bile, Greek with hole, + kystis a bubble + grapho to write, represent; synonym: the contrast cholecystography, the concentration cholecystography) — the radiological method of a research of a gall bladder consisting in its X-ray analysis through certain time after introduction to an organism of special radiopaque substances to-rye are caught from blood by a liver, allocated with bile and collect in a gall bladder.
The cholecystography is developed in 1923 — 1924 an amer. surgeons E. Graham and W. H. Cole. This method quickly entered a wedge, practice in view of relative simplicity and safety. The cholecystography allows to investigate morphology and function of a gall bladder (with - m), to find in it patol. changes (anomalies of development, concrements, inflammatory process, tumor).
The cholecystography is shown in all cases when it is necessary to find out a condition of a gall bladder of the patient; people of any age can see off it. Contraindications are an idiosyncrasy of the patient to iodine and acute dystrophic damages of a liver. A relative contraindication consider coronary insufficiency and the expressed abnormal liver function and kidneys. In recent years radio iso-topnoy cholecystographies began to apply the cholecystography less often in connection with development of ultrasonic diagnosis (see) diseases of bilious ways, and also (see. Gall bladder, methods of a research; Holegrafiya radioisotope of N and I).
Fig. 1. Holetsyastogramma is normal (a direct projection) at vertical position of the patient: the shadow of a gall bladder is intensive and homogeneous.
Radiopaque substance can be entered intravenously, through a mouth, via the probe into a duodenum or by means of an enema in a rectum. Into a crust, time a contrast agent is entered, as a rule, orally. As radiopaque substances use iodide organic compounds. The modern radiopaque substances entered orally to-rye apply to X. — iopa-noyevy to - that (Cholevidum, yopagnost, Telepaquum), bilimin, etc. — derivatives of triyodiro-bathing benzene represent.
Special preparation for the cholecystography is not required. On the eve of day of a research in the evening after a dinner of the patient accepts X-ray contrast agent in a dose of 1 g on 20 kg of body weight, washing down it with water, fruit juice or sweet tea. Radiopaque substance in a stomach is not soaked up, it rezorbirutsya in a small bowel and, coming to blood, contacts albumine of serum. Hepatocytes bring radiopaque substance out of blood in bile in the form of a water-soluble metabolite. Concentration of drug in bile is low in this connection the shadow of bilious channels at a X-ray analysis is usually badly distinguishable. In a gall bladder because of the occurring pachycholia in it drug concentrates, and the shadow of a bubble appears on roentgenograms in 3 — 4 hour. The image gradually amplifies, reaching a maximum in 15 — 17 hours (fig. 1). At children optimum contrasting occurs quicker.
The cholecystography is made on an empty stomach, in 9 — 10 hours of morning next day after administration of drug. At first usually do the survey roentgenogram in vertical position of the patient, sometimes — at once aim pictures bilious puzy-
to Fig. 2. Holetsistogramma (a direct projection) at a single holesterolovy polyp of a gall bladder: the arrow specified the defect of filling caused by a polyp.
Fig. 3. Holetsistogramma at cholelithiasis (a direct projection): the multiple enlightenments in a gall bladder caused by gallstones are visible.
rya under control of roentgenoscopy (separate pictures carry out at a compression of area of a gall bladder a tube of a X-ray apparatus). At the expressed meteorism resort to cleansing enemas, however if after that accumulation of gas in a large intestine interferes with obtaining the clear image of a gall bladder, then carry out a tomography or a zono-grafiya (see the Tomography). On pictures estimate situation, a form, size, contours, intensity p structure of a shadow of a gall bladder. For establishment of relationship of a gall bladder with a stomach and a duodenum to the patient allow to drink a water suspension of fixed white.
Fig. 4. A series of holetsisto-grams before reception of a cholagogue breakfast are normal: / — before reception of a cholagogue breakfast; 2 — 7 — during reduction of a gall bladder; 8 — during the period on the h av shegos I r the expert of l and bl e N and I am l of the h but go and bonds r I.
At the cholecystography defects (enlightenments) in a shadow of a gall bladder (fig. 2, 3) can be found, to-rye are caused by a stone (see Cholelithiasis), a holesterolovy polyp (see the Cholesterosis) or a tumor. If there are no defects of filling of a bubble, to the patient for the purpose of strengthening of motility of a gall bladder allow to drink 20 g of the sorbite dissolved in a glass of water. With the same purpose investigated it is possible to give 60 ml of crude egg yolk or other so-called cholagogue breakfast, napr, Boyden's breakfast consisting of mix of two egg yolks and one glass of cream. In pictures in 15-— 20 min. quite often it is possible to receive a shadow of the general bilious channel (see. Bilious channels) which is filled with the contrasted bile from a bubble. Besides, on roentgenograms of the reduced gall bladder (20 — 45 min. later after reception of a cholagogue breakfast) small stones or polyps can be found, to-rye were not noticeable in pictures before reduction of a bubble. A series of pictures allows to estimate motive function of a gall bladder (fig. 4). Stronger and bystry reduction of a bubble happens after intravenous or intramuscular administration of cholecystokinin (see), but resort to it seldom in view of a possibility of emergence of abdominal pains and vomiting.
The radiopaque substance which partially passed into intestines with bile is removed with excrements, a part it is repeatedly soaked up and circulates in a hepatoenteric circle. Therefore identification of a shadow of a gall bladder on roentgenograms perhaps and next day. The technique of so-called saturation at the cholecystography also is based on it. If the shadow of a gall bladder on roentgenograms in the first day of a research is absent, then the patient is given during the day in addition one or two full doses of radiopaque substance and repeat a research in the morning next day.
By-effects at the cholecystography are expressed poorly. There are dizziness, nausea, a liquid chair, pressure sense in epigastric area. At symptoms of an iodism appoint antihistaminic drugs, other by-effects disappear without treatment.
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