preparing for a bronchoscopy

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Preparing for a Bronchoscopy Informed Consent: As a patient, you have the right to understand your health and lung condition in words that you understand. You have the right to plan your medical care, including whether you need a bronchoscopy; you always have the right to refuse a procedure. To help with your planning, you must learn about your health and lung condition and how it may be treated or diagnosed. To that end, you should work with your lung physician (pulmonologist) to understand what tests, treatments, or procedures may be used to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You will be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. Before giving your consent, though, make sure all your questions have been answered. History and Physical: A thorough medical history and physical examination should be performed prior to a bronchoscopy. A specific history of bleeding or clotting (coagulation) disorders, irregular heart rhythms (arrhythmias), reactive airways disease (asthma), hypoxemia (low oxygen), hypercarbia (high carbon dioxide) and allergies (environmental, drug, latex and tape) should be obtained and recorded. Additional Testing: You may need to have new or repeat radiographic imaging of your chest prior to the bronchoscopy, such as a chest x-ray or chest CT scan. You may need other heart, electrocardiogram (ECG), and lung tests (pulmonary function tests, PFTs) prior to a bronchoscopy. You may need to have additional blood drawn for tests, such as a complete blood count, arterial blood gas (ABG), and clotting tests. These additional chest imaging, heart, lung, and blood tests will provide your pulmonologist with more information regarding the location of your lung abnormality and your general health condition. That information will determine your ability to safely tolerate a bronchoscopy.

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Preparing for a BronchoscopyInformed Consent: As a patient, you have the right to understand your health and lung condition in words that you understand. You have the right to plan your medical care, including whether you need a bronchoscopy; you always have the right to refuse a procedure. To help with your planning, you must learn about your health and lung condition and how it may be treated or diagnosed. To that end, you should work with your lung physician (pulmonologist) to understand what tests, treatments, or procedures may be used to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You will be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. Before giving your consent, though, make sure all your questions have been answered.

History and Physical: A thorough medical history and physical examination should be performed prior to a bronchoscopy. A specific history of bleeding or clotting (coagulation) disorders, irregular heart rhythms (arrhythmias), reactive airways disease (asthma), hypoxemia (low oxygen), hypercarbia (high carbon dioxide) and allergies (environmental, drug, latex and tape) should be obtained and recorded. Additional Testing: You may need to have new or repeat radiographic imaging of your chest prior to the bronchoscopy, such as a chest x-ray or chest CT scan. You may need other heart, electrocardiogram (ECG), and lung tests (pulmonary function tests, PFTs) prior to a bronchoscopy. You may need to have additional blood drawn for tests, such as a complete blood count, arterial blood gas (ABG), and clotting tests. These additional chest imaging, heart, lung, and blood tests will provide your pulmonologist with more information regarding the location of your lung abnormality and your general health condition. That information will determine your ability to safely tolerate a bronchoscopy. Pre-Bronchoscopy Instructions: If you are having a bronchoscopy as an outpatient or as a noncritically ill inpatient, you will be instructed not to eat for 6 to 8 hours before the procedure. This helps decrease the risk of vomiting during a bronchoscopy. You will also receive instructions about taking your regular medicines, smoking cessation, and removing any dentures or partial dental plates before the bronchoscopy. Patients who have diabetes mellitus may need to follow special instructions about their diet and medications (insulin and diabetic pills). Medicines that you may need to stop taking before your bronchoscopy include aspirin, ibuprofen, or prescription blood thinners. Post Bronchoscopy Discharge Planning: If you are having your bronchoscopy as an outpatient or you are to be discharged from the hospital after your bronchoscopy, arrangements must be made for a family member or friend to drive you home after the bronchoscopy. Because you may receive sedative (calming) and analgesic (pain relieving) medications you should not operate a motor vehicle.

