gallbladder and bile duct B-ultrasound

B-ultrasound examination of the gallbladder biliary tract is to use the B-ultrasound to examine the gallbladder biliary tract of the patient. It is often used to diagnose the gallbladder and biliary tract diseases. It can also be used for acute cholecystitis without abdominal surgery under the guidance of B-ultrasound. General gallbladder examination should be performed two days after X-ray gastrointestinal angiography and two days after biliary angiography. Basic Information Specialist classification: Digestive examination classification: ultrasound Applicable gender: whether men and women apply fasting: fasting Tips: Patients should be fasted for more than 8 hours and checked on an empty stomach in the morning. Normal value [normal gallbladder and reference value] 1. The longitudinal section of the gallbladder is mostly pear-shaped or long-shaped, with an elliptical cross section. The wall of the gallbladder is smooth, and the bile in the gallbladder is echo-free and sound-permeable. 2. The longitudinal axis of the gallbladder points to the hepatic hilum, and the neck is located deeper, adjacent to the right branch of the portal vein. The anterior wall of the body is attached to the gallbladder bed of the liver, and the bed is free from the lower anterior wall of the liver. 3. Ultrasound measurement (1) The long diameter of the normal gallbladder is generally not more than 8.5cm, and the anteroposterior diameter is not more than 3.5cm; the anteroposterior diameter is more valuable for reflecting the gallbladder tension. (2) The thickness of the normal gallbladder wall does not exceed 2.5 mm in the fasting state. The probe must be perpendicular to the gallbladder wall during measurement, otherwise the illusion of thickening of the gallbladder wall may occur. [normal biliary tract and reference value] 1. Intrahepatic bile duct, the left and the hepatic duct are in front of the left and right branches of the portal vein, and the inner diameter is below 2 mm; it is difficult to clearly show the ultrasound of the secondary intrahepatic bile duct. 2. Extrahepatic bile duct, the extrahepatic bile duct on the sonogram is roughly divided into upper and lower segments; the upper segment is closely attached to the ventral side of the portal vein, accompanied by the lower segment and the inferior vena cava, the front is the gastroduodenum, the lower bile duct Extends to the outside of the back of the pancreas. The lower bile duct is difficult to clearly display due to the interference of gastrointestinal gas. In normal people, the inner diameter of the upper segment of the extrahepatic bile duct does not exceed 5.0 mm, and the inner diameter of the lower segment does not exceed 8 mm. Clinical significance Check the content: 1. The shape, size, thickness of the gallbladder and whether it is smooth. 2. There are no gall bladder, stones, bulging lesions or tumors in the gallbladder. 3. Suspected cholecystitis or gallbladder neck obstruction, the fat meal test to observe the gallbladder contractile function. 4. Intrahepatic and extrahepatic bile duct diameter; bile duct expansion, extent, extent, and location. 5. The bile duct has stones, tumors, local wall thickening or cystic dilatation. Abnormal results: 1. Thickening of the gallbladder wall is a double layer, acute cholecystitis, cirrhosis with hypoproteinemia and ascites, acute severe hepatitis can occur. 2. The initial ultrasonography of simple cholecystitis is not typical. The gallbladder is slightly enlarged and the wall of the capsule is slightly thickened. 3. In suppurative cholangitis with cholecystitis, the gallbladder is not large, only the wall of the capsule is thickened, blurred, and there are sediments inside. The hypoechoic zone of the liver tissue outside the gallbladder may be an inflammatory exudation of severe cholecystitis. 4. Gallbladder stones are easily misdiagnosed in the following (1) Inflammatory deposits in the gallbladder or old concentrated bile are easily misdiagnosed as sediment-like stones. (2) When the stone is not large or incarcerated in the neck of the gallbladder, it is easy to miss the diagnosis. (3) Extrahepatic bile duct stones located near the hepatic hilum are mistaken for gallstones. (4) gallbladder neck tube stones, adhesion scar tissue, cancer, gallbladder neck lymph node calcification, etc. are easily misdiagnosed as bile duct stones. (5) Hepatic bile duct gas accumulation and posterior multiple reflexes are easily misdiagnosed as calculus, and attention should be paid to identification. (6) Cancer at the end of the common bile duct, corpus callosum and sticky bile, purulent bile, bile duct papillary ulcer inflammation, etc. also have similar ultrasound findings with the same stone. 5. Gallbladder gas gangrene, gallbladder increased, the wall of the capsule was significantly thickened, the capsule contained gas, and the rear was unclear. 6. Or after gastrectomy, common gallbladder enlargement with sediment echo, but the wall does not thicken without tenderness, which is helpful for identification. 7. Mild chronic cholecystitis is not specific, and chronic gallbladder gallbladder atrophy is often unclear. Ultrasound diagnosis is difficult. 8. Cholecystitis proliferative type needs to be differentiated from thick-walled type of gallbladder carcinoma and gallbladder gland-like hyperplasia. 