Ultrasound of the gallbladder with a choleretic breakfast. Preparing for an ultrasound of the gallbladder

Instrumental examination methods play an important role in the diagnosis of liver and gall bladder diseases. Ultrasound of the gallbladder is an accessible, inexpensive, informative, convenient for the doctor and painless for the patient way of visualizing the organ in real time. You can undergo the procedure at a district clinic, or you can call a diagnostician at home; most private medical centers provide this service. You should prepare for an ultrasound of the gallbladder in advance. High-quality preparation provides good “access” to the organ and ducts, allowing for reliable diagnosis.

The operating principle of ultrasound is based on echo signals (sound waves). It does not use ionizing radiation as with X-rays, it is much cheaper than tomography and does not require bulky equipment.

Indications for the study

Ultrasound examination of the gallbladder (GB) includes examination of the organ itself and ducts. During a routine medical examination, a comprehensive scan of the liver condition is carried out.

Targeted ultrasound is prescribed by a therapist or gastroenterologist for the following indications:

• the patient's complaints of pain in the liver (in the area of ​​the right hypochondrium), which are regular, do not go away when taking analgesics and antispasmodics;
• monitoring the condition of the organ during long-term medication use;
• yellowness of the skin, eye sclera;
• the patient complains of heaviness in the right side, which is associated with nausea and lack of appetite;
• persistent bitterness in the mouth;
• obesity;
• eating disorders - the predominance of heavy foods in the daily menu (fatty, fried, fast food);
• with prolonged fasting, excessive dieting;
• with alcohol abuse;
• before prescribing oral contraceptives to women who have diagnosed problems with the gallbladder, liver, or who express characteristic complaints (some hormonal contraceptives negatively affect the condition of these organs and can provoke the development of inflammation, the formation of stones, and stagnation of bile);
• with long-term use of hormonal and other medications to monitor the condition of organs;
• as a clarifying study in case of deviation from the norm, which is revealed by a laboratory blood test;
• cholelithiasis;
• cholecystitis (acute, chronic);
• biliary dyskinesia;
• preoperative examination;
• if malignant pathologies are suspected;
• post-traumatic examination of the abdominal organs;
• monitoring the patient after removal of the gallbladder;
• dynamic monitoring of the condition of the gallbladder during therapy;

Children undergo an ultrasound of the gallbladder if pathology is suspected:

• yellowness of the skin, sclera of the eyes;
• lethargy, vomiting, nausea, diarrhea;
• vague abdominal pain;
• unmotivated weight loss;
• poor appetite;

For newborns and premature babies, this type of diagnosis is included in the mandatory comprehensive examination. When the gallbladder is removed, an ultrasound examination of the bile ducts is performed in dynamics - before, after and during the food load.

Contraindications

There are no contraindications to ultrasound examination, except for one relative one – violation of the integrity of the skin in the place where it will be necessary to move the scanner.

If there is an open, inflamed wound on the stomach, or a burn that has not healed, then the procedure is postponed until the wound heals. There is no complete contraindication for ultrasound - the procedure is safe even for pregnant women and infants.

Preparation for the procedure

To increase the information content of the study, before performing an ultrasound, you should change (if necessary) your diet, take certain medications, and perform bowel cleansing procedures.

Ignoring the preparatory period leads to distortion of the results of the diagnostic study. In some cases, it makes performing a high-quality ultrasound impossible.

There are two conditions that are necessary for visual diagnosis of the condition of the gallbladder and ducts:

1. The intestines should be free of food and gases, so as not to “block” the passage of ultrasonic waves;
2. The gallbladder itself should be filled with bile as much as possible. Since taking any food and even water causes an outflow of bile, a dry fast is necessary 8 hours before the procedure - a complete refusal of food and drink;

Ultrasound of the gallbladder in a child requires the following dietary restrictions:

• newborn babies and toddlers up to one year are limited in food and drink 3-3.5 hours before the procedure;
• from one year to 3 years, the abstinence interval is set to 4 hours;
• from 3 to 8 years from 4 to 6 hours for the maximum possible time;
• from 8 to 12 years at least 6 hours;
• older children prepare for an ultrasound examination according to “adult rules”;

In order to properly prepare for an ultrasound examination of the gallbladder, you must adhere to the following dietary restrictions 5 days before it:

• Avoid fatty, fried, smoked and canned foods. The recommended menu consists of boiled, stewed, baked dishes, without the use of tomato, frying, spices, or flavor enhancers.
• Exclude foods rich in fiber from your diet - vegetables, fruits, bran (as a food additive, in finished products), rye bread, wholemeal products.
• Exclude legumes, sauerkraut, whole milk, carbonated drinks.
• Completely abstain from alcoholic beverages and, if possible, do not use alcohol-based medications.

