Gallbladder X Rays Health Article

Preparation

The day before the test, patients are instructed to eat a normal breakfast and lunch and a light fat-free dinner (no fried or fatty foods, cream, milk, or butter). The night before, six Telepaque pills (iodine tablets) are taken one at a time, five minutes apart, with a large glass of water. Only water or juice is permitted until midnight. After midnight no food or liquids are allowed until after the exam. In some instances the clinic or hospital may prefer that a double-dose OCG be routinely done. This involves taking the Telepaque tablets over a two-day period. The pills may be taken two at a time with each fat-free meal or all at once, depending on the routine requested by the radiology department.

Aftercare

No special care is required after the study.

Complications

There is a small chance of an allergic reaction to the contrast material. In addition, there is a low level of radiation exposure. X rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits. Pregnant women and children are more sensitive to the risks of x rays, and the risk versus the benefits should be discussed with the treating physician. In some cases diarrhea or vomiting may occur. The x-ray technologist should be informed, since the gallbladder might not be well visualized.

Results

A normal OCG will show a normal gallbladder. The gallbladder should visualize, and be free of any solid structures, such as stones, polyps, or tumors. It should empty freely with no obstruction after the PFM (post-fatty meal).

Abnormal results may show gallstones, tumors, or cholesterol polyps (a tumor growing from the lining that is usually non-cancerous). Typically stones will "float" or move around as the patient changes position, whereas tumors will stay in the same place.

Health care team roles

The radiography technologist works closely with the nurses (if the patient is hospitalized) to make sure the patient is given the Telepaque tablets and follows a fat-free diet. Any diarrhea or vomiting must be noted and the radiology department advised. The x-ray technologist must also be aware of the bilirubin level, which could indicate liver disease and a non-functioning gallbladder. In the case of a high bilirubin level the exam would not be done. All x-ray technologists must be certified and registered with the American Society of Radiologic Technologists or an equivalent association, depending on where the exam is being done.

Patient education

Patients must understand the importance of taking the contrast tablets and following a fat-free diet. All women of child-bearing age should be aware of the dangers of x rays to a fetus, and will be protected as much as possible without obstructing the image of the gallbladder.

KEY TERMS

Bile—A yellow-green liquid produced by the liver, which is released through the bile ducts into the small intestines to help digest fat.

Bilirubin—A reddish-yellow pigment formed from the destruction of red blood cells, and metabolized by the liver. Levels of bilirubin in the blood increase in patients with liver disease or blockage of the bile ducts.

Body habitus—The size and shape of a person's body.

ERCP—An endoscopic retrograde cholangio-pancreatography. A flexible telescope is placed through the nose or mouth into the stomach, upper intestine and then the common bile duct to visualize the GB and pancreas. This is done when there is poor visualization of the gallbladder on an ultrasound examination, CT scan or OCG.

Ultrasound—A noninvasive procedure based on changes in sound waves of a frequency that cannot be heard, but respond to changes in tissue composition. Patients must be fasting for at least six hours but no contrast material is given. There is no radiation used in an ultrasound exam, so it is the exam of choice for the diagnosis of stones in the gallbladder, but is less accurate in diagnosing stones in the bile ducts. Gallstones as small as 2 mm can be identified.

BOOKS

Levenson, Deborah E. and Hans Fromm. "Oral Cholecystogram." In Hepatology: A Textbook of Liver Disease, edited by David Zakim and Thomas D. Boyer et al. Philadelphia: W.B. Saunders Company. 1996, p.1883.

Zeaman, Robert K. "Oral Cholecystography." In Bockus Gastroenterology, edited by William S. Haubrich et al. Philadelphia: W.B. Saunders Company. 1995, pp. 208-211.

OTHER

Gall Bladder Exam from Harvard Medical School. <http://www.bih.harvard.edu/radiology/Modalities/Xray/xraysSubdivsf/gallbl.html>.

Gallbladder X-ray. <http://www.dev.bidmc.harvard.edu/radiology>.

Gallstones from NIDDK. <http://www.niddk.nih.gov/health/digest/pubs/gallstns/gallstns.htm>.

Information on Gallstone Disease from the University of Connecticut Health Center. <http://www6.uchc.edu/zakko/info-gsd.htm>.

Oral cholecystogram from healthanswers.com. <http://www.healthanswers.com/database/ami/converted/003821.html>.

Methodist Health Care System. <http.www.methodisthealth.com/radiology/gallblad.htm>.

Women's healthabout.com. <http.www.surgeries.com/gallblas.shtml>.

Lorraine K. Ehresman