The Trumpet Medical Advisor

Patricia Naeder, RN, BS.

Pat Naeder

September, 2011 Edition ew3

GALLBLADDER  HEALTH  INFORMATION  PART 2

Gallbladder Tests

Introduction:

When the pain from a gallbladder stone, wedged in one of the ducts in your gallbladder, liver, or pancreas area happens, you will know it.

It causes relentless spasms throughout an elaborate network of nerve branches traveling around your torso. It can be under your right ribs and/or it can “refer” or radiate to the back and even up to the scapula, shoulder blades.

It can feel like a 12” wide vice is all the way around your torso. There is no comfortable position and it is steady until the stone drops back into the gallbladder or, less commonly, if it is small enough, passes through the duct.

These attacks can go on for hours or days. See your Physician, or go to the E.R. The complication is that the gallbladder can rupture causing peritonitis.

In the E.R. they will put warm blankets on you because the warmth may dilate the ducts just that little bit needed. Walking may be more comfortable than lying down at this time, but that’s not usually possible in the E.R.

Blood Tests:

1-   Bilirubin and liver enzyme alkaline phosphatase can be elevated.

2-   AST, Aspartate aminotransferase can be up.

3-   ALT, Alanin aminotransferase can also be up as indicator of inflammation.

These enzymes are mobilized in response to the injury happening

4-   Tumor marker CA 19-9 can be elevated if there is rare cancer starting.

5-   The blood work can be normal even though there may be pathology going on.

Ultrasound of Gallbladder:

1-   Gel is placed on area under right ribs, and a short baton is use to elicit sound waves which bounce off the gall bladder and it’s margins and surrounding area to show any stones, inflammation or thickened bile, called “sludge.” Also any edema around the gall bladder can be seen. Very safe test. No side effects.

2-   The liver & pancreas are visualized and of course the presence of stones.

3-   Cancer mass can be seen in 50% of the cases

MRCP:

Magnetic Resonance Cholangio-Pancreatography is using magnetic resonance imaging to observe the liver, gallbladder, pancreas and the ducts between them. It can see stones and any abnormal mass

Computer Tomography. CT Scan:

1-   Can see the viscosity of the bile fluid to see if there is biliary sludge (condensed bile)

2-   Stones can be seen

3-   Cancer in the GB or bile ducts can be evaluated.

4-   Air in the gallbladder signifies an infection

General X-Ray flat plate of the abdomen-

1-   Will show big gallstones. It can also show air in gallbladder signifying infection, (cholecystitis)

HIDA Scan:

1-   May be done when there is suspicion of a gallbladder dysfunction, but no stones. It challenges and evaluates the gallbladders physiology.

2-   Radioactive dye, Hydroxy Imino DiaeticAcid (HIDA) is injected into your vein. HIDA is metabolized through the liver into the bile and gallbladder, and the common bile duct, and all of the ducts.

3-   It can be traced & recorded by radio-detective camera.

4-   Every half hour or so a hormone, cholecystokinin (CCK) is injected to cause gallbladder contractions and then images are taken to see how the ejection function of the gallbladder is performing. Ejection Fraction, EF above 50% is normal. 30 to 50% is borderline. Below 30% is abnormal. It takes about 3 hours for this test, with resting in between x-rays.

ERCP:

1-   Endoscopic Retrograde Cholangio-Pancreatography is the insertion of an endoscopic catheter through the mouth, and subsequent  X-ray of the biliary tract.

2-    It is performed when there is suspicion of obstruction of cystic, pancreatic or common bile duct.

3-   The flexible catheter is advanced through the mouth down the esophagus and into the duodenum. A contrast dye is injected to outline the biliary tract.

4-   An X-ray is done to look for abnormalities like blockage, gallstones, inflammation scaring or cancer.

5-   Stones can be removed and stents can be inserted to keep ducts open.

6-   A gallstone can be removed during this procedure.

7-   Biopsy can be taken if cancer is suspected

~ Eating a low fat diet can help prevent stone formation and sludge type bile fluid. Don’t drink or smoke.

In my 3^rd and final installment on gallbladder health in October, I  will talk about treatments, supplements, diets and other things that you can talk to your physician about, to keep your gallbladder, liver and pancreas as healthy as possible.

It’s never too late to be as healthy as you can be!

Good Health to You!

Patricia Naeder, RN, BS

Medical Advisor