Prior to a Bronchoscopy (Pre-Operative Care)

Checking In: If you are an outpatient, you will be instructed to check into the pre-operative area. You will be asked to change into a hospital gown, and go to the bathroom before the procedure so that you will be comfortable. Your informed consent for the bronchoscopy will be obtained and/or confirmed prior to the procedure. Caregivers will have you remove your glasses, dentures, or partial dental plates. Vital Signs: Your temperature, heart rate, respiratory rate, blood pressure and oxygen saturation will be documented prior to the bronchoscopy procedure. Intravenous Access: An intravenous (IV) line will be placed in your vein for the administration of intravenous fluids, sedative and analgesic medications during the procedure. Intraoperative Monitoring: You will be connected to a monitor for continuous electrocardiogram (ECG) to monitor your heart rate and rhythm, respiratory rate, blood pressure, and blood oxygenation during the bronchoscopy procedure. This is to monitor your vital signs and condition before, during, and after the bronchoscopy.

Patient Preparation Prior to BronchoscopyLocal Anesthesia: Before beginning a bronchoscopy, you will inhale an aerosol spray of a numbing medication (i.e., lidocaine), which anesthetizes (numbs) the nose and the posterior throat area to prevent coughing and gagging during the procedure. Conscious Sedation: If the bronchoscopist determines that a patient is an appropriate candidate for conscious sedation, a combination of anti-anxiety medications (i.e., benzodiazepines) and analgesic medications (i.e., narcotics) will be administered intravenously. These intravenous medications will help you to relax, relieve your anxiety, and make you drowsy while your vital signs are continuously monitored. Conscious sedation may also help you forget any unpleasant sensations experienced during the bronchoscopy. The use of intravenous benzodiazepines and/or narcotics for conscious sedation, and cough suppression without impairment of ventilation (breathing), oxygenation or cooperation are controversial. Many side effects of bronchoscopy are secondary to the side effects and combination use of these medications. Patient Positioning: If you are awake (conscious) during the procedure, the bronchoscopist will be able to explain what is happening step-by-step. You will be lying down in a supine position (on your back, looking up) with the head of the procedure bed tilted slightly upward. It is important for you to hold still during the bronchoscopy. Patients who are unable to hold still during a bronchoscopy may require general anesthesia. You may also need general anesthesia when having some bronchoscopy procedures, such as removing foreign objects and will need general anesthesia for a rigid bronchoscopy. If you have general anesthesia, you will be completely asleep during your bronchoscopy. Usually the lights in the procedure room are dimmed during the procedure to enhance the viewing of the bronchoscopy video screen or fluoroscopy (x-ray) screen which is used for biopsies.

Flexible Fiberoptic Bronchoscopy Procedure

Routine intraoperative monitoring during a bronchoscopy includes continuous heart rate, heart rhythm (electrocardiogram), respiratory rate, blood pressure, and pulse oximetry (oxygen saturation). All patients receive supplemental oxygen during and after the procedure. Three approaches are available for passage of a flexible fiberoptic bronchoscope. Transnasal (thru the nose) and transoral (thru the mouth) routes may be used in non-endotracheal tube intubated patients; however, mechanically ventilated patients require passage through the endotracheal tube. The transnasal route provides the greatest patient comfort; the transoral approach is reserved for patients with bleeding disorders or obstructive nasal anatomy. The flexibility of the FOB allows the bronchoscope to pass through the nose or oral route into the posterior throat to a position above the vocal cords. The vocal cords are numbed and the FOB is advanced through the vocal cords into the trachea (windpipe). Once the FOB passes through the vocal cords you will not be able to talk. After insertion into the trachea, the FOB is advanced to the carina, which divides the trachea into the left and right mainstem bronchi (left and right lung airways). During this time your airway passages will be numbed with an anesthetic. The FOB is then advanced through the mainstem bronchi into the smaller segmental and subsegmental airways of both the left and right lung. This allows the bronchoscopist the ability to examine the inside of the lungs through the mini-camera at the bronchoscopes distal illuminated tip. You may feel like you cannot catch your breath, but there is enough room to breathe and receive oxygen. To help relieve this feeling, you may be instructed to swallow or take deep breaths. As noted above, your vital signs are continuously monitored and your anxiety is relieved with an intravenous combination of anti-anxiety medications (benzodiazepines) and analgesic (pain) medications (narcotics). All the carinae (branching points) and segmental bronchial orifices (airway openings) of the tracheobronchial tree are directly visualized on the bronchoscopy video screen. Each carina of all the sub-segments of the lung are examined for sharpness, position, texture, color, size and patency. The bronchial mucosa (airway lining) is also inspected for the presence of infiltration, inflammation, and secretions. The bronchoscopy could take anywhere from 30 minutes to an hour, depending on how long it takes for patient preparation, the intraoperative medications to take effect, the reason for the procedure, and/or the type or number of samples to be obtained.

