section name header

Introduction ⬇

A cholangiogram, also known as cholangiography, is an x-ray that visualizes the bile ducts by enhancing them with an iodinated contrast agent. Often performed on the patient after they have undergone cholecystectomy, a cholangiogram is used to identify intraductal mass lesions and calculi. A number of approaches may be used to opacify and image the bile ducts:

  1. T-tube cholangiogram: Following cholecystectomy, a self-retaining T-shaped drainage tube may be surgically inserted into the common bile duct. Before removal, patency is verified by injecting iodinated contrast into the T-tube to fill the biliary tree.

  2. Cholangiogram with stone removal: This study combines diagnostic visualization of the bile ducts with therapeutic capture and removal of ductal calculi.

  3. IV cholangiogram: This study allows x-ray visualization of the large hepatic ducts and the common ducts by means of IV injection of a contrast medium. It is rarely performed.

  4. Operative cholangiogram: Cannulation and injection of contrast medium into the exposed cystic duct or common bile duct is performed during surgery.

  5. Percutaneous transhepatic cholangiogram: This procedure involves inserting a thin, 22-gauge needle into the liver and the bile duct for the administration of contrast medium in order to visualize the common bile ducts. The dilated biliary tree can be shown up to the point of obstruction, which is usually in the common duct. This procedure is frequently done for patients with jaundice whose liver cells are unable to transport oral or IV contrast agents properly.

  6. Oral cholecystogram: Rarely used, this x-ray visualization of the gallbladder is performed after oral administration of an opaque medium. This test is often combined with or replaced by gallbladder sonography.

  7. Endoscopic retrograde cholangiopancreatography (ERCP): This endoscopic procedure uses an injection of a contrast agent to evaluate the patency of pancreatic and common bile ducts, the duodenal papilla, and the normalcy of the gallbladder (see Chapter 12). Often, the ERCP is performed therapeutically, involving stone extraction, stent placement, or other treatments.

Procedure ⬆ ⬇

Procedure: T-Tube Cholangiogram

  1. Have the patient lie on the x-ray table as an iodine contrast medium is injected into the T-tube.

  2. Alert the patient that typically no pain or discomfort should be felt; however, some persons may feel pressure during the injection.

  3. Unclamp the T-tube after the procedure and allow it to drain freely unless otherwise ordered. This minimizes prolonged, irritating contact of residual contrast in the bile duct.

  4. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

Abnormal duct and gallbladder images may reveal stenosis, obstruction, or choledocholithiasis (calculi of the common bile duct).

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose and procedure of the test. Assure the patient that the procedure is not painful, but some discomfort or pressure may be felt when the contrast is injected. If the patient has diabetes, special precautions may be necessary.

  2. Instruct the patient to remove street clothing and accessories such as jewelry before the study. Provide a gown for patient use.

  3. Stress the importance of remaining still and following breathing instructions during the procedure.

  4. Refer to iodine test precautions. Assess female patients for pregnancy status. If positive, advise the radiology department.

  5. Omit food and fluid before the examination. Check institutional protocols for specific dietary and fluid restrictions. A laxative may be ordered the evening before the examination.

  6. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Clinical Alert

  1. If the patient has diabetes, assess whether they are taking metformin. Because of an increased risk for acute kidney injury (AKI), this medication regimen must be discontinued the day of and several days after administration of contrast media. Consult the radiology department for specific instructions.

  2. Assess the patient for allergies to all substances, specifically latex, and inform the radiology department of any known or suspected sensitivities before study.

  3. Assess whether the patient is allergic to iodine. If iodine contrast sensitivities are known or suspected, inform the radiology department before study.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Warn the patient that nausea, vomiting, and transient elevated temperature may occur as a reaction to the iodine contrast.

  3. Document observations and notify the healthcare provider if necessary.

  4. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

  1. Persistent fever, especially if associated with chills, may indicate bile duct inflammation.

  2. Monitor for hemorrhage, pneumothorax, or peritonitis after percutaneous transhepatic cholangiography. Unusual pain or tenderness, difficulty breathing, or change in vital signs may signal these complications. If these side effects occur, take immediate action to treat.

Reference Values ⬆

Normal

Patent bile ducts