Liver, Biliary, and Pancreatic Diagnostic Procedures

How is a liver, biliary, or pancreatic disorder diagnosed?

To diagnose you, your healthcare provider will ask about your health history. He or she will also give you a physical exam. You will also need some tests.

You may have one or more of these tests:

• Cholecystography. This is also called oral cholecystography or a gallbladder series. A series of X-rays are taken of the gallbladder after you swallow a special contrast dye. This test can show gallstones, inflammation of the gallbladder (cholecystitis), and other problems. But this test isn’t used often.

• CT scan. This is a test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

• Endoscopic retrograde cholangiopancreatography (ERCP). This is a procedure that helps diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It uses X-rays and a long, flexible, lighted tube (endoscope). The scope is put into your mouth and throat. Then it is guided down into your esophagus, stomach, and the first part of the intestines (duodenum). The provider can examine the inside of these organs and find any problems. A tube is then passed through the scope. The tube is put into the duct that drains the gallbladder and pancreas into the duodenum. A dye is injected to better see those organs on an X-ray.

• Esophagogastroduodenoscopy. This is also called EGD or upper endoscopy. This lets the healthcare provider see the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube (endoscope) is put into the mouth and throat. It is then guided down into the esophagus, stomach, and duodenum. The endoscope allows the healthcare provider to view the inside of this area of the body. If needed, the provider can also put in tiny tools through a scope to remove a tissue sample for biopsy.

• Hepatobiliary scintigraphy. This is a nuclear medicine imaging test. It is used to view the liver, bile ducts, gallbladder, and upper part of the small intestine. This may also be called a HIDA or PIPIDA scan. This depends on which nuclear isotope is used.

• Laparoscopy. This test uses a long, thin tube with a tiny camera and a light on the end (laparoscope). It is put into a small cut (incision) in the belly (abdomen). It can check the contents of the abdomen and remove tissue samples.

• Liver biopsy. Tissue samples from the liver are removed with a needle or during surgery. They are checked under a microscope.

• MRI. This test uses large magnets, radio waves, and a computer. It makes detailed images of organs and structures within the body.

• Magnetic resonance cholangiopancreatography (MRCP). This is a type of MRI. It uses radio waves and magnets to take pictures of the bile ducts and organs.

• Percutaneous transhepatic cholangiography (PTC). A needle is put through the skin and into the liver. A contrast dye is injected through the needle. This lets the bile duct be seen on an X-ray.

• Ultrasound. This is also called sonography. This imaging test uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. It can show organs such as the liver, spleen, and kidneys. It can also check blood flow through blood vessels. This test can be done by pressing down with an ultrasound wand on your belly. Or it may be done inside your body with ultrasound on the end of an EGD scope. This is called an endoscopic ultrasound (EUS.)

• X-ray. This test uses electromagnetic energy beams to make images of internal tissues, bones, and organs.