Rigid Bronchoscopy ProcedureRigid bronchoscopy is typically performed with the patient under general anesthesia. It should be performed by an experienced bronchoscopist in an operating room.

Fiberoptic Bronchoscopy Specimens and Diagnostic YieldFiberoptic bronchoscopy provides lung specimens for microbiological, cytological, and histological (under the microscope) analysis in order to evaluate for infectious, inflammatory, and malignant diseases of the chest. Specimens are collected using a variety of techniques,

including bronchial washing, bronchial brushing, bronchoalveolar lavage (BAL), endobronchial or transbronchial biopsy (TBBx), and endobronchial or transbronchial needle aspiration (TBNA).

Diagnostic yield (i.e, the ability to obtain a diagnosis) is influenced by specimen size, specimen number, disease distribution, and biopsy specimen crush artifact (tissue distortion as a result of the sampling procedure), which can make the histological pattern recognition difficult. The diagnostic yield for endoscopic visible lesions when using a variety of sampling techniques is approximately 70-95% (9). The diagnostic yield of transbronchial procedures for peripheral (distal) nodules depends on the size of the lesion and the number of specimens obtained. Yield for non-bronchoscopically visible peripheral lung lesions greater than 3 cm in diameter is greater than 80% (range 44-85%) (10). However, the yield for peripheral lesions less than 2 cm in diameter is as low as 20% (range 23-58%) (10). The addition of washings, brushings, BAL, and TBNA increases the yield to approximately 60% (10,11). The yield of TBNA in evaluating mediastinal nodes in patients with lung cancer is 10-50% and depends on detection of mediastinal lymphadenopathy by chest computed tomography (CT) scanning. (10,11) Additional techniques such as autofluorescent bronchoscopy have increased the detection of premalignant and malignant lung cancers (12); whereas, endobronchial ultrasound (EBUS), and electromagnetic navigational bronchoscopy (ENB) have improved the yield of flexible bronchoscopy in the diagnosis of peripheral lung lesions without compromising safety of the bronchoscopy (13). The discussion of these multimodality bronchoscopic techniques is beyond the scope of this article.

Rigid Bronchoscopy Diagnostic YieldRigid bronchoscopy is primarily a therapeutic modality and is rarely used for diagnostic purposes. The advantages of the procedure are that the central lumen of the instrument provides access for a variety of instruments while maintaining maximal central airway patency (clearance).

Risks and Complications of Fiberoptic BronchoscopyFiberoptic bronchoscopy is safe in the hands of experienced operators. Major complications have been reported in 0.08-5% of procedures, with a mortality of 0.01-0.5% (14). The risk of major complications is highest in those with active ischemic heart disease and advanced pulmonary disease. Major complications include pneumothorax (punctured and collapsed lung), pulmonary hemorrhage, and respiratory failure. Other complications include conscious sedationinduced hypoventilation, hypoxemia, cardiac dysrhythmias, cardiac ischemia, bronchospasm, fever and, rarely, bacteremia (bacteria in the blood).

Risk and Complications of Rigid Bronchoscopy

The major risks of this procedure are those associated with general anesthesia. In addition, cervical spine, mandible, or skull injuries may be aggravated due to manipulation during the procedure. Limitations of rigid bronchoscopy include inability to evaluate distal airways or to perform it on mechanically ventilated patients.

