Clinical Investigations

There is considerable overlap in the investigation of gall bladder and extrahepatic bile duct disease.

• FBC - elevated WCC in cholecystitis.

• AXR - 10% of stones are radio-opaque; gas in the gall bladder wall (emphysematous cholecystitis) is a serious complication of cholecystitis seen most commonly in diabetics; in gallstone ileus it will show the classic triad of small-intestinal obstruction, gallstone in the right iliac fossa and gas in the biliary tree.

• Oral cholecystogram - oral contrast is taken and this is absorbed from the gut, bound to albumin in the portal vein, and subsequently secreted in bile. Radiological imaging of the gall bladder is then carried out 10 hours after ingestion. Although largely replaced by USS, this investigation is still indicated when the clinical symptoms are strongly suggestive of gallstones and the USS is negative.

• Radionucleotide scanning - high sensitivity in acute cholecystitis.

• Percutaneous drainage - under radiological guidance can be used to drain the gall bladder in, e.g., empyema.

• CT scan (chest, abdomen and pelvis), cholangiography (percutaneous or at ERCP) - to demonstrate a tumour mass, invasion of the liver and compression of bile ducts.

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