Medicinal bowel preparation

Begins 3 days before the ultrasound. It includes:

• Taking enzyme preparations (Pancreatin, Festal, Panzinorm, Creon, Mezim) is indicated to increase the digestibility of food, reduce the likelihood of bloating, and eliminate other digestive disorders. The dosage recommended for adult patients is 1 tablet with each meal, but not more than 3 per day.
• Taking medications that inhibit the processes of gas formation in the intestines promote their release. These are Espumisan, Motilium, Metsil, Domperon. Dosage: 1-2 tablets after meals.

Note! Children are not given medication preparation!

Direct preparation

On the last day before the scheduled examination, it is recommended to have dinner before 7 pm in order to maximize the time it takes to fill the gallbladder and “keep” the intestines free.

It is necessary to empty the intestines naturally. If difficulties arise with the natural process, then defecation is stimulated with suppositories (Glycerin) or a mild laxative such as Duphalac.

If you are prone to constipation, then take Duphalac (or analogues) in advance. There is no need to do a cleansing enema.

After waking up, you should not eat, drink water, or chew gum if the ultrasound examination is scheduled for the morning. If the procedure is after lunch, then a light breakfast is allowed.

An ultrasound of the ducts and gallbladder in the morning is more informative than an examination in the afternoon.

Methodology

The procedure for ultrasound examination of the gallbladder is painless and takes little time.

Conventional echo scanning

The patient goes into the office, where he lies down on the couch (on his back) and exposes his stomach. The operator applies a special gel to the skin in the liver area, which ensures better contact between the skin and the scanner. During the study, the doctor moves the scanner over the liver area. The results are displayed on a computer monitor in the form of a two-dimensional image in real time.

If the doctor does not see the gallbladder or ducts, then he may ask the patient to change his body position, inhale and exhale deeply. If it is necessary to clarify the presence of stones in the gall bladder or ducts, the patient is asked to stand up and bend over. Small stones in the ducts are not reflected on the screen; their presence is judged by the expansion of the duct at the site of its blockage.

At the end of the procedure, the patient is given a napkin to wipe the stomach (it is better to take your own towel with you to the municipal clinic). The results are given out immediately.

Echo scanning in dynamics

If an ultrasound of the gallbladder is required to determine the function, then after the initial examination according to the procedure described above, the patient should take a choleretic food. It can be sour cream, cream, sorbitol, cottage cheese, egg yolks. After which, 5 minutes later, a repeat ultrasound of the gallbladder is performed with a load.

Dynamic changes in the state of the gallbladder are viewed and recorded after another 10 and 15 minutes. An examination with a functional test is necessary when pathological changes are observed only after eating. If an examination of a calm gallbladder does not reveal pathologies, then a study of the dynamics of its work shows them.

Another type of examination of the gastrointestinal tract is ultrasound with color Doppler mapping (color Doppler mapping). It is carried out if there is a suspicion of the presence of polyps, neoplasms, or cholesterol stones in the organ. Allows you to visually assess blood flow.

Dynamic echo-choledochography

Dynamic echo-choledochography is an ultrasound examination of the condition of the bile ducts in patients after cholecystectomy (removal of the gallbladder). The technique for carrying it out does not differ from echo scanning with a food load. The patient is examined before and after meals. The difference is that ultrasound of the bile ducts is repeated at longer intervals - the first time after half an hour, the second time after an hour.

Decoding the results

Ultrasound of the ducts and gallbladder allows you to visually evaluate the following parameters:

• size and location of the gallbladder (normal dimensions (in cm): length 7–10, width 3–5);
• its mobility, volume (normally 30–70 cm³);
• wall thickness (normal up to 4 mm), uniformity of structure (normal boundaries are clear);
• the presence of stones, stagnant bile;
• presence of neoplasms;
• the functioning of the gallbladder in dynamics, its contractility (the norm is up to 70% after eating);
• diameter of the bile ducts (normally total 6–8 mm, lobar up to 3 mm);

The unchanged gallbladder has a pear-shaped or oval shape. Located under the liver, it can protrude beyond its lower edge by 1–1.5 cm.