Post Bronchoscopy RecoveryAlthough most patients tolerate bronchoscopy well, physicians require that the patient remain under a brief period of observation. Recovery room nurses watch closely for two to four hours following the procedure, obtaining vital signs every 15 minutes for the first hour, and then every 30 minutes for the second hour while the patient is kept in the semi-fowler or upright position. Most complications occur early and are readily apparent at the time of the procedure. During the recovery period, the patient is assessed for respiratory difficulty (stridor and dyspnea (shortness of breath) resulting from laryngeal edema or laryngospasm). Monitoring continues until the effects of sedative medications wane and the patients gag reflex returns. If the patient has had a transbronchial biopsy, he or she will have a chest x-ray to rule out any air leakage in the lungs (pneumothorax) after the procedure. The patient will be hospitalized if there is any bleeding, air leakage (pneumothorax), or respiratory distress. Remember that you may feel dizzy or light-headed as you wake up, or may have a dry mouth, a sore or scratchy throat, or a low grade fever (101oF). If you had general anesthesia, you may feel sick to your stomach (nausea) and may throw up (vomit). If you had a biopsy, your caregiver may tell you not to cough forcefully or clear your throat. This is to keep the biopsy site in the lung from bleeding. Do not try to stand until your caregiver says it is okay to do so. If you are allowed to go home after your bronchoscopy, someone else must drive. You also may be tired for a day or two after the procedure.

Activity and Home CareDo not eat or drink anything until the numbing medicine in your throat has worn off. You can usually begin drinking sips of water about two to four hours after the procedure. You may try eating food after you can drink without choking or getting sick (nausea). Your throat may feel scratchy for a few days after the bronchoscopy. Take throat lozenges or gargle with salt water if your throat is sore and drink liquids to help decrease dryness in your mouth or throat. You may also have a low grade fever after your bronchoscopy. If you had a biopsy, do not cough forcefully or clear your throat for a day or two. This is to keep the biopsy site in the lung from bleeding. You may be tired for a day or two after your bronchoscopy. Rest when you feel it is needed. Do not drive or do anything that requires your full attention for at least 12 to 24 hours.

Call Your Doctor

Call your doctor if you have any of the following symptoms: Shortness of breath A temperature above 101oF for more than 24 hours. Bleeding from your nose or throat. If you have chest pain or severe shortness of breath. Seek medical care immediately if: You have chest pain or discomfort. You have bleeding from your nose that cannot be stopped after 10 minutes. You have new or worsening trouble breathing.

barium enema

What is a barium enema?A barium enema, also called a lower gastrointestinal (GI) series, uses x-rays to diagnose problems in the large intestine, which includes the colon and rectum. The barium enema may show problems like abnormal growths, ulcers, polyps, diverticuli, and colon cancer.

What happens during a barium enema?Before taking x-rays of your colon and rectum, the radiologist will put a thick liquid called barium into your colon via an enema. The barium coats the lining of the colon and rectum and makes these organs, and any signs of disease in them, show up more clearly on x-rays. It also helps the radiologist see the size and shape of the colon and rectum. You may be uncomfortable during the barium enema. The barium will cause fullness and pressure in your abdomen and will make you feel the urge to have a bowel movement. However, that rarely happens because the tube used to inject the barium has a balloon on the end of it that prevents the liquid from coming back out.

You may be asked to change positions while x-rays are taken. Different positions give different views of the colon. After the radiologist is finished taking x-rays, you will be able to go to the bathroom. The radiologist may also take an x-ray of the empty colon afterwards. A barium enema takes about one to two hours. The barium may cause constipation and make your stool turn gray or white for a few days after the procedure.

How do you prepare for a barium enema?Your colon must be empty for a barium enema to be accurate. To prepare, you will have to restrict your diet for a few days beforehand. For example, you might be able to drink only liquids and eat only non-sugar, non-dairy foods for two days before the procedure; only clear liquids the day before; and nothing after midnight the night before. To make sure your colon is empty, you will be given a laxative or an enema before the procedure. Your physician may give you other special instructions.

What results will I have if I am suffering from IBS?There will be no visible signs of abnormalities if you are suffering from IBS.

barium enema experiencesIMPORTANT NOTE: Although some people find these tests uncomfortable and occasionally painful, they are vital diagnostic tools. I would always recommend having any and all of these tests if they are recommended by your doctor. You should also make sure you follow your doctor's preparation instructions carefully.

