Oral cholecystography

Premitive method of radiographic technique for billiary tract

1. ORAL CHOLECYSTOGRAPHY Moderator: - Dr. Mukesh Kr. Gupta (Head of Department and Associate Professor) Department of Radiodiagnosis and Imaging,BPKIHS,Dharan Presenter: - Saru Gosain Roll n0: - 112 Batch: - 2017

2. An oral cholecystography is a radiological investigation of gallbladder by the oral administration of contrast media. It was first described by Graham et al. in 1925 using sodium tetraiodophenolphthalein . Oral cholecystography is now largely suppressed by ultrasound and MRCP due to its low success rate and raised serum bilirubin during the procedure. INTRODUCTION

3. Investigation of non-acute gallbladder pathology; gallstone, adenomyomatosis , polyps, tumors, gallstones To visualize pathologies in the cystic duct and common bile duct. T o define anatomic variations As a part of preparation of non-surgical gallstone treatments INDICATIONS

4. Pre-severe hepatorenal disease Acute cholecystitis Iodine sensitivity Pregnancy Dehydration Intravenous cholangiography within the previous week Previous cholecystectomy Pyloric obstruction CONTRAINDICATIONS

5. CONTRAST MEDIA Sodium ipodate ( Biloptin ); 6 capsules each containing 500 mg. Iopanoic acid ( Telepaque ); 6 capsules each containing 500 mg

6. A laxative 2 days prior to the examination Light, fat-free diet on the day before the examination. No food from 18:00 h on the day before the examination until after the examination has been completed. The cholecystographic agent is taken with water after the last meal prior to the patient’s appointment. PATIENT PREPARATION

7. Preliminary film: - Prone 20° LAO, centered 7.5 cm to the right of the spinous processes, 2.5 cm cephalad to the lower costal margin. Contrast media; 3gm orally before 14 hr and another 3 gm before 3-4 hr of radiographic examination. FILMS Prone 20° LAO as in preliminary film- to see the fundus of the gallbladder Supine 20° RPO, centering 7.5cm to the right of L3 and 4.5cm cephalad- to see the neck and Hartmann’s pouch Erect 20° LAO, centering 5cm below the centering point of prone LAO- may demonstrate floating gallstones Prone 20° LAO, 30 min after a fatty meal- occasionally helpful in diagnosing small stones. -essential for the cholecystographic diagnosis of adenomyomatosis and cholesterolosis - to visualize cystic duct/CHD?CBD in greater details TECHNIQUE

8. Biloptin - 12 capsules at the usual time or - 6 capsules 10-12 h before the examination plus another 6 capsules 3 hr before Telepaque - 3-6 tablets are taken 4 h after a fatty lunch on the day preceding the examination, and then a full dose of 6 tablets after a fat-free meal in the evening. ADDITIONAL TECHNIQUES For better visualization

9. Mild gastrointestinal disturbances: Nausea, vomiting, diarrhea, abdominal pain Skin reactions: urticaria , vasodilatation and pruritus Minor elevation of serum creatinine Alteration of serum urate level Elevated protein bound iodine for 3 months Rarely thyrotoxicosis COMPLICATIONS