Cholangiography

For x-ray diagnostics of diseases of the biliary tract is applied cholangiography.
Cholangiography is performed by an intravenous injection of special preparations contrast agent. For this purpose, has fully justified itself domestic product bilignost. This iodine-containing drug that, standing out biliary tract, creates their contrasting and good visibility. It is analogue of foreign drugs biligrafin, cholografin etc. and does not cause any significant side effects.
Prior to intravenous injection of bilignost need to check investigated the tolerability of iodine, and to ensure that no reaction to it, you can conduct the study. In 15 minutes after intravenous bilignost on radiographs can observe the emergence of the common bile duct, the gallbladder and biliary ducts. Better visibility of their achieved through 25-30 minutes (Fig. 126). In an hour can already be seen filling contrast content of the gallbladder. By this time, the intensity of the shadow of the bile ducts significantly reduced, and in two hours gives better visibility of the gall bladder, while the ducts become invisible.

Fig. 126. Cholangiography. Stone bile duct.
Fig. 127. Cholangiography. Multiple stones in the gall bladder.

Thus, using intravenous cholangiography is available all there is to see in oral x-ray study, and explore the bile ducts and to have an idea about the functional features of the biliary system. This method is called cholecystocholangiography.
At intravenous cholangiography possible to determine the presence of stones in the bile ducts. These stones, as well as in the gall bladder, form filling defects (Fig. 127). Often the stones stuck in the ducts, clog their clearance. In such cases ducts above any blocked stretched, sometimes reaching large limits. Such extensions are accompanied sometimes by a winding course of the modified duct. Under normal terrain ducts contrast weight flowing freely out into the duodenum. In some cases, to ensure better visibility of the ducts is recommended subcutaneous administration of 0.01 morphine. Then as a result of spasm of the sphincter of Oddi is delayed after contrasting bile into the duodenum, which is the best opportunity to study the condition of the ducts.
If cholecystocholangiography to study the state of the motor function of the gall bladder is also yolk sample according to the same scheme, as is done in the usual x-ray study.
Cholecystangiography can be carried out during surgery of biliary tract, if necessary, the immediate clarification of patency of the bile ducts. In such cases, after opening the abdominal cavity through the gallbladder or the common bile duct by aspiration sucked bile, and then injects contrast (yodolipola, diodon, bilignost). Operating cholangiography is intended to examine the position, shape and permeability of the bile ducts, as well as establish the presence in them of stones. Cholangiography is performed in an operating with the help of x-ray machine, which is located directly at the operating table. When the serial operating cholangiography identifies functional features ducts, which may depend on the selection of appropriate surgical intervention to ensure drainage ducts (B. M. stern, N. A. Postrelmov, 1969, 1970).
When operating cholangiography is sharp contrast images of the bile ducts. In this x-ray procedure is the possibility of detection fistular moves between biliary tract and other organs that may develop as a result of various pathological disorders.
Recently used percutaneous puncture bladder or one of the large ducts with following injection of contrast medium with a high content of iodine (centuries Vinogradov and others, 1969). Most convenient for these purposes is a domestic product 70% cardiotest. Using transcutaneous horeografii, how is this a method of observing the biliary tract, you can examine the state of the intrahepatic bile ducts (Fig. 128).

Fig. 128. Operating cholangiography.
a - percutaneous holografia; b - cholangiography on the operating table. Stone bile duct.

Cholangiography can be carried out and in the postoperative period by injecting a contrast agent through a drainage tube left in the common bile duct. This cholangiography allows the study of post-operative condition duct in the sense of revealing violations of their cross or other postoperative complications.
Thus, the modern radiology has currently the biggest Arsenal of diverse study the state of the biliary system, than are achieved wide possibilities of x-ray diagnostics of functional and morphological changes of the gallbladder and bile ducts.