The tale of...PeterHello, here I am, fresh from the hospital and just having had an enema at 9.30 this morning. The experience was a painless one, with the exception of the intestinal cramps which can occur with the introduction of air into the colon. There is a certain amount of discomfort and nothing to cause concern. I had an injection of Buscopan roughly half-way through the procedure, and afterward was able to drive home myself. By far the worst of the procedure is in the prep the day before. I had Picolax and I think the effects of this stuff being described as 'vigorous' are an understatement. Apart from that, all is well and I'm a happy bunny again. If you are referred for this procedure, don't worry, it's a doddle. If you are worried about embarrassment, again, the doctors have seen it all and there really is nothing to be embarrassed about. Just relax and all will be well.

The tale of...BarbaraI agree with everyone on this page - the prep is the worst part (good Lord, castor oil is bad - I felt like I was on Fear Factor), and the exam itself is ridiculously uncomfortable but it's over quickly. The tech that I had was great, because she explained everything and her sweetness made me relax even more. Plus when you think that little bit of uncomfortable-ness can save your life...it's worth it! Good luck!

The tale of...MarianneI had my barium enema last week and it wasn't that bad. The Picolax is powerful stuff - I did spend most of the day on the toilet, and it did make me quite weak and very hungry. I took the advice I was given by the hospital and bought some vaseline which was very useful. The exam wasn't too bad, just a bit uncomfortable, and at one point near the beginning I thought 'I can't do this, I'm going to have to tell them to stop', but I just did deep breathing and tried to relax, and the rest of it went quite well with the odd bit of humor thrown in from the nurse, which did help the situation. I can't believe I was actually laughing during my exam. The exam took about an hour and then I could go home. The pain from the wind was barely manageable, but it only lasted an hour and started to go, so all in all I am really pleased I wasn't silly enough not to turn up. So that's another thing to add to my list of things I didn't want to do in life but weren't as bad as I thought. Just relax and you will be fine.

The tale of...GeoffI had my first experience of a barium enema last week, and I have to say that the whole thing was remarkably OK. The Picolax laxative is powerful stuff and kicked in within about 30 minutes of taking it (drink loads of fluids). Having said that, whilst I had to make frequent visits to the toilet, at no point was I uncomfortable, and even managed to sleep most of the night. The enema and x-ray procedure itself is OK providing you can manage to relax. It's an odd sensation as the barium mixture is poured inside you, but not one which I would describe as uncomfortable. The most discomfort I had was having to spend 30 minutes lying on the hard, uncushioned x-ray table. As for going to the bathroom when the procedure is finished - again no problem. I actually struggled to go at all in the hospital and it was only several hours later at home that I actually passed most of the barium. The effects of the Picolax seem to wear off pretty quickly.

All in all, whilst it's not a pleasant procedure, it's not particularly uncomfortable and certainly not something to fear.

The tale of...JayI would echo what others say on this page. By far the worst part for me was drinking the stuff the night before. The fasting made me light-headed and gave me a headache. The test itself was not nearly as bad as I thought. Uncomfortable at certain points (insertion of enema) but not painful at all. The exam itself only lasted like 15 minutes with about 10 minutes before and after for preparation, etc. When the barium flows in I would describe it as a very mild cramping/bubbling sensation. After the test was done, I sat there for like 10 minutes with the barium still in me and felt fine. That was when the doctor showed me the results immediately on the video screen - I felt well enough to sit there and converse with him/ask questions while everything was still in me. So if you're preparing to have one of these, don't sweat it. Just pace yourself drinking the crud the night before.

The tale of...LeeI went for my test yesterday! The worst of it all was the prep for it. The night prior was horrible, I pretty will slept in the bathroom after taking the laxatives. The next day I was weak, nauseous, and felt like jello. The test itself was not as bad as I had anticipated and the radiologist added some humor in order to alleviate the discomfort. It simply feels like you're going to have the biggest explosion, but thank goodness with some muscle control you are able to hold it until the x-rays are done. Not as bad as I thought. I ran to have a bagel with coffee right after the test and vomited within half an hour, so go easy on the stomach once you've done your test. I was nauseous for the rest of the day and slept the entire afternoon.

