Functional dyspepsia is a very common disease and there are two types of dyspepsia. One is functional dyspepsia in the gastrointestinal tract and the other is pancreatobiliary dyspepsia. Biliary dyspepsia is caused by biliary tract disease and can even cause biliary pain. Acalculous biliary pain (ABP) is biliary colic without gallstones, it is caused by functional biliary disorder or structural disorders such as microlithiasis, sludges or parasitic infestation like Clonorchiasis. The endoscopic ultrasonography is helpful tool for differential diagnosis of ABP. Although sphincter of Oddi manometry (SOM) is performed for the confirmative diagnosis of sphincter of Oddi dysfunction (SOD), several non-invasive tests have been studied because of some practical limitations and invasiveness of SOM itself. In fact, the most clinically used easy test to diagnose functional biliary disorder is quantitative hepatobiliary scintigraphy and it can distinguish gallbladder dyskinesia, SOD, or combined type. Initial treatment of functional biliary disorder is adequate dietary control and medication, but if the symptoms worsened or recurred frequently, laparoscopic cholecystectomy could be performed with gallbladder dyskinesia. If SOD is suspected, additional SOM should be considered and endoscopic sphincterotomy (EST) can be done according to the outcome. If the SOM is not available, the patient could be diagnosed by stimulated ultrasound.
Biliary Dyskinesia ; Biliary Tract Diseases ; Cholecystectomy, Laparoscopic ; Clonorchiasis ; Colic ; Diagnosis ; Diagnosis, Differential ; Dyspepsia* ; Endosonography ; Gallstones ; Gastrointestinal Tract ; Humans ; Manometry ; Radionuclide Imaging ; Sphincter of Oddi ; Sphincter of Oddi Dysfunction ; Sphincterotomy, Endoscopic ; Ultrasonography

The purpose of this volunteer study was to investigate whether pretreatment with UDCA before the administration of 99mTc DISIDA affects the biliary excretion of the DISIDA, and whether it can shorten the total imaging time. Ten young, healthy volunteers (eight males, two females, mean age: 26.3 +/- 2.1 years) participated in the study. Hepatobiliary scintigraphies were performed twice per volunteer within three days, for the control and the UDCA-pretreated studies. In the control study, the gallbladder (GB) was observed first in four cases and the intestine was observed first in another four cases; in contrast, in the UDCA challenge study, the GB was observed first in eight cases. The quantitative results for the factors related to the GB differed significantly between the control and challenge studies. When the subjects were pretreated with UDCA, the time duration until visualization of the GB was shortened, and the maximum activity of the GB became more intense. In conclusion, UDCA pretreatment before hepatobiliary scintigraphy can shorten the total imaging time for evaluating functional obstructions of the cystic duct and increase the specificity of the process.
Adult ; Biliary Tract/*radionuclide imaging ; Female ; Humans ; Liver/*radionuclide imaging ; Male ; Radionuclide Imaging/*methods ; Radiopharmaceuticals/*pharmacokinetics ; Technetium Tc 99m Disofenin/*pharmacokinetics ; Ursodeoxycholic Acid/*pharmacology

Choledochal cyst is a congenital anomaly with classic triad of abdominal pain, jaundice and right upper abdominal mass. Bile peritonitis caused by cyst rupture is relatively not rare in infancy. The mechanism of rupture must be epithelial irritation of the biliary tract by refluxed pancreatic juice caused by pancreatico-biliary malunion associated with mural immaturity in infancy, rather than an abnormal rise in ductal pressure or congenital mural weakness at a certain point. We experienced a case of bile peritonitis caused by spontanenous rupture of choledochal cyst in a 10-month-old girl presented with abdominal distension, persistent fever, diarrhea, irritability and intractable ascites. She was presumed as having bile peritonitis by bile colored ascitic fluid with elevated bilirubin level and diagnosis was made by 99mTc DISIDA hepatobiliary scan showing extrahepatic biliary leak. The perforated cyst was surgically removed and the biliary tree was reconstructed with a Roux-en-Y hepaticojejunostomy.
Abdominal Pain ; Ascites ; Ascitic Fluid ; Bile* ; Biliary Tract ; Bilirubin ; Choledochal Cyst* ; Diagnosis ; Diarrhea ; Female ; Fever ; Humans ; Infant* ; Jaundice ; Pancreatic Juice ; Peritonitis* ; Radionuclide Imaging* ; Rupture ; Rupture, Spontaneous* ; Technetium Tc 99m Disofenin