What pathologies can be detected using echo scanning of the gallbladder?

Ultrasound of the gallbladder and its interpretation allows you to diagnose:

• congenital anomalies;
• cholecystitis acute, gangrenous, chronic;
• gallstone disease (cholelithiasis), with the exact location of stones;
• biliary dyskinesia, bladder inflection;
• cholangitis (inflammation of the ducts);
• dropsy of the gallbladder;
• tumors, polyps;

If this is not your first time undergoing an ultrasound, take the results of previous studies. They will help to more fully and objectively assess changes in the condition of organs.

Ultrasound examination is a safe diagnostic method used for preventive examination of the condition of internal organs. An important question is: how is it done, and what should be the preparation for the procedure?

When the disease is already diagnosed, it is used in conjunction with other diagnostic methods. An ultrasound of the gallbladder reveals problems in the digestive system and helps to get an idea of ​​the condition of this organ.

The diagnostic method is used if:

• diagnosed gallstone disease or the presence of corresponding symptoms;
• biliary dyskinesia;
• abdominal trauma;
• tumors, malignant processes in the biliary system;
• before selecting hormonal contraceptives;
• if abnormalities are noticed in blood tests for bilirubin.

Can also be applied to check the correctness of the treatment prescribed by the gastroenterologist.

How to prepare?

How to properly prepare for an ultrasound of the gallbladder?

To make the research results informative, it is important to create conditions during preparation:

• gases do not accumulate in the intestines;
• bile should not accumulate, this increases the size of the bladder.

These factors make diagnosis difficult and distort its results.

Important! It is advisable to begin preparation 7 days before the examination.

Can I eat or drink before the procedure?

The study is done on an empty stomach, mainly in the morning. You cannot drink water 2 hours before.

Important! On the eve of the procedure, it is important to empty your bowels. It is desirable that this happens naturally. In case of constipation, you can use a mild laxative.

Last meal 8 hours before the scheduled examination. If it is supposed to take place in the morning, then the dinner the day before is hearty, but consists of light dishes. Dinner should be no later than 19.00. If the examination is carried out in the afternoon, a light breakfast is allowed. It is advisable to consult a doctor regarding possible dishes.

What is possible and what is not?

Exclude from the diet:

• legumes;
• raw fruits and vegetables;
• pastries and brown bread;
• milk;
• carbonated drinks;
• various types of snacks.

You cannot drink alcoholic beverages.

Avoid fried and fatty foods, spicy foods, marinades and smoked foods. Such food creates additional stress on the liver.

What diet?

• boiled, steamed steamed fish of low-fat varieties;
• porridge;
• chicken, beef;
• scrambled eggs";
• low-fat cottage cheese.

If you need to follow a strict diet that involves eating regularly, it is important to get advice from a specialist. The rule applies to the mandatory use of a number of life-saving medications. Following the doctor's instructions will ultimately ensure an error-free examination.

How do they do it?

The examination takes place through the anterior abdominal wall without entering the peritoneal cavity.

The video below will tell you about preparing for the study and how the procedure is carried out.

The standard procedure involves the person lying on their back. Gel is applied to the skin. Sometimes the doctor asks you to take a deep breath and then hold your breath.

Reference! To more accurately identify stones, sand or other unwanted inclusions, the patient may be asked to bend forward several times.

When to do a test after gallbladder removal?

After removal, some patients continue to experience unpleasant symptoms. This - postcholecystectomy syndrome. To eliminate this condition, you need to contact a hepatologist. Repeated examinations are scheduled every 6 months.

How often can I do it?

There are no contraindications for this type of research. Ultrasound can be performed any number of times. The number of examinations is determined by the diagnostic need and the patient’s condition.

Conclusion

Ultrasound examination is an inexpensive and accessible diagnostic method. It is non-invasive and has no contraindications. Ultrasound can be used any number of times during illness. The doctor also uses this method to monitor changes in the patient’s condition over several months or years.

