Diagnosis of cholestasis | Symptoms of cholestasis | Cholestasis Gallstones

Diagnosis of Cholestasis

Clinical diagnosis can be attainted through signs and symptoms of cholestasis. For further diagnosis special investigations can be of help.

Blood examination

  • Leucocytosis (increased WBC count) is present in 85% of cases with high poly-morph-nuclear count.
  • There may be elevation of serum bilirubin and serum amylase (in 1/3rd of the cases). Serum amylase may be as high as 1000 Somogyi units in acute cases.

X-ray investigation

  • Straight X-ray of the abdomen in supine and in erect posture and an upright chest X-ray study are essential.
  • Only 15% of gallstones are radio-opaque. Upright chest X-ray is performed to exclude other conditions of acute abdomen.
  • Straight X-ray may indicate gallbladder-intestinal fistula.

Cholecystography

  • There is no place for oral cholecystography. Intravenous cholangiography may be performed, but it is gradually taken over by cholescintigraphy and ultrasonography.

Cholescintigraphy

  1. This is performed with a derivative of 99mTechnetium-iminodiacetic acid (technetium-IDA scan).
  2. This is the only specific test for cholestasis and acute cholecystitis.
  3. After intravenous injection with contrast material is excreted by the liver and extra-hepatic biliary system including the gallbladder.
  4. In acute cholestasis and acute cholecystitis the gallbladder is not seen in the scan as the gallbladder outlet or the cystic duct is obstructed.
  5. This test is positive in almost all patients who are actually suffering from acute cholecystitis.
  6. Obstruction of the hepatic duct or the common bile duct problems is also detectable by this scan but these are more clearly visualized by PTC or ERCP.

Ultrasonography

  • This can detect calculi within the gallbladder as also right upper quadrant mass and enlargement of the bile duct due to obstruction and pancreas enlargement.

Percutaneous transhepatic cholangiography (PTC)

  • This investigation shows intra and or extra-hepatic and gallbladder obstruction due to various causes. This should be done in the operation theater, keeping everything ready for surgery, if be needed.
  • PTC has largely been replaced by ERCP which has lower complication rate and a greater therapeutic potential.

Endoscopic Retrograde Cholangio-pancreatography (ERCP)

  • This is carried out through cannulated fiber-optic duodenoscope. Main indications are jaundice due to obstruction, bile tract problems and pancreatic diseases.