The tale of...PaulineThe worst part is definitely the prep. Drink plenty of water if you are given Picolax laxative. Normally you take two but I took three as I thought two did not flush my bowel out enough. The actual test is fine, relax and it will be OK. Honest!

The tale of...AI am younger than 16 years of age and have had a barium enema. For everyone concerned with going through a barium enema, try to relax. The worst part of it all is the 24 hour prep. It can be very difficult to always run back and forth to the bathroom and some of the physical things you must do to prepare are not very great either, such as the bag enema. During prep I began to get dehydrated because I was losing so much liquid, and this resulted in vomiting and nausea. Therefore, it is very important to remain hydrated at all times. A barium enema does not take very long at all. You will feel uncomfortable during the exam because there is a bit of pressure and you feel as though you need to use the bathroom immediately. This is all normal and trust me, once the exam is over you will be glad to go to the bathroom. If you co-operate and relax and turn when the doctor tells you to turn, everything will go well and quickly. There is no reason to fear the exam itself because it does not hurt, it just has an uncomfortable feeling. Good luck, and remember to relax!

holecystography(Gallbladder Series, GB Series, Oral Cholecystography, Oral Cholecystogram, X-rays of the Gallbladder)

Procedure OverviewWhat is cholecystography?

Cholecystography is an x-ray procedure used to examine the gallbladder when gallstones are suspected. A contrast dye is swallowed prior to the procedure. The contrast dye allows for better visualization of gallstones and other abnormalities of the gallbladder that cannot be seen on a standard x-ray of the abdomen. X-rays use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays are made by using external radiation to produce images of the body, its organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially-treated plates (similar to camera film) and a "negative" type picture is made (the more solid a structure is, the whiter it appears on the film).

Contrast dye, when swallowed prior to the cholecystogram, causes the gallbladder to appear opaque on a cholecystogram x-ray film. Gallstones will appear as dark spots within the gallbladder or bile ducts. Depending on how well the contrast dye has been absorbed, polyps and tumors may also be visible on the x-ray film. Due to the development of improved technology, cholecystography is no longer performed routinely. Ultrasound and computed tomography (CT scans) are faster and often more accurate in diagnosing conditions of the gallbladder. Other related procedures that may be used to diagnose problems of the gallbladder include abdominal x-rays, CT scan of the liver and biliary tract, abdominal ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), and gallbladder nuclear scans. Please see these procedures for additional information.What are gallstones?

Click Image to Enlarge

Gallstones form when bile stored in the gallbladder hardens into stone-like material. Too much cholesterol, bile salts, or bilirubin (bile pigment) can cause gallstones. Slow emptying of the gallbladder can also contribute to the formation of gallstones. When gallstones are present in the gallbladder itself, it is called cholelithiasis. When gallstones are present in the bile ducts, it is called choledocholithiasis. Gallstones that obstruct bile ducts can lead to severe or life-threatening infection of the bile ducts, pancreas, or liver. Bile ducts can also be obstructed by cancer or trauma. There are two types of gallstones: cholesterol stones and pigment stones. Eighty percent of gallstones are cholesterol stones. The size of gallstones varies from a grain of salt to golf-ball size. A person can develop a single stone or several stones.What are the symptoms of gallstones?

At first, most gallstones do not cause symptoms. However, when gallstones become larger, or when they begin obstructing bile ducts, symptoms or "attacks" begin to occur. Attacks of gallstones usually occur after a fatty meal and at night. The following are the most common symptoms of gallstones. However, each individual may experience symptoms differently. Symptoms may include, but are not limited to, the following:

y y y y y y y

pain that comes and goes in the abdomen nausea and/or vomiting fever and/or chills jaundice - yellowing of the skin and eyes abdominal bloating intolerance of fatty foods belching or gas, and indigestion

The symptoms of gallstones may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Reasons for the ProcedureCholecystography may be performed when signs and symptoms of gallbladder disease, such as right upper quadrant abdominal pain, jaundice, and intolerance of fat in the diet are present. These symptoms may indicate the presence of gallstones or other obstructions in the gallbladder and/or bile ducts. In addition to gallstones and obstruction of the bile ducts, other conditions that may be detected by cholecystography include, but are not limited to, polyps, tumors, inflammation, infection, and nonfunctioning gallbladder. There may be other reasons for your physician to recommend cholecystography.

