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Introduction ⬇

A hepatobiliary ultrasound is an imaging test of the GB, liver, and biliary tree. These images are helpful in differentiating hepatic disease from biliary obstruction. Unlike the oral cholecystogram, this procedure allows visualization of the GB and ducts in patients with impaired liver function, and stones and evidence of cholecystitis are readily visualized. This procedure is indicated as an initial study for patients with right upper quadrant pain. It is also useful as a guide for biopsy or other interventional procedures. Posttransplantation color Doppler sonography of the reconstructed vessels is an important diagnostic tool.

Procedure ⬆ ⬇

  1. Ask the patient to lie still on an examination table. Scans usually are performed with the patient in the supine and decubitus positions.

  2. Cover the skin with a layer of couplant (ultrasound gel).

  3. Ask the patient to regulate breathing patterns as instructed during the examination.

  4. Tell the patient that total examination time is about 10–30 minutes.

  5. See Chapter 1 guidelines for intratest care.

Procedural Alert

  1. Scans cannot be done over open wounds or through dressings.

  2. This examination must be performed before x-ray studies involving barium. If such scheduling is not possible, at least 24 hours must elapse between the barium procedure and the sonogram.

  3. The GB’s ability to contract may be tested by administering a fatty substance and rescanning.

Clinical Implications ⬆ ⬇

  1. GB abnormal patterns reveal:

    1. Size variations

    2. Thickened wall, indicative of cholecystitis, adenomyomatosis, or tumor and commonly seen as a manifestation of cholecystopathy in patients with AIDS

    3. Benign and malignant lesions such as polyps

    4. Gallstones

  2. Bile duct abnormalities reveal:

    1. Dilation of ducts

    2. Duct obstruction by calculi, tumor, or parasites

    3. Congenital abnormalities such as choledochal cysts

  3. Adjacent liver pathologies may include:

    1. Parenchymal disease such as cirrhosis

    2. Masses, including cysts, solid lesions, and metastatic tumors

  4. If combined with Doppler evaluation, portal hypertension and hepatofugal (portal blood flow away from the liver) flow can be detected. Posttransplantation stenoses or flow variances can be monitored.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose, benefits, and procedure of the test.

  2. Ensure that a signed consent is in the patient’s medical record if an invasive procedure is to take place.

  3. Instruct the patient to remain NPO at least 8 hours before the examination to fully dilate the GB and to improve anatomic visualization. Some laboratories prefer that the last meal before the study contain low quantities of fat.

  4. Assure the patient that there is no pain involved. However, the patient may feel uncomfortable lying still for a long period.

  5. Explain that a liberal coating of coupling agent must be applied to the skin so that there is no air between the skin and the transducer and to allow for easy movement of the transducer over the skin. A sensation of warmth or wetness may be felt. The couplant (ultrasound gel) does not stain or discolor clothing, but the patient may prefer to don a gown.

  6. Explain that the patient will be instructed to control breathing patterns while the images are being made.

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

Posttest Patient Care

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

  2. Counsel the patient appropriately about further testing (biopsy).

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

Clinical Alert

Results of ultrasounds alone cannot differentiate cancers from benign processes

Interfering Factors ⬆ ⬇

  1. Intestinal gas overlying the area of interest interferes with sonographic visualization.

  2. Barium from recent x-ray studies compromises the study.

  3. Obesity adversely affects tissue visualization.

Reference Values ⬆

Normal