If necessary, the study is repeated even several times a day. But improper preparation, obesity or post-operative scars reduce the reliability.

Like most ultrasound examinations, gallbladder ultrasound is performed on an empty stomach. This research method is a non-invasive diagnostic method and allows you to obtain comprehensive information about the condition of the gallbladder and its ducts. Very often, an ultrasound of the gallbladder is performed in conjunction with an ultrasound of the liver or other abdominal organs. This procedure is prescribed by a gastroenterologist, and like other procedures for examining the internal organs of the abdominal cavity, ultrasound of the gallbladder is absolutely painless and safe for the patient’s body.

Preparing for an ultrasound of the gallbladder

To properly prepare, you must follow the instructions below. And it is IMPORTANT to remember that ultrasound of the gallbladder is performed strictly on an empty stomach. Only in this case is it filled with bile and slightly enlarged in size, otherwise it may be smaller in size, which will make it difficult for a gastroenterologist to diagnose.

Sign up for an ultrasound of the gallbladder

Who is prescribed an ultrasound of the gallbladder? Symptoms for undergoing an ultrasound of the gallbladder?

Regardless of the symptoms, you first need to see a doctor, and only after an initial examination, a gastroenterologist will, if necessary, prescribe an ultrasound of the gallbladder if he recognizes the following symptoms or diseases:

How is an ultrasound of the gallbladder done?

Almost the entire time of the examination using ultrasound of the gallbladder, the patient is in a supine position; at the doctor’s request, he can roll over to one side. The examination takes place in the area where the gallbladder is located and allows you to localize the size of the organ, its shape and size, the presence of stones or other neoplasms, as well as the amount of accumulated bile. The procedure lasts 15-20 minutes, and allows you to exclude diseases such as dropsy, cholecystitis, cholelithiasis, dyskinesia of the gallbladder and tract. The procedure itself does not cause any pain or other discomfort in the patient.

Cost of ultrasound of the gallbladder

Where to get an ultrasound of the gallbladder in Moscow?

At the DoctorStolet multidisciplinary medical center, you can always undergo an examination - ultrasound of the gallbladder. Our medical center is located between the Konkovo ​​and Belyaevo metro stations. The journey from each of them will take no more than 10 minutes. Here you will find highly qualified personnel and the most modern diagnostic equipment. Our clients will be pleasantly surprised by our quite affordable prices.

Ultrasound examination of the gallbladder is a completely safe, simple and non-invasive method for diagnosing the condition of this organ. Preparation for the examination rests with the patient and comes down to following a few simple recommendations related to nutrition. The more effectively a person prepares for this procedure, the better the image on the ultrasound machine and its interpretation by the doctor will be.

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Preparing for the study

An ultrasound of the gallbladder is most often performed in conjunction with an examination of the liver and spleen, so the preparation for these two procedures will be the same. If the patient’s condition is not emergency, then a special diet must be followed. Three days before the examinationIt is necessary to exclude the consumption of fatty foods, fried foods and alcohol. Such foods put a lot of stress on the gallbladder and can distort the results.

Ultrasound is a high-quality visualization method, but if there is gas in the intestines, it is impossible to remove the organ using a sensor, so for 2-3 days food that increases gas formation is eliminated. This includes all fermented milk products (cheese, milk, kefir and others), baked goods made from yeast dough, grain bread, raw fruits and vegetables, as well as legumes. You should also avoid carbonated drinks, be it sweet soda or mineral water. It is not recommended to drink coffee and tea the day before the test.

The following products are allowed for consumption:

• cottage cheese with a fat content of less than 5%;
• steamed fish or fish soup (low-fat);
• dairy-free cereals;
• steamed chicken or beef (can be boiled);
• scrambled eggs.

It is recommended to drink water one hour before meals and two hours after them. If bloating occurs, it is necessary to take Espumisan or Motilium twice a day for 2-3 days before the examination. If the patient has a disease of the pancreas, then during food preparation for ultrasound it is necessary to take enzyme preparations - Creon or Ermital in a dosage of 25,000 units for each meal. Mezim or Pancreatin are not suitable in this case, since their activity is significantly lower and they are not able to adequately compensate for the function of the pancreas.

