concentrate its contents, contract, and empty. An iodide-containing

 contrast agent excreted by the liver and concentrated in the gallbladder is

administered to the patient. The normal gallbladder fills with this

radiopaque substance. If gallstones are present, they appear as shadows

on the x-ray film.

• CHOLANGIOPANCREATOGRAPHY

Endoscopic retrograde cholangiopancreatography (ERCP) permits

direct visualization of structures that could once be seen only during

laparotomy. Fluoroscopy and multiple x-rays are used during ERCP to

evaluate the presence and location of ductal stones. Careful insertion of a

catheter through the endoscope into the common bile duct is the most

important step in sphincterotomy (division of the muscles of the biliary

sphincter) for gallstone extraction via this technique.

• PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY

Percutaneous transhepatic cholangiography involves the injection of dye

directly into the biliary tract. Because of the relatively large concentration

of dye that is introduced into the biliary system, all components of the

system, including the hepatic ducts within the liver, the entire length of the

common bile duct, the cystic duct, and the gallbladder, are outlined

clearly.

• Laboratory Test Results

Serum alkaline phosphatase, aspartate aminotransferase and lactate

dehydrogenase may be elevated, indicating abnormalities in liver function.

The direct and indirect serum bilirubin levels are elevated if an obstructive
process is present. White blood cell count with a left shift on the

differential count indicates inflammation. If there is pancreatic involvement,

serum amylase and lipase levels are elevated.