Non-invasive imaging methods
These studies are aimed at examining organ structures without physically penetrating the internal environments of the body.
- Ultrasound examination (ultrasound). It serves as the primary routine tool. The method allows for detailing the anatomy, detecting signs of bile stasis (cholestasis), splenomegaly, and free fluid accumulation in the abdomen (ascites). Ultrasound is also used for puncture navigation.
- Computed tomography (CT). Provides an in-depth assessment of anatomy, including a detailed examination of the vascular bed and ducts. CT is specific for finding stones, abscesses, cysts, and neoplasms (adenomas, hemangiomas). For an advanced analysis of vascular pathology, tomography is supplemented with angiography.
- Scintigraphy (radionuclide method). Used to search for focal lesions (metastases, tumors) and diffuse pathologies, which is especially important in the late stages of cirrhosis.
Radiopaque and endoscopic studies
X-ray contrast methods are indispensable for visualizing ducts and vessels.
- Esophageal radiography. Contrast enhancement helps detect varices, which serves as a crucial indirect sign of portal hypertension (high portal vein pressure).
- Transhepatic percutaneous cholangiography. Administration of a contrast agent using a needle through the skin and liver parenchyma directly into the biliary tract.
- Endoscopic retrograde cholangiopancreatography (ERCP). Contrast is administered retrogradely (in an ascending manner) through the ampulla of the major duodenal papilla during endoscopy. The procedure determines the causes of impaired bile outflow (strictures, stones).
Fibroesophagogastroduodenoscopy (FEGDS) is used as the leading method for detecting GI complications. Endoscopy allows the detection of portal gastropathy, assessment of the duodenum, and finding etiological markers of alcoholic damage.
Duodenal intubation
Although the method is used less frequently due to the widespread availability of ultrasound, it remains useful for diagnosing functional disorders and inflammatory processes.
The essence lies in introducing a double-channel tube with a metal olive into the duodenum. The depth of insertion is controlled by special marks. The procedure is performed strictly on an empty stomach in the morning; the patient actively makes swallowing movements.
Stages and analysis: The multi-stage fractional intubation method allows for collecting five portions of substrate from three different levels:
- From the common bile duct.
- From the gallbladder (cystic portion).
- From the intrahepatic ducts.
The obtained aspirate (a mixture of bile, gastric and pancreatic juices, and duodenal secretion) is sent for biochemical and microscopic examination to search for crystals and inflammatory elements, as well as for bacteriological culture. Evaluation of the bile secretion rhythm provides a picture of duct motility.
Invasive diagnostics: Biopsy and Laparoscopy
Invasive procedures are necessary for the final verification of the diagnosis and assessment of pathological foci at the cellular level.
Liver biopsy comes in three types: "blind" percutaneous, ultrasound-guided target biopsy (most common), and during laparoscopy. Indications for tissue sampling:
- Enlarged liver (hepatomegaly) of unclear origin.
- Persistent elevation of liver enzymes (cytolysis and cholestasis syndromes — AST, ALT, GGT).
- Search for viral markers directly in the tissue (hepatitis B, C, D), toxic or drug-induced injuries, storage diseases.
- Examination of relatives in hereditary diseases.
Laparoscopy allows for a visual inspection of the organ surface. This helps distinguish chronic hepatitis from cirrhosis, determine the morphological type of cirrhosis (micronodular, macronodular, mixed), see signs of portal hypertension, and take a biopsy precisely from the affected area.
Briefly: answers to topical questions
What radiopharmaceuticals are used for liver scintigraphy?
For radionuclide imaging (scintigraphy) of the liver, $^{99m}$Tc-sulfur colloid or albumin colloid are usually used.
For hepatobiliary scintigraphy, a technetium-99m ($^{99m}$Tc)-labeled iminodiacetic acid (HIDA) derivative—a bilirubin analog—is used.
What are all the contraindications to duodenal intubation?
A contraindication to duodenal intubation is suspected cholelithiasis (gallstone disease).
The reason is that stimulation of bile secretion during the procedure can trigger stone movement and biliary colic.
To memorize the levels of bile collection during intubation: CBD — Common bile duct, Gallbladder, Intrahepatic ducts.
Class and exam questions
Why is duodenal intubation not performed in gallstone disease?
Stimulation of bile secretion during the procedure can provoke the migration of stones into the ducts. This threatens the development of acute biliary colic.
Why is FEGDS (stomach examination) prescribed for liver diseases?
Endoscopy is necessary to search for dangerous complications of portal hypertension, primarily esophageal varices and portal gastropathy.
What is the advantage of laparoscopy over ultrasound or CT?
Laparoscopy provides a direct visual picture of the macroscopic changes of the organ. It allows for accurately determining the type of cirrhosis and taking a targeted biopsy from a suspicious area.
What else to study on this topic
- Changes in biochemical markers (AST, ALT, GGT)
- Morphological classification of liver cirrhosis
- Technique of multi-stage duodenal intubation
- Differential diagnosis of lesions on CT (hemangiomas, adenomas, cysts)
- Radiological and endoscopic markers of portal hypertension
Master the entire topic in the "Propaedeutics" course
This is a summary. The course covers everything tested in classes and exams.
- Full textbook on "Instrumental Diagnostics of Hepatobiliary System Diseases" and 3,152 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 113 video lessons on the subject
Other topics in the section "Liver, Biliary Tract, and Spleen"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.