Indications for ultrasound of the gallbladder

Indications for ultrasonography of the gallbladder - this is almost all anomalies of the development of this organ, a specific symptomatic complex, clarification and addition of diagnosis in case of unclear etiology of the disease. Echography has a high efficiency in the study of 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 location and size of the calculus. On ultrasound, stones are seen in the form of dense objects, located most often in the posterior zone of the bladder. Concrements are able to change the location depending on the change in position, the patient's posture. Echography makes it possible to visually identify stones of very small size - no more than 2 mm and even a sludge (sediment), sand. It should be taken into account that the scanning somewhat exaggerates the size of the formations due to its specific signal technology, besides, it does not always determine their structure (composition), and also the quantity. Therefore, ultrasound in such situations is supplemented by other diagnostic measures. Nevertheless, it is LCF (calculosis, cholelithiasis) leading in a number of prescriptions and indications for gallbladder echography. Also, the reason for carrying out an ultrasound examination may be a suspicion of a so-called "off", non-functioning bladder, which is due to overcrowding with stones and the absence of bile (free) in the ducts. Cholesterosis as a hypertrophic disease, adenomyomatosis (proliferation, hyperplasia of the epithelium of the bladder), polypoid atypical form of the bladder along with cholelithiasis are determined with the help of echography and precisely differentiated.

Indications for ultrasonography of the gallbladder include rather rare pathologies, for example, a primary oncology process that occurs as a consequence of chronic LBC, which is not common, mainly in elderly patients. Ultrasound helps diagnose primary cancer with an accuracy of 85-88%, this is a good indicator, since in the old age the clinical picture of oncology is often erased due to a complex of other diseases. Also, ultrasound is able to detect hepatitis of the viral etiology, especially well on the echography shows the size of the bladder, which tend to decrease in the early days of the disease.

Ultrasound as a diagnostic method aimed at differentiating the pathologies of the gallbladder is much more effective than cholecystography, including intravenous. The echogram is absolutely safe, and X-ray methods do not exclude the radiation load on the body. This is especially important in diagnosing diseases of those patients who have a decreased, weak activity of the liver function. Such tests are safe during pregnancy, as well as in the elderly and children.

Indications for ultrasound of the gallbladder include: 

• Symptomatology of inflammation (cholecystitis) - chronic, acute; 
• LCB - cholelithiasis; 
• Jaundice Syndrome; 
• Oncoprocess; 
• Intraluminal abscess (empyema - purulent inflammation); 
• Dropsy; 
• Monitoring, monitoring after cholecystectomy (removal) of the gallbladder.

The echogram evaluates the zonal position, deviations in size, shape, deviations in the thickness and structure of the walls of the bladder, external and internal contours, evacuation ability, presence or absence of concrements and many other parameters of gallbladder functioning. Also, the parameters of the ducts-location, deviations from normal boundaries in diameter, clearance, wall state and the presence of anomalous inclusions are investigated.

The list of indications for ultrasound investigation 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 diagnosis of the gallbladder is considered accurate also because in the normal state it is visualized by the echo signal as an elongated, elongated object of the echo-negative structure with respect to the liver. Normally, the echography of the gallbladder is carried out in conjunction with a liver examination, and only with a threateningly acute form of the LCB, the study is carried out separately. Among the typical diseases diagnosed with the help of ultrasound are the following: 

1. Acute inflammation is cholecystitis. Echographic features are characterized by the fact that scanning shows thickened walls. The bubble echostructure, especially the inner contour, is reduced. In the presence of phlegmon contours are poorly visualized, and the fluid around the contours of the bladder indicates a developing peritonitis. 
2. Inflammation in chronic form. In remission, the dimensions can be normal, echographic parameters of the deviations can be characteristic thickened, excessively dense walls with distinct contours. The shape of the bubble can be changed, curved, the walls are deformed. The diagnosis is confirmed by additional clinical studies, analyzes. 
3. ZHB (gallstone disease). Chololithiasis is a major problem in gallbladder pathologies. Calculus (accumulation of concretions) on the echography is manifested in two ways - direct and indirect signs. An impermeable bile structure (echo negative) and a signal amplification in the lumen is a clear direct sign of calculosis. Also, the movement of stones is characteristic, depending on how the patient's pose changes. At the bottom of the stones move when the patient stands up or stands. An indirect sign of calculosis can be an increase, a deviation from the norm of up to 5 cm, a bubble size in width and more than 10 cm in length. The contours are uneven, fuzzy, the walls are visualized as thickened. 
4. Differentiation of jaundice. Ultrasound most accurately concretizes the etiology of icteric syndrome, as the mechanical form of this disease is characterized by dilated biliary tracts.

Indications for ultrasonography of the gallbladder are any changes in the evacuation and motor function of the gallbladder, obvious symptoms of dyskinesia, a clinic of inflammatory processes, pigmentation abnormalities (jaundice), pancreatitis of any etiology. Timely conduct of ultrasound examination of the gallbladder makes it possible to accurately diagnose the disease, make a plan for therapeutic actions, prescribe treatment - conservative or operative.

[1], [2], [3], [4], [5]