HOLEGRAFIYA

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HOLEGRAFYYa (Greek chole grapho bile to write, represent; synonym: the angiokholegrafiya, a biligrafiya, a holangiokholetsistografiya intravenous, a holangiokholetsistografiya secretory) — the method of X-ray inspection of bilious ways consisting in their X-ray analysis in certain terms after introduction to an organism of radiopaque substances to-rye come from blood to a liver and are allocated with bile.

Depending on a way of administration of X-ray contrast agent distinguish an intravenous, intramuscular and peroral holegra-fiya. In a crust, time apply generally intravenous holegrafiya, at a cut as radiopaque substances use the triyo-dirovanny derivatives of benzene connected with acid groups (see Radiopaque substances). The first drug of this kind — Biligrafinum was produced in 1953. The technique of a holegrafiya with this drug was described by Hornikevich (Th. Hornykiewytsch, 1956). The first triyodirovanny domestic drug for a holegrafiya — Bilignostum (see) was synthesized in 1954 by JI. M. Yagupolsky. In the subsequent drugs bilivistan, to biligra, etc. appeared, to-rye later introduction to a vein connect to albumine of blood serum. 11 ri it the small part of drug which did not contact blood proteins is allocated with nights, its main part (apprx. 90%) is absorbed by a liver and allocated with hepatocytes with bile (see the Liver). At a holegrafiya the image of bilious ways (see Zhelch-


of Fig. 1. The intravenous holegramma is normal: clearly shadows of large bilious channels (1) and a gall bladder are allocated (2).

ny channels, the Gall bladder) appears on roentgenograms even at partially broken concentration ability of a gall bladder. Unlike holetsis togas of a raffia (see) in pictures the shadow not only a bubble, but also bilious channels (fig. 1) is found.

Holegrafiya is applied to assessment of a morphological and functional condition of biliary tract; it is the only way of studying of concentration ability of a gall bladder (see. Gall bladder, physiology). Holegrafiya is shown at inspection of patients with a postcholecystectomy syndrome (see), the patients with disturbances of absorption in intestines having repeated vomitings with a stenosis of a gullet or stomach, after a resection of a stomach. In a crust, time scope of a holegrafiya was sharply narrowed, especially at the solution of a question of a possible operative measure on the bilious ways that is connected with implementation in a wedge, practice of methods of ultrasonic scanning (see. Ultrasonic diagnosis), a radionuclide holestsintigrafiya (see Holeg a raffia radio isotope), a transhepatic holangiografiya (see Holangiografiya) and an endoscopic retrograde pankreatokholangio-grafiya (see Pankreatokholangiografiya retrograde).

Abs.o of l yutny iirotivopokazani I-mi to a holegrafiya are acute dystrophy of a liver, a heavy renal failure, and also an idiosyncrasy to iodide drugs. As relative contraindications serve the dekokhmpensation of cordial activity (which is especially followed by disturbances of a cordial rhythm), hyperfunction of a thyroid gland, a tetany, the acute cholangitis which is followed by fervescence.

During preparation for a holegrafiya in a diet of patients limit the products promoting gas generation; to the persons inclined to allergic reactions, within 3 days give Prednisolonum or means, similar on action. On the eve of the research the dinner shall be a lung. In the morning in day of a research the food, smoking and drug intake is forbidden. Before an intravenous injection of radiopaque substance for decrease in side reactions the patient should drink 2 — 3 cups of tea; after that enter

1 — 2 ml of 50% of solution of Bilignostum or 30 or 50% of solution of Biligrafinum warmed to body temperature into a vein and wait for 3 min. to be convinced of absence of an anaphylaxis. Further slowly, within 5 — 10 min., enter other 18 — 19 ml of solution of Bilignostum or Biligrafinum. Slow administration of radiopaque substance reduces by-effects. At a holegra-fiya at the corpulent patients and persons who transferred a cholecystectomia (see) it is recommended to use 50% solution of Bilignostum or Biligrafinum. To children Biligrafinum enter in a dose 0,1 — 0,3 g/kg, Bilignostum in a dose of 0,5 — 0,75 ml/kg of 50% of solution for 1 kg of the weight (weight) of a body.

