Do you sometimes have a sharp pain or ache in your right abdomen, specifically under your ribs? Maybe your doctor suspected a gallbladder problem and suggested a 'HIDA scan'? Even though the name may sound a little scary, it's actually not that scary. It's not a surgery, nor is it a very painful test. So today, let's talk about everything about this HIDA scan, very simply.
What is a HIDA scan simply?
A HIDA scan is an imaging test. To be precise, it's a nuclear medicine test. Okay, don't be scared by those big words. Simply put, it looks at how your gallbladder and related systems are functioning.
Let's first understand a little about this system. Think of it this way.
1. Our liver produces a digestive juice called bile . This helps dissolve the fats in the foods we eat.
2. The bile produced in this way is stored in a small sac-like organ under the liver called the gallbladder.
3. When we eat, this gallbladder contracts (squeezes) and sends the bile it contains through the ducts into the small intestine.
Now, what this HIDA scan does is to check whether the bile duct is working properly, whether there is a blockage somewhere, and whether there is a bile leak .
To do this, they inject a very small, harmless chemical called a 'radioactive tracer' into your vein. This substance travels exactly along the path of the bile. Then, a special camera (a `gamma camera`) takes pictures of the substance as it travels. By looking at the pictures, the doctors can get a good idea of how your gallbladder is working.
Other names for this are `cholescintigraphy` and `hepatobiliary scintigraphy`.
What diseases can be detected with this scan?
A doctor will order a HIDA scan mainly if he suspects several gallbladder-related diseases. Let's see what they are.
| Medical condition | Simply put... |
|---|---|
| Acute Cholecystitis | This is a sudden condition. Gallstones can cause the gallbladder to swell, causing severe pain in the right side of the abdomen and fever. This can be accurately diagnosed with a HIDA scan. |
| Chronic Cholecystitis | This is when the gallbladder becomes inflamed again and again due to gallstones. The pain may not be as severe as before, but it will still be frequent. |
| Sphincter of Oddi dysfunction | This is a little complicated. There is a muscle that controls the flow of bile and pancreatic juice into the small intestine. When this doesn't open properly, the juices back up and cause severe pain. |
| Biliary Atresia | This is a rare but dangerous condition that occurs in newborn babies. The baby's bile ducts are blocked. This causes the baby's body to turn yellow (newborn jaundice). If surgery is not done quickly, the liver can be damaged. |
| Biliary Leak | Bile can leak from the bile ducts, such as after gallbladder removal surgery, an accident, or a liver transplant. This can cause swelling of the surrounding tissue and lead to infection. |
When would you need a HIDA scan?
There are several main reasons why your doctor may refer you for this test:
- Severe pain in the right side of the abdomen: Especially if the pain starts suddenly and is persistent, it could be an inflammation of the gallbladder (cholecystitis). This is the main reason for having a HIDA scan.
- Postoperative pain and fever: If you have had a gallbladder removal surgery, liver transplant, or other related surgery and are experiencing fever and pain afterward, this scan is done to check for bile leakage.
- Excessive jaundice in a newborn baby: If a baby becomes very jaundiced within a few days of birth, this test is essential to determine if the cause is biliary atresia.
- To check a stent placed in the bile duct: Sometimes when a bile duct becomes blocked, a small tube (stent) is placed to keep it open. A HIDA scan may also be done to see if this is working properly.
How do you prepare before the scan?
This is very important. For the test results to be accurate, you must follow these instructions exactly.
Most importantly: If you are pregnant, trying to get pregnant, or breastfeeding, be sure to tell the medical staff before the scan. This is very important.
- Tell your doctor about any medications you take (including vitamins and herbal remedies). Some medications (especially painkillers) can affect the test results, so you may be asked to stop taking them a few hours before the scan.
- Fasting: You will need to fast for at least 4 hours before the scan. It is okay to drink a little water. You may be asked to fast for longer. You will be advised about this in advance.
- Remove jewelry: Do not wear any jewelry or metal objects during the scan.
- Don't be afraid: Some people are afraid of being in a confined space like an MRI scan. The camera in this one isn't a closed tube. It's just a camera that's open on both sides and is placed over your stomach. So you don't have to worry about getting stuck.
What happens during the scan?
Performing the scan is a very simple process.
1. First, you will be given a hospital gown to wear. Your stomach area should be exposed.
2. You will be made to lie down on an examination table.
3. Then a nurse or technician will insert a small catheter (IV catheter) into a vein in your arm. They will inject a chemical called a ``radiotracer'' through it. At this point, you will feel a stinging sensation, like a small ant.
4. The camera is slowly and carefully positioned over your stomach.
5. Then start taking pictures. The most important thing at this point is that you don't move at all. That way you can get clear pictures.
6. After taking some pictures, sometimes another medicine may be given through an IV to help your gallbladder contract (empty). You may feel a little stomach ache at this time. This is because the gallbladder is getting tight. After giving you that medicine, more pictures will be taken.
7. The entire test can take anywhere from 1 to 4 hours . In some rare cases, you may be asked to come back after 24 hours to take more pictures.
The scan is not painful. However, if you already have gallbladder pain, you may still feel pain during the scan.
What should I do after the scan?
Once the scan is over, you can go home or go to the hospital ward. Then do these things.
- Drink plenty of water: Drink plenty of water and fluids for the next 24 hours. This will help the radiotracer to quickly leave your body through your urine and stool.
- After using the toilet: Always flush the toilet thoroughly after using it, and wash your hands thoroughly with soap. The radioactivity of the chemical is very low, so there is no risk to those around you.
- For breastfeeding mothers: This is very important. Do not breastfeed your baby for 24 hours after the scan. Discard any breast milk that is expressed during that time. This is because the radioactivity from the radiotracer can pass into the breast milk and harm the baby. Therefore, it is very helpful to express breast milk before the scan.
Is there a risk in this?
The risks of a HIDA scan are very low.
- The IV may be slightly bruised where it was inserted.
- The radiation exposure is very small. This is about the same amount of radiation our bodies receive from the environment in an average year.
- It is very, very rare to have an allergic reaction to the chemicals used.
The information obtained from this test may not be available from other tests, such as ultrasound. Therefore, for someone who is not pregnant, the benefits of having this scan far outweigh the very small risks.
How do I get the report? What does it contain?
A radiologist will review your scans and write a report, which will be sent to your treating doctor. The results are usually available within 24 hours. Your doctor will explain the report to you.
| Possible facts in the report | What it could mean |
|---|---|
| Normal | There are no obstructions in the bile flow path. Bile travels smoothly from the liver to the gallbladder and from there to the small intestine. |
| Slow movement of the chemical | It may indicate a blockage in the bile ducts or some weakness in liver function. |
| Chemical not visible in the gallbladder | This often indicates a condition called acute cholecystitis, which means that the bile duct into the gallbladder is blocked. |
| