First, B-ultrasound examination
It is a non-invasive examination with clear images and high resolution. It is a safe, rapid, simple, economical and accurate examination method, and it is the first choice for biliary diseases. It is suitable for the diagnosis of bile duct stones, tumors and cystic lesions and the differential diagnosis of obstructive jaundice. Due to the influence of intestinal gas accumulation, we should fast 12 hours and drink alcohol for 4 hours before examination to ensure that the gallbladder and bile duct are full of bile and reduce the interference of gastrointestinal contents and gas.
Second, X-ray examination.
1. Cholesterol stones are not developed on abdominal plain film, and gallbladder stones are about 10%- 15% because they contain enough calcium.
2. Oral cholecystography was performed by taking oral iodine compound iodophanic acid as contrast agent and taking a film. Used to check whether there are stones, tumors or polyps in the gallbladder, and to understand the contraction function of the gallbladder after eating fat meals. However, due to many factors, the accuracy is low. At present, it has been gradually replaced by B-ultrasound.
3. Percutaneous transhepatic cholangiography (PTC) and percutaneous transhepatic catheter drainage (PTCD)PTC inject bile contrast agent directly into intrahepatic bile duct through puncture needle, which can clearly display the whole biliary system (including intrahepatic bile duct), understand the location, degree and scope of lesions in bile duct, and help to distinguish jaundice. This method is simple to operate, clear to display, not limited by liver dysfunction or jaundice, and gradually replaces intravenous cholangiography in clinic. However, PTC is an invasive examination method, which may cause complications such as bile leakage, bleeding, pneumothorax and acute cholangitis.
4. Endoscopic retrograde cholangiopancreatography (ERCP): The lesions in duodenum were observed by fiberoptic duodenoscopy, bile duct or pancreatic duct was inserted through the duodenal opening, and then contrast agent was injected through the catheter for retrograde cholangiography, so as to show the biliary and pancreatic system and determine the location and lesion scope of bile duct obstruction inside and outside the liver, which was not affected by liver function. It is suitable for the examination of biliary calculi, intrahepatic and extrahepatic bile duct dilatation and obstructive jaundice. At present, the sphincters of * and 0ddi are also cut through duodenoscope or intubated into bile duct for lithotomy and drainage. But it can induce complications such as acute pancreatitis, cholangitis, digestive tract perforation and heart accident.
5. Website arrangement of hypotonic duodenal barium meal examination.
Use anticholinergic drugs to inhibit duodenal peristalsis, and when it relaxes, perform double contrast examination of gas and barium. Small lesions on duodenal mucosa can be displayed, which is helpful to distinguish cancerous and calculous obstruction at the lower end of bile duct.
Third, duodenal drainage.
Put the catheter into the duodenum, inject magnesium sulfate, relax the sphincter of common bile duct 0ddi, make the gallbladder contract, and collect bile in common bile duct, gallbladder and hepatobiliary duct respectively. Check the color, transparency and concentration of bile, and check whether there are cholesterol crystals, pus cells, abnormal cells, eggs and bacteria under the microscope.
Fourth, CT examination
It can accurately judge the occupying lesions of liver, gallbladder, pancreas and other organs. It is not affected by duodenal gas mask, and it is better than B-ultrasound in displaying the lesions at the lower end of common bile duct. This is a safe and accurate noninvasive diagnosis method.
Five, radionuclide scanning
Intravenous injection of 99m technetium -EHIDA, followed by continuous photography with ya camera, can dynamically observe the pathological changes of biliary system and liver inside and outside the liver, which is helpful for differential diagnosis of jaundice. This method is simple and harmless, and is suitable for patients with jaundice.