The X-ray analysis is made at horizontal (on a stomach or on spin) or vertical position of the patient. Shooting in horizontal position is carried out with turn of a body of the patient on 30 ° that the image of a backbone did not accumulate on a shadow of the general bilious channel. If a shadow of bilious channels of a malointensivn, or the general bilious channel it is expanded, or on its image gas bubbles in intestines are projected, it is necessary to resort to a tomography (see). Roentgenograms make in 20, 30—40 and 45 — 60 min. after

the termination of an intravenous injection. Survey pictures supplement with aim pictures at vertical position of the patient. This reception allows to track process of filling and to study concentration function of a gall bladder. If on the roentgenogram made in 20 min. after the end of administration of radiopaque substance there is no image of bilious channels, to the patient enter 0,5 ml of 1% of solution of morphine of a hydrochloride or 0,5 ml of 1% of solution of Pilocarpinum of a hydrochloride that promotes more intensive and long filling of bilious ways radiopaque substance.

After intravenous administration of radiopaque substance patients usually feel bitter taste in a mouth, feeling of heat. Register -


Fig. 2. An intravenous holegramma at cholelithiasis: the general bilious channel (1) is sharply expanded, contains numerous large gallstones (2); gallstones come to light also in the field of a bottom of a gall bladder (z).

with I short-term changes of concentration in blood serum of transaminases and an alkaline phosphatase. Occasionally there is nausea, vomiting, pain in an anticardium, weakness, heartbeat, sneezing develops. Also heavier complications — the general excitement, spasms, disturbances of breath, an acute renal failure are described. At emergence of complications the procedure is stopped, to the patient carry out the disintoxication and desensibilizing therapy.

For improvement of results and increase in safety of a holegrafiya the technique of drop administration of radiopaque substance is developed (infusion cholegraphy). Intravenously kapelno within 20 — 40 min. enter 150 — 200 ml of 5% of solution of glucose with divorced in them 30 — 40 ml of 50% of solution of Bilignostum or Biligrafinum. By the end of introduction on the roentgenogram the image of bilious ways appears, a cut in 15 — 30 min. amplifies. Bilious channels come to light in pictures still during 21/2 — the 3rd hour.

The infusion cholegraphy is shown when at ultrasonic scanning stones in a gall bladder are found, the content of bilirubin in blood is increased, and at the cholecystography the shadow of a gall bladder is not received. Patients with a bilirubinemia have higher than 3 mg / 100 ml (see the Hyperbilirubinemia) resort sometimes to long-term (during 8 — 12 hours) infusions of radiopaque substance. At an infa of a hot holegrafiya the frequency and expressiveness of side reactions decrease.

In the analysis holegramm establish situation, a form, contours, the size and structure of a shadow inside - and extrahepatic bilious channels and a gall bladder, paying special attention to existence of defects of filling in them most often caused by stones (fig. 2).

Make a series of bucketed aim roentgenograms 15 min. within the first hour after intravenous administration of radiopaque substance for studying of concentration ability of a gall bladder and in 30 — 60 min. in subsequent (fig. 3). All pictures shall be made at vertical position of the patient and an invariable ratio of distances between a X-ray tube, the patient and the cartridge with a film. Consider the following indicators: time from the moment of an injection of radiopaque substance before emergence of the contrasted bile in a proximal part of a gall bladder, time of emergence accurate two-layer sti shadows of a bubble and the nature of division of layers of bile in it (accurate or indistinct, languages), time of emergence of the contrasted bile at the bottom of a gall bladder (a phase trekhsloy-


Fig. 3. A series holegramm is normal: in 30, 60, 90 and 120 minutes after the end of intravenous administration of radiopaque substance the amount of not contrasted bile in a gall bladder gradually decreases.

to Nosta of bile) and to uniformity of a shadow of a bubble. If in the visual analysis do not find disturbance of normal process of filling of a gall bladder, then investigate dynamics of volumes kontrastirovan-N0Y and not contrasted bile in a bubble. For studying of motive function of a gall bladder to the patient allow to drink 100 — 150 ml of water from 20 g of sorbite or to eat two crude egg yolks (a so-called cholagogue breakfast). By means of a series of roentgenograms fix duration of reduction of a gall bladder and time of approach of its relaxation. For specification of relationship of the general bilious channel and a duodenum the holegrafiya is combined with rentgenol. a research of the last (see the Duodenum, methods of a research), i.e. make a holeduodenografiya.

See also Bilious channels. Bibliography: Lindenbraten L. D.

Radiology of a liver and bilious ways, M., 1980; Petrova I. S. and Pole E. 3. X-ray radiological researches of bile-excreting channels, Kiev, 1972; Salman M. M. Radiodiagnosis of diseases of gepatopankrea-toduodenalny system, Tashkent, 1977; F and" with h s W. And. and. R of e i s i g R. Die Langzeitinfusionseholangiographie bei Pa-ticnten mit Ikterus, Fortsghr. Rontgenstr., Bd 122, S. 148, 1975. JI. D. Lindenbraten.

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