Risks of the ProcedureYou may want to ask your physician about the amount of radiation used during the procedure and the risks related to your particular situation. It is a good idea to keep a record of your past history of radiation exposure, such as previous scans and other types of x-rays, so that you can inform your physician. Risks associated with radiation exposure may be related to the cumulative number of x-ray examinations and/or treatments over a long period of time. If you are pregnant or suspect that you may be pregnant, you should notify your physician. Radiation exposure during pregnancy may lead to birth defects. If contrast dye is used, there is a risk for allergic reaction to the dye. Patients who are allergic to or sensitive to medications, contrast dye, or iodine should notify their physician. Patients with kidney failure or other kidney problems should notify their physician. In some cases, the contrast dye can cause kidney failure, especially if the person is taking Glucophage (a diabetic medication). Patients with liver disease or other liver damage should notify their physician, as impaired liver function decreases the usefulness of the contrast dye.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure. Certain factors or conditions may interfere with the results of the test. These factors include, but are not limited to, the following:y y

inadequate absorption of the contrast dye due to liver disease or damage, vomiting and/or diarrhea after swallowing the dye, intestinal malabsorption, or gallbladder inflammation barium within the intestines due to a recent barium x-ray procedure

Before the Procedurey y y y y

y y

y

y

Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear. Notify the radiologic technologist if you have ever had a reaction to any contrast dye, or if you are allergic to iodine. Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general). Your physician will give you instructions regarding fasting prior to the procedure. Generally, you will be instructed to eat a fat-free meal the night before the procedure, then withhold food and liquids after midnight. You may also be instructed to withhold cigarettes and chewing gum as well. Notify the radiologic technologist if you are pregnant or suspect you may be pregnant. Your physician will give you the contrast dye (tablets taken by mouth one at a time) to swallow the night before the procedure. It is very important that you follow the instructions exactly as given in order to obtain adequate contrast visualization of the gallbladder. Notify the radiologic technologist if you have any vomiting or diarrhea after taking the contrast dye, because the procedure may have to be rescheduled if too much contrast dye was lost. Based upon your medical condition, your physician may request other specific preparation.

During the ProcedureCholecystography may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician's practices. Generally, cholecystography follows this process: 1. You will be asked to remove any clothing or jewelry that may interfere with the exposure of the body area to be examined. 2. If you are asked to remove clothing, you will be given a gown to wear.

3. You may be given an enema prior to the procedure to clear the intestines of gas or feces that may interfere with imaging of the gallbladder. 4. You will be positioned in a manner that carefully places the part of the abdomen that is to be x-rayed between the x-ray machine and a cassette containing the x-ray film. You may be asked to stand erect, to lie flat on a table, or to lie on your side on a table, depending on the x-ray view your physician has requested. You may have x-rays taken from more than one position. 5. Body parts not being imaged may be covered with a lead apron (shield) to avoid exposure to the x-rays. 6. Once you are positioned, the radiologic technologist will ask you to hold still for a few moments while the x-ray exposure is made. 7. It is extremely important to remain completely still while the exposure is made, as any movement may distort the image and even require another x-ray to be done to obtain a clear image of the body part in question. 8. The x-ray beam will be focused on the area to be photographed. 9. The radiologic technologist will step behind a protective window while the image is taken. 10. Several x-rays will be taken while you are in various positions. 11. If testing of the gallbladder's ability to contract is requested, you will be given some type of fatty intake to stimulate gallbladder contraction. You may be given a fatty meal, or you may be given a fatty synthetic substance either by mouth or by intravenous (IV) injection. Additional x-rays will be taken after you have consumed the fatty intake. The radiologist will look at the x-ray films before you leave to ensure that the gallbladder was adequately visualized during the procedure. If the x-rays are inadequate, the test may need to be repeated.

After the ProcedureGenerally, there is no special type of care following cholecystography. However, your physician may give you additional or alternate instructions after the procedure, depending on your particular situation. Because the contrast dye is excreted from the body through the kidneys, you may feel some slight discomfort with urination for a day or so.