Ultrasound diagnostics
Zhelchekamenic disease (housing and communal services, golitiasis) is a disease of the hepatobiliary system, accompanied by a violation of lipid metabolism and bilirubin. It is characterized by the formation of bile calculi in the gall bladder, bile ducts. The prevalence of the disease is large, at the age of older than 40, the housing and communal services occur in every fifth woman and every tenth man. Among people over 70 years old, the prevalence of the disease is 33-50%. Gallstones are cholesterol, pigmented and with an admixture of lime. Cholesterol stones are most common, purely pigmented black stones are found in patients with blood hemolysis, mainly in the Holedoch.
The classic ultrasound image of a gallbladder is a dense structure, visualization of only its front surface, and an acoustic shadow across the entire width of the stone. When the body position is changed, the concretion shifts. When visualizing concretions, it must be remembered that they are located in the most sloping places. If the patient came to the study on his own, then the most likely position of the concretions is the bottom area, if delivered on a gurney, any position of the stones is possible, including in Hartmann's pocket. For a thorough search, it is advisable to change the position of the patient's body: the movable stone will move, the fixed stone will remain in place. The reasons for fixation may be pinching in the neck or the formation of local changes in the gallbladder in the area of the concretion. The sizes of bile nodules vary. The smallest concretions that can be visualized on modern diagnostic devices are up to 2-3 mm in size. Large concretions can occupy the entire lumen of the bladder, the latter loses its operability. Large concretions can injure the bladder wall, lead to the formation of pressure sores, and are considered a predisposing factor for the development of gallbladder cancer. Small concretions are the most dangerous, as they can enter the cystic duct, which is about 3 mm in diameter, scratch the wall and lead to duct spasm. With a duct spasm, the development of biliary colic begins. The diagnosis of multiple concretions adjacent to each other and filling the entire lumen of the bladder presents certain difficulties, there is no bile in it. In this case, ultrasound examination shows the front wall of the bladder, behind it the jagged surface of the front row of stones is determined, and distally the acoustic shadow is determined for the entire width of the bladder. It is not possible to determine the size of each of the concretions in such a bubble, it is usually sufficient to specify the size of the largest and smallest concretions. Sometimes it is difficult to visualize very small concretions that are small and located at the bottom, or move in the form of a small path of stones" with shadows, merging with the gas-containing loops of the intestine at the wall of the bladder. Such concretions require attention and careful polypositional examination. Concretions can exit the gallbladder into the common bile duct, which leads to an increase in its diameter. During ultrasound examination, against the background of bile, a concretion of various sizes is visualized in the duct, usually corresponding to the size of the choledochus. Choledoch stones may not obstruct the outflow of bile, they may be ventilated, with a certain turn, lead to a blockage of the lumen, or completely block it, leading to the development of biliary tract hypertension and mechanical jaundice. Concretions in the choledochus can be multiple, adjacent to each other, have a faceted structure and completely block the lumen. The stone may be pinched in the distal part of the choledochus and in the ampoule of the large duodenal nipple, also leading to hypertension of the biliary tract and the development of cholestasis. During ultrasound examination, the concretion in the ampoule or distal part of the choledochus is better visualized on sections of the pancreatic head in the intrapancreatic part of the choledochus. It is positioned as an acoustically dense structure with a shadow that fills the lumen of the expanded choledochus.
