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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


Diagnostic Tests for Liver and Gallbladder Disorders

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Laboratories can carry out a variety of tests that help doctors assess disorders of the liver, gallbladder, and biliary tract. Among the most important are a group of blood tests known as liver function tests. Depending on a patient's suspected problem, a doctor may also order certain imaging tests, such as an ultrasound scan, computed tomography, and magnetic resonance imaging. Also, a doctor may take a sample of liver tissue for examination under a microscope, a procedure called a liver biopsy

Laboratory and Imaging Tests

Breath tests measure the ability of the liver to metabolize a variety of drugs. The drug, which is tagged with a radioactive tracer, may be given orally or intravenously. The amount of radioactivity in the person's breath is a measure of the amount of drug metabolized by the liver.

Ultrasound scanning uses sound waves to provide images of the liver, gallbladder, and biliary tract. The test is better for detecting structural abnormalities, such as tumors, than diffuse abnormalities, such as cirrhosis. It is the least expensive, safest, and most sensitive technique for creating images of the gallbladder and biliary tract.

Using ultrasound, a doctor can readily detect gallstones in the gallbladder. Ultrasound scanning easily distinguishes jaundice caused by bile duct obstruction from jaundice caused by liver cell malfunction. A type of ultrasound scanning, vascular Doppler ultrasound, can be used to show the blood flow in the blood vessels of the liver. A doctor also may use ultrasound scanning as a guide when inserting a needle to obtain a tissue sample for biopsy.

Radionuclide (radioisotope) imaging uses a substance containing a radioactive tracer that is injected into the body and taken up by a particular organ. The radioactivity is detected by a gamma-ray camera attached to a computer that generates an image. Liver scanning is a type of radionuclide imaging that uses radioactive substances taken up by liver cells. Cholescintigraphy, another type of radionuclide imaging, uses radioactive substances excreted by the liver into the biliary tract; it is used to detect acute inflammation of the gallbladder (cholecystitis).

Computed tomography (CT) scanning can provide excellent liver images and is particularly useful in detecting tumors. It can detect diffuse disorders, such as fatty liver, and abnormally dense liver tissue caused by iron overload (hemochromatosis). However, because CT uses x-rays and is expensive, it is not as widely used as ultrasound.

  



Magnetic resonance imaging (MRI) provides excellent images, similar to those obtained with CT. However, it has drawbacks: It is more expensive than CT, takes longer than other imaging methods, and requires lying in a narrow chamber, which makes some people claustrophobic.

Endoscopic retrograde cholangiopancreatography is a test in which an endoscope (a flexible viewing tube) is inserted into the mouth, through the stomach and duodenum, and into the biliary tract. A radiopaque substance is then injected into the ducts of the biliary tract, and x-rays are taken of the biliary tract. This test causes inflammation of the pancreas (pancreatitis) in 3 to 5 percent of the people.

Percutaneous transhepatic cholangiography involves inserting a long needle through the skin and into the liver, then injecting a radiopaque substance into one of the liver's bile ducts. A doctor may use ultrasound for guidance when inserting the needle. The x-rays clearly reveal the biliary tract, particularly a blockage within the liver.

Operative cholangiography uses a radiopaque substance that is visible on x-rays. During an operation, the substance is injected directly into the ducts of the biliary tract. X-rays then reveal clear images of the biliary tract.

Simple x-rays can often reveal a calcified gallstone.

Liver Biopsy

A liver specimen can be obtained during exploratory surgery but is more often obtained by inserting a needle through the skin and into the liver. Before the procedure, the patient receives local anesthesia. Ultrasound or CT scans may be used to locate the abnormal area from which the specimen is taken. In most medical centers, a liver biopsy is performed as an outpatient procedure.

After the specimen is obtained, the person stays in the hospital for 3 to 4 hours because there is a small risk of complications. The liver may be lacerated, and bleeding into the abdomen may occur. Bile may leak into the abdomen, causing inflammation of the abdominal lining (peritonitis). Because bleeding can start up to 15 days later, the person should stay within an hour's drive of the hospital during that period. In about 2 percent of people, these complications cause serious problems, and 1 in 10,000 die from the procedure. Mild pain in the upper right abdomen, sometimes extending to the right shoulder tip, is common after a liver biopsy and is usually relieved by analgesics.

  



In transvenous liver biopsy, a catheter is inserted into a neck vein, threaded through the heart, and placed into one of the hepatic veins that come from the liver. The needle of the catheter is then inserted through the wall of the vein into the liver. This technique is less likely to injure the liver than is a percutaneous liver biopsy, and it can be used even in people who bleed easily.