9. The gallbladder outline of the stone is not clear, only the curved high echo of the anterior wall of the gallbladder, with wide and wide sound shadow, can not see the contour of the stone, showing a typical "WES" sign. (wallechoshadow, the shadow of the wall echo) Ultrasound examination is easily misdiagnosed as "WES" with the following conditions: (1) The sonogram of calcium bile or calcified gallbladder is shown as a high echo zone, followed by clear sound and shadow, the lumen of the gallbladder can not be displayed, and the identification is difficult. (2) The gallbladder is too small or congenitally absent. The gastro-intestinal tract near the hepatic hilum is easily misdiagnosed as gallbladder filled with stones. (3) Scar tissue or gallbladder fossil fibrosis after cholecystectomy should be diagnosed in combination with medical history. 10. The incidence of cystic stones combined with gallbladder cancer is high. More stones and high echoes and sound shadows cover the tumor are the main reasons for missed diagnosis. Solid block gallbladder cancer is sometimes indistinguishable from liver cancer. (1) protruding into the gallbladder cavity, the tumor seems to be close to the right branch of the portal vein; (2) There is a strong echo in the stone; (3) From the gallbladder artery, gallbladder cancer should be highly indicated. 11. The degree of intrahepatic bile duct dilatation can not be used as a basis for the identification of benign and malignant obstruction. 12. Extrahepatic bile duct dilatation is a sensitive indicator of ultrasound for obstructive jaundice. The expansion of the bile duct precedes the clinical jaundice. 13. Judgment level of obstruction: (1) Total tube expansion is a reliable basis for lower end obstruction. (2) The external bile duct is normal or not displayed, and the intrahepatic bile duct or the left and right hepatic ducts only expand on one side to indicate the obstruction of the upper hepatic hilum. (3) In most cases, the tension state of the gallbladder and the common bile duct is consistent, that is, the enlargement of the gallbladder suggests that the lower segment is obstructed, and the gallbladder does not conform to the upper obstruction. (4) Sometimes the gallbladder and the common bile duct are in a state of tension, suggesting that the gallbladder neck is obstructed or the gallbladder itself has lesions. Whether the gallbladder is enlarged or not cannot be used as a marker for judging the level of obstruction. Need to check the crowd: diagnose the gallbladder and biliary system diseases. Or abdominal pain, suspected of having a biliary tract. Precautions Taboo before inspection: (1) The patient must be fasted for more than 8 hours, and an early fasting examination is more appropriate. (2) Drinking water 300-500ml if necessary is beneficial to the extrahepatic bile duct display. (3) Gastrointestinal tract gas interference is obvious, can be checked after enema and bowel movement. (4) Emergency patients are not subject to the above conditions. Note when checking: General gallbladder examination should be performed two days after X-ray gastrointestinal angiography and two days after biliary angiography. Inspection process Instrument conditions: Real-time ultrasonic diagnostic equipment can be used for biliary system examination. The adjustment of the instrument is similar to the liver examination. The principle of clear display of the biliary structure of the observation site is as follows. The probe selects convex array, linear array, fan sweep probe, convex array. The probe effect is better, the probe frequency is generally 3 to 5 MHz, and the child can choose 5 to 7 MHz. When observing the gallbladder blood flow signal, it is necessary to adjust the focus area, color display range, sensitivity, filtering frequency, etc. at any time, and try to eliminate artifacts. Scanning method: (1) The liver is used to display the filling of the gallbladder and the extrahepatic bile duct. In the deep inhalation of the patient, the pressure of the probe can be used to increase the bile duct display rate. (2) The longitudinal section of the right superior rectus abdominis is longitudinally cut, and the probe is slightly tilted to the left to show the longitudinal axis of the gallbladder. (3) After the patient inhales deeply after inhalation, the probe scans from the lower edge of the costal margin to the oblique section of the diaphragm, showing that the gallbladder is located in front of the right kidney, and moving to the left is visible. The neck of the gallbladder and the section of the extrahepatic bile duct are located in the cross section of the inferior vena cava. The anterior lateral side, and the left and right branches of the portal vein and the left and right hepatic bile ducts accompanying the ventral side are visible. (4) The patient took the right anterior oblique position 45°, and the probe placed the right upper flank of the right lower rib. The lower part of the lower longitudinal section was scanned to the right lateral side to show the extrahepatic bile duct. (5) The chest and knee position may remove the intestinal gas accumulated around the biliary tract, and more clearly show the gallbladder neck and extrahepatic bile duct lesions. Not suitable for the crowd Generally no taboos. Adverse reactions and risks Generally not.