Cholecystography

(Gallbladder Series, GB Series, Oral Cholecystography, Oral Cholecystogram, X-rays of the Gallbladder)

Procedure Overview

What is cholecystography?

Cholecystography is an x-ray procedure used to examine the gallbladder when gallstones are suspected. A contrast dye is swallowed prior to the procedure. The contrast dye allows for better visualization of gallstones and other abnormalities of the gallbladder that cannot be seen on a standard x-ray of the abdomen.

X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially-treated plates (similar to camera film) and a "negative" type picture is made (the more solid a structure is, the whiter it appears on the film).

Contrast dye, when swallowed prior to the cholecystogram, causes the gallbladder to appear opaque on a cholecystogram x-ray film. Gallstones will appear as dark spots within the gallbladder or bile ducts. Depending on how well the contrast dye has been absorbed, polyps and tumors may also be visible on the x-ray film.

Due to the development of improved technology, cholecystography is no longer performed routinely. Ultrasound and computed tomography (CT scans) are faster and often more accurate in diagnosing conditions of the gallbladder.

Other related procedures that may be used to diagnose problems of the gallbladder include abdominal x-rays, CT scan of the liver and biliary tract, abdominal ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), and gallbladder nuclear scans. Please see these procedures for additional information.

What are gallstones?

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Gallstones form when bile stored in the gallbladder hardens into stone-like material. Too much cholesterol, bile salts, or bilirubin (bile pigment) can cause gallstones. Slow emptying of the gallbladder can also contribute to the formation of gallstones.

When gallstones are present in the gallbladder itself, it is called cholelithiasis. When gallstones are present in the bile ducts, it is called choledocholithiasis. Gallstones that obstruct bile ducts can lead to severe or life-threatening infection of the bile ducts, pancreas, or liver. Bile ducts can also be obstructed by cancer or trauma.

There are two types of gallstones: cholesterol stones and pigment stones. Eighty percent of gallstones are cholesterol stones. The size of gallstones varies from a grain of salt to golf-ball size. A person can develop a single stone or several stones.

What are the symptoms of gallstones?

At first, most gallstones do not cause symptoms. However, when gallstones become larger, or when they begin obstructing bile ducts, symptoms or "attacks" begin to occur. Attacks of gallstones usually occur after a fatty meal and at night. The following are the most common symptoms of gallstones. However, each individual may experience symptoms differently. Symptoms may include, but are not limited to, the following:

• pain that comes and goes in the abdomen
• nausea and/or vomiting
• fever and/or chills
• jaundice - yellowing of the skin and eyes
• abdominal bloating
• intolerance of fatty foods
• belching or gas, and indigestion

The symptoms of gallstones may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Reasons for the Procedure

Cholecystography may be performed when signs and symptoms of gallbladder disease, such as right upper quadrant abdominal pain, jaundice, and intolerance of fat in the diet are present. These symptoms may indicate the presence of gallstones or other obstructions in the gallbladder and/or bile ducts.

In addition to gallstones and obstruction of the bile ducts, other conditions that may be detected by cholecystography include, but are not limited to, polyps, tumors, inflammation, infection, and nonfunctioning gallbladder.

There may be other reasons for your physician to recommend cholecystography.

Risks of the Procedure

You may want to ask your physician about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of x-rays, so that you can inform your physician. Risks associated with radiation exposure may be related to the cumulative number of x-ray examinations and/or treatments over a long period of time.

If you are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects.

If contrast dye is used, there is a risk for allergic reaction to the dye. Patients who are allergic to or sensitive to medications, contrast dye, iodine, or shellfish should notify their physician.

Patients with kidney failure or other kidney problems should notify their physician. In some cases, the contrast dye can cause kidney failure, especially if the person is taking Glucophage (a diabetic medication).

Patients with liver disease or other liver damage should notify their physician, as impaired liver function decreases the usefulness of the contrast dye.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Certain factors or conditions may interfere with the results of the test. These factors include, but are not limited to, the following:

• inadequate absorption of the contrast dye due to liver disease or damage, vomiting and/or diarrhea after swallowing the dye, intestinal malabsorption, or gallbladder inflammation
• barium within the intestines due to a recent barium x-ray procedure

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• Notify the radiologic technologist if you have ever had a reaction to any contrast dye, or if you are allergic to iodine or seafood.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Your physician will give you instructions regarding fasting prior to the procedure. Generally, you will be instructed to eat a fat-free meal the night before the procedure, then withhold food and liquids after midnight. You may also be instructed to withhold cigarettes and chewing gum as well.
• Notify the radiologic technologist if you are pregnant or suspect you may be pregnant.
• Your physician will give you the contrast dye to swallow the night before the procedure. It is very important that you follow the instructions exactly as given in order to obtain adequate contrast visualization of the gallbladder.
• Notify the radiologic technologist if you have any vomiting or diarrhea after taking the contrast dye, because the procedure may have to be rescheduled if too much contrast dye was lost.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

Cholecystography may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, cholecystography follows this process:

1. You will be asked to remove any clothing or jewelry that may interfere with the exposure of the body area to be examined.
2. If you are asked to remove clothing, you will be given a gown to wear.
3. You may be given an enema prior to the procedure to clear the intestines of gas or feces that may interfere with imaging of the gallbladder.
4. You will be positioned in a manner that carefully places the part of the abdomen that is to be x-rayed between the x-ray machine and a cassette containing the x-ray film. You may be asked to stand erect, to lie flat on a table, or to lie on your side on a table, depending on the x-ray view your physician has requested. You may have x-rays taken from more than one position.
5. Body parts not being imaged may be covered with a lead apron (shield) to avoid exposure to the x-rays.
6. Once you are positioned, the radiologic technologist will ask you to hold still for a few moments while the x-ray exposure is made.
7. It is extremely important to remain completely still while the exposure is made, as any movement may distort the image and even require another x-ray to be done to obtain a clear image of the body part in question.
8. The x-ray beam will be focused on the area to be photographed.
9. The radiologic technologist will step behind a protective window while the image is taken.
10. Several x-rays will be taken while you are in various positions.
11. If testing of the gallbladder’s ability to contract is requested, you will be given some type of fatty intake to stimulate gallbladder contraction. You may be given a fatty meal, or you may be given a fatty synthetic substance either by mouth or by intravenous (IV) injection. Additional x-rays will be taken after you have consumed the fatty intake.

The radiologist will look at the x-ray films before you leave to ensure that the gallbladder was adequately visualized during the procedure. If the x-rays are inadequate, the test may need to be repeated.

After the Procedure

Generally, there is no special type of care following cholecystography. However, your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

Because the contrast dye is excreted from the body through the kidneys, you may feel some slight discomfort with urination for a day or so.