The evening before your scheduled ultrasound, you should have dinner no later than four hours before bedtime. You should not have breakfast in the morning before the ultrasound. A light breakfast is possible if the gallbladder examination is scheduled for the afternoon. Three hours before the study, you should not even drink water - any nutritional load leads to the emptying of a full gallbladder and makes it difficult to conduct the study.

It is forbidden to smoke or chew gum on the eve of the study, since the components of cigarettes and chewing gum have a bile-stimulating effect.

Features of ultrasound examination of the gallbladder

When examining the gallbladder using ultrasound, three procedure options are possible:

• simple ultrasound of the biliary system;
• Ultrasound of the gallbladder with determination of function;
• Ultrasound of the bile ducts after cholecystectomy - removal of the gallbladder.



Simple ultrasound

The patient lies on the couch on his back, with his legs slightly bent at the knee and hip joints to relax the anterior abdominal wall. The doctor applies a special gel that conducts the ultrasound wave and places an external sensor on top of it perpendicular to the front wall of the abdomen and begins the examination. Due to the gel, all air, which is a strong interference for the ultrasound wave, is eliminated between the skin and the attachment with the sensor.



Sensor for ultrasound of the abdominal organs. It is located perpendicular to the midline of the abdomen in the area of ​​the right hypochondrium

Due to individual characteristics, in some people the gallbladder is better visualized when lying on the left side. If the organ is covered by the ascending or transverse colon, the doctor will ask you to breathe deeply and will examine the gallbladder at the moment of inhalation. If formations are detected in the cavity of the gallbladder, the doctor needs to determine their mobility: to do this, he asks the patient to stand up and bend down 2-3 times - the mobile formation will shift.



Ultrasound of the gallbladder with determination of function

Before such examinations, doctors often tell patients: “Bring a choleretic breakfast with you to the ultrasound,” but they do not always explain which one.

First, the doctor examines the patient using a simple ultrasound on an empty stomach, and then the patient needs to take a breakfast of his choice: two chicken yolks, one banana or 250 g of low-fat cottage cheese. In a hospital setting, patients are usually offered an aqueous solution of sorbitol. Repeated ultrasound is performed after 5, 10 and 15 minutes. This study design makes it possible to assess the quality of contractions of the gallbladder and the processes of bile secretion into the lumen of the duodenum.

Ultrasound of the bile ducts with removed gallbladder

In the absence of a gallbladder, the examination is always carried out to determine the function. The bile duct (choledochus) replaces the gallbladder and must adequately deliver bile into the intestinal lumen. It is this function that is checked by ultrasound. After the load, the common bile duct is viewed with an ultrasonic sensor after 30 minutes and after 1 hour.

Interpretation of research results

Carrying out the procedure, the doctor records in the apparatus all the dimensions of the organ and the features of its functioning, and then deciphers it. After the examination is completed, the patient gets dressed, and the doctor at this time fills out an ultrasound examination protocol form and attaches an image of the organ to it. The ultrasound diagnostic doctor enters information on the form about the position of the organ in the abdominal cavity and its mobility, the shape and size of the organ, the thickness of its walls and the diameter of the ducts.

If the procedure included the stage of determining the function of the gallbladder, then all these parameters are recorded over time. If, during an ultrasound, the doctor finds any formations, stones or polyps in the gallbladder or near it, he will definitely record these findings in the image.

A normal gallbladder looks like a pear or has a simple oval shape; with pathology, its shape can be sharply deformed. The bubble is clearly contoured and protrudes from the lower edge of the liver by no more than 1.5 cm.



Ultrasound version of a normal human gallbladder

Dimensions of a healthy gallbladder compared to cholecystitis:

Thus, thanks to ultrasound, it is possible to detect changes in the size and shape of the organ, thickening of its walls, changes in the functional state of the biliary system and various pathological conditions. The latter include:

• acute and chronic cholecystitis;
• inflection of the neck of the gallbladder;
• dyskinesia of the biliary tract of the hypomotor and hypermotor type;
• internal septa (septa) in the organ cavity;
• cholelithiasis - in the presence of stones;
• biliary sludge is a condition that predisposes to the appearance of stones;
• gallbladder polyps;
• organ tumors - their diameter is usually more than 1 cm, they often deform the bladder cavity.

Polyps and tumors require constant ultrasound monitoring - at least once every six months. This is necessary to record the growth of these formations and make a decision on further treatment tactics.



