Gallbladder and biliary system scanning is a nuclear study performed to assist in diagnosing gallbladder disease and duct obstruction. The radionuclide 99mTc as Tc 99m diisopropyl iminodiacetic acid (DISIDA) is administered IV followed by serial imaging. Biliary and duct concentrations are achieved by the liver excretion of the radionuclide into the bile. Failure of the substance to enter the gallbladder demonstrates duct obstruction, and the organ and ducts will not be visualized. The ejection capabilities of the gallbladder can also be calculated to evaluate gallbladder functional disorders.⁵⁷

Compared with ultrasonography, this study demonstrates a higher sensitivity in providing diagnostic information. It is also preferred for clients with sensitivities to contrast media used in oral cholecystography or IV cholangiography, and it provides information about clients with bilirubinemia, information not obtainable with cholangiography.

• Normal size, shape, and function of the gallbladder with patent cystic and common bile ducts; no inflammation of the gallbladder or obstruction of ducts

• Inability of client to remain still during the procedure
• Absence of food ingestion for longer than 24 hours as in fasting, total parenteral nutrition, or alcoholism
• Bilirubin levels of greater than 30 mg/dL depending on the radionuclide used, because increased bilirubin decreases hepatic uptake

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Indications

• Suspected gallbladder disorders such as inflammation, perforation, or calculi as revealed by decreased or absent radionuclide flow to the gallbladder or into the peritoneal cavity
• Diagnosing acute cholecystitis revealed by nonvisualization in 1 hour after the injection of the radiopharmaceutical
• Diagnosing chronic cholecystitis revealed by a delayed visualization caused by fibrosis, calculi, or viscous bile
• Determining common duct obstruction caused by tumor or cholelithiasis revealed by a dilated duct; nonvisualization of the common bile duct, gallbladder, and duodenum; or visualization of the common bile duct or gallbladder with absence of flow into the duodenum
• Evaluating biliary enteric bypass patency after surgery as revealed by delayed bowel visualization
• Assessing obstructive jaundice when the procedure is performed in conjunction with radiography or ultrasonography

Contraindications

• Pregnancy, unless the benefits of performing the procedure greatly outweigh the risks to the fetus

[Section Outline]

• Indications
• Contraindications

Nursing Care Before the Procedure

Client teaching and physical preparation are the same as for any nuclear scan study (see section under "Brain Scanning").

• Instruct the client to restrict food and fluid for 4 to 6 hours before the study.
• Explain the scanning schedule and that the study takes 1 to 4 hours.
• Inform the client that a fatty meal or medication may be given during the study for special additional tests.
• History should include hepatic and gallbladder conditions and laboratory function tests and signs and symptoms of biliary system abnormalities.

The client is placed on the examining table in a supine position. The client is then requested to remain very still during the imaging, and the radiopharmaceutical is administered IV. Scanning begins immediately, with images taken every 5 minutes for the first 30 minutes and every 10 minutes for the next 30 minutes. Delayed views are taken in 2, 4, and 24 hours if the gallbladder is not visualized to differentiate acute from chronic cholecystitis or to detect the degree of obstruction. Instruct the client to restrict fats during the 24 hours before returning to the department for further scanning. The drug sincalide is given by some departments before the study to promote release of cholecystokinin, which causes the gallbladder to contract and empty. Also, if the organ is not visualized within 1 hour after injection of the radiopharmaceutical, morphine sulfate can be administered to initiate spasms of the sphincter of Oddi, forcing the radionuclide into the gallbladder. Imaging is then performed 20 to 50 minutes after the morphine administration to determine delayed visualization or nonvisualization related to cystic duct patency.⁵⁸

Nursing Care After the Procedure

Care and assessment after the procedure are the same as for any nuclear scan study (see section under "Brain Scanning").

• Resume food and fluids after the study, and monitor for mentation effects of morphine sulfate, if it was administered.