Indications for gallbladder ultrasound

Indications for ultrasound of the gallbladder are almost all anomalies in the development of this organ, a specific symptomatic complex, clarification and addition of diagnostics in case of unclear etiology of the disease. Echography is highly effective in studying general and specific parameters of the gallbladder, but its most important role is the diagnosis of cholelithiasis (cholelithiasis), since cholecystography does not give a clear picture of the localization and size of stones. Ultrasound shows stones as dense objects, located most often in the posterior zone of the bladder. Stones can change their location depending on the change in position, posture of the patient. Echography makes it possible to visually determine stones of a very small size - no more than 2 mm and even sludge (sediment), sand. It should be taken into account that scanning somewhat exaggerates the size of formations due to its specific signal technology, in addition, it does not always determine their structure (composition), as well as quantity. Therefore, ultrasound in such situations is supplemented by other diagnostic measures. Nevertheless, it is cholelithiasis (calculus, cholelithiasis) that is the leader in the series of appointments and indications for gallbladder echography. Also, the reason for conducting an ultrasound examination may be a suspicion of the so-called "switched off", non-functioning bladder, which occurs due to overfilling with stones and the absence of bile (free) in the ducts. Cholesterosis as a hypertrophic disease, adenomyomatosis (proliferation, hyperplasia of the bladder epithelium), polypoid atypical form of the bladder along with gallstone disease are determined using echography and accurately differentiated.

Indications for ultrasound of the gallbladder include quite rare pathologies, such as primary oncological process, arising as a consequence of chronic cholelithiasis, which is not common, mainly in elderly patients. Ultrasound helps to diagnose primary cancer with an accuracy of up to 85-88%, this is a good indicator, since in old age the clinical picture of oncology is often erased due to a complex of other diseases. Ultrasound is also able to clearly identify hepatitis of viral etiology, especially well visible on echography are the sizes of the bladder, which tend to decrease in the first days of the disease.

Ultrasound as a diagnostic method aimed at differentiating gallbladder pathologies is much more effective than cholecystography, including intravenous. Echogram is absolutely safe, and X-ray methods do not exclude radiation exposure to the body. This is especially important in diagnosing diseases in patients with reduced, weak liver function. Such examinations are safe during pregnancy, as well as in the elderly and children.

Indications for ultrasound examination of the gallbladder include:

• Symptoms of inflammation (cholecystitis) – chronic, acute;
• CHL – cholelithiasis;
• Jaundice syndrome;
• Oncoprocess;
• Intraluminal abscess (empyema – purulent inflammation);
• Dropsy;
• Monitoring and control of the condition after cholecystectomy (removal) of the gallbladder.

The echogram evaluates the zonal position, deviations in size, shape, deviations in the thickness and structure of the bladder walls, external and internal contours, evacuation capacity, the presence or absence of stones and many other parameters of the functioning of the gallbladder. The parameters of the ducts are also examined - location, deviations from normal boundaries in diameter, lumen, condition of the walls and the presence of abnormal inclusions.

The list of indications for ultrasound examination has long been formed by specialists and practically does not change, since almost all problems and pathologies of the gallbladder have obvious clinical manifestations. Echographic diagnostics of the gallbladder is considered accurate also because in a normal state it is visualized by an echo signal as an elongated, extended object of an echo-negative structure in relation to the liver. Standardly, echography of the gallbladder is carried out in combination with an examination of the liver, and only in the case of a threatening acute form of cholelithiasis is the study carried out separately. Among the typical diseases diagnosed with the help of echography are the following:

1. Acute inflammation – cholecystitis. Echographic signs are characterized by the fact that scanning shows thickened walls. The echostructure of the bladder, especially the internal contour, is reduced. In the presence of phlegmon, the contours are poorly visualized, and the fluid around the bladder contours indicates developing peritonitis.
2. Chronic inflammation. In remission, the size may be normal, echographic parameters of deviations may include characteristic thickened, excessively dense walls with clear contours. The shape of the bladder may be changed, curved, the walls are deformed. The diagnosis is confirmed by additional clinical studies, tests.
3. Cholelithiasis (gallstone disease). Cholelithiasis is the main problem in gallbladder pathologies. Calculation (accumulation of stones) is manifested in two ways on ultrasound - by direct and indirect signs. Echo-opaque structure of bile (echo-negative) and signal amplification in the lumen are a clear direct sign of calculus. Also characteristic is the movement of stones depending on how the patient changes his position. Stones move to the bottom when the patient gets up or stands. An indirect sign of calculus may be an increase, deviation from the norm up to 5 cm, in the size of the bladder in width and more than 10 cm in length. The contours are uneven, unclear, the walls are visualized as thickened.
4. Differentiation of jaundice. Ultrasound most accurately specifies the etiology of jaundice syndrome, since the mechanical form of this disease is characterized by dilated bile ducts.

Indications for ultrasound examination of the gallbladder are any changes in the evacuation and motor function of the gallbladder, obvious symptoms of dyskinesia, clinical picture of inflammatory processes, pigmentation deviations (jaundice), pancreatitis of any etiology. Timely ultrasound examination of the gallbladder makes it possible to accurately diagnose the disease, draw up a plan of therapeutic actions, prescribe treatment - conservative or surgical.

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