(e) As the gallbladder discharges the bile containing the contrast
medium into the small bowel after the ingestion of fatty meal, the medium is reabsorbed
and conveyed to the liver and secreted again. This cycle continues until the contrast
medium is completely eliminated from the body via the kidneys and colon.
b. Preparation of Patient and Scheduling. Patient preparation and scheduling
are in accordance with the established clinical routine. In general, the preparation of the
patient may be as follows.
(1) On the day before the examination (before ingestion of the contrast
medium), a PA projection of the abdomen (11x14) may be done. This is a survey or
(2) The patient is not allowed to eat fats after the noon meal the day before
(3) About 12 hours prior to the examination, the patient ingests the contrast
medium according to the manufacturer's instructions. Telepaque is usually used with
the average dose being 6 tablets.
(4) After taking the pills, the patient should not be allowed to eat or drink
anything until the time of the examination.
(5) To make certain that none of the contrast medium has been lost, the
patient should be instructed to report any vomiting or bowel movements.
(6) If the initial films show no stones, the patient is given a fatty meal to
promote good gallbladder contraction. An additional film is usually done 30 minutes to
one hour after the fatty meal. Sometimes commercially prepared compounds or
mixtures may be used in place of the fatty meal.
Before giving a fatty meal, consult the radiologist. A fatty meal should not be
given to patients if stones are seen in the initial films). This precaution is
necessary because the "emptying" of the gallbladder caused by the fatty meal
may release one or more stones into the biliary ducts causing obstruction.
(7) The procedure may vary since every radiologist has his preferred
method. For example, some radiologists may request that the patient be given two
teaspoonfuls of paregoric one-half hour after the ingestion of cholecystopaque or that
an enema be administered one hour prior to radiography.