PURPOSE: Biliary atresia, one of the major causes of neonatal cholestais, is an idiopathic, serious disorder, affecting the newborn that results in complete obstruction of biliary tract. Successful reestablishment of bile flow is dependent on early surgical intervention, early diagnosis is imperative. The authors evaluate the utility of Tc-99m-labeled diisoprpyliminodiacetic acid (DISIDA) hepatobiliary scintigraphy in the diagnosis of biliary atresia. METHODS: From January, 1995 to August, 1999, total 60 patients with neonatal cholestasis underwent Tc-99m DISIDA hepatobiliary scintigraphy at Asan Medical Center. RESULTS: The undelying causes of neonatal cholestasis were biliary atresia in 14, neonatal hepatitis in 33, intrahepatic bile duct paucity in 9, and total parenteral nutrition induced cholestasis in 4. All patient with biliary atresia were interpreted correctely in DISIDA hepatobiliary scintigraphy, showing 100% sensitivity. Of the 46 patients with neonatal hepatitis and other causes, 37 patients had intestinal radioactivity showing 80% specificity. CONCLUSION: Visualization of DISIDA in the intestinal tract indicates patency of the biliary ducts and excludes the diagnosis of biliary atresia. But the absence of intestinal excretion on the DISIDA hepatobiliary scintigraphy dose not necessarily indicate biliary atresia.
Bile ; Bile Ducts, Intrahepatic ; Biliary Atresia* ; Biliary Tract ; Cholestasis ; Chungcheongnam-do ; Diagnosis* ; Early Intervention (Education) ; Hepatitis ; Humans ; Infant, Newborn ; Parenteral Nutrition, Total ; Radioactivity ; Radionuclide Imaging* ; Sensitivity and Specificity

Hepatobiliary scintigraphy using Tc-labelled radiopharmaceuticals is employed primarily for the diagnosis ofacute cholecystitis and for demonstration of biliary tract patency. We conducted a retrospective study of 55patients with hepatobiliary disease from Jun. '84 to Sep. '84 at Taegu Catholic Hospital and tried to determinethe etiology and fine the possible differential points by analyzing the scintigraphic findings. The followingresults were obtained: 1. Tree-like photon defect on hepatic parenchyme was suggested characteristic of completeobstructive biliary diseases, but could be seen in either benign or malignant etiology. 2. The grade of hepatocyteclearance was not useful in detemining whether the cause of obstructive biliary disease was benign or malignant inthis study. 3. Hepatocyte clearance was more severely impaired in hepatocellular disease than in obstructivebiliary disease. 4. The photon defect in porta hapatis with complete biliary obstruction was suggestedcharacteristic of common bile duct cancer. 5. The meniscus appearance at obstructed site of common bile duct waspathognomonic sign of choledocholithiasis. 6. When the gallbladder was not visualized, the differential diagnosisbetween acute and chronic cholecystitis was possible without delayed image by observing the transist time tobowel. The delayed transit to bowel was a favorable of chronci cholecystitis rather than of acute cholecystitis.7. Acute pancreatitis could be easily differentiated from partial biliary obstruction by clinical and laboratoryexamination, but the finding of abrupt narrowing of pancreatic common bile duct with sligt proximal dilatation oncholescintigraphy was also a key point in acute pancreatitis. 8. The segmental dilatation of intrahepatic duct wasthought meaningful sign of clonorchiasis.
Biliary Tract ; Cholecystitis ; Choledocholithiasis ; Clonorchiasis ; Common Bile Duct ; Daegu ; Diagnosis ; Dilatation ; Gallbladder ; Hepatocytes ; Pancreatitis ; Radionuclide Imaging ; Radiopharmaceuticals ; Retrospective Studies