Cholelithiasis. Gallstone on ultrasound

In addition to pathologies, ultrasound can detect congenital developmental anomalies, such as:

• ectopia of an organ - localization different from the norm;
• agenesis - the gallbladder has not developed at the time of formation of the body during pregnancy;
• organ doubling;
• diverticular structure of the organ - the gallbladder has many protrusions.

Who is indicated for ultrasound of the biliary system?

Ultrasound examination is absolutely safe and is performed on all categories of citizens: children and adults, men and women. The examination is prescribed by a therapist or gastroenterologist, and in paid clinics specialists perform ultrasound examinations upon the patient’s own request. The only contraindication to ultrasound of the gallbladder is extensive damage to the anterior abdominal wall in the acute stage, when contact of the sensor with the surface of the abdomen is impossible.

The doctor prescribes an ultrasound for the following symptoms:

• discomfort or pain in the right hypochondrium;
• a feeling of bitterness in the mouth;
• heaviness in the stomach;
• bloating or diarrhea;
• alcohol abuse;
• eating disorders with frequent intake of fatty and fried foods;
• history of viral hepatitis;
• jaundice - a change in the color of the skin towards different shades of yellow;
• suspicion of stones;
• changes in the biochemical blood test - increased ALT, AST, alkaline phosphatase, gamma GTP, total bilirubin.

An ultrasound examination of the biliary system may be required in the presence of other diseases, but the decision to prescribe an examination must be made by the attending physician.

Ultrasound examination (ultrasound) is an informative, non-invasive, practically safe examination of human internal organs.

The main obstacle to performing an ultrasound is the presence of air. Therefore, the main task of preparing for an ultrasound examination is to remove all excess air from the intestines. Preparation for ultrasound is especially important for obese people, since fat is the second most important obstacle to ultrasound.

Preparation:

Diet:

For 2–3 days do not consume brown bread, milk, carbonated water and drinks, vegetables, fruits, juices, confectionery, and alcohol.

In the absence of contraindications, you can also take any enterosorbent (polysorb, polyphepan, “white coal”, enterosgel) in a standard dosage; it is also advisable to do a cleansing enema 1.5–2 hours before the test.

The study is carried out strictly on an empty stomach (at least 6, and preferably 12 hours after eating). For example, the pancreas in a living person is located behind the stomach, and when the stomach is full, it is practically invisible on ultrasound.

Ultrasound examination of the abdominal organs.

Ultrasound can be used to examine parenchymal organs, as well as hollow organs filled with fluid. In the abdominal cavity these include liver, gall bladder, pancreas and spleen, bile ducts. Kidneys anatomically located in the retroperitoneal space, but usually they are examined together with the above-mentioned abdominal organs.

The intestines and stomach are hollow organs in which air is almost always present, so it is extremely difficult to examine them. And although very good preparation of the patient for ultrasound allows partially examine the walls of the stomach and colon; these techniques are extremely complex, time-consuming and painful for patients (the colon is first completely emptied using siphon enemas and then filled with liquid). Therefore, to examine the intestines, a simpler and more informative method is used - colonoscopy.

Ultrasound is performed with the patient lying on his back. Sometimes, to get a better picture, the doctor asks the patient to turn on his right or left side, take a deep breath, and hold his breath. Some patients with individual characteristics (for example, with a high position of the spleen) have to be examined while sitting or even standing.

During ultrasound, they evaluate dimensions liver, its position, shape, ability to transmit ultrasonic waves, structure, condition of blood vessels and bile ducts, presence of foreign inclusions(for example, stones), shape, condition of the walls, size of the gallbladder, its position, the condition of the bile, the presence of foreign inclusions, structure, shape, position, ability to transmit ultrasonic waves, the condition of the pancreatic duct are studied condition of the biliary tract (with measurement of their lumen), portal, inferior vena cava and splenic veins. The same scheme is used to evaluate pancreas, spleen, kidney. At the end of the study, the general condition of the upper abdominal cavity is assessed.

Based on the results of the ultrasound, the doctor writes a research protocol with a conclusion.

Important note. We have all seen photographs of internal organs obtained using an ultrasound machine - an echogram. They are not the subject of study and are not commented on. and serve only as an additional, optional appendix to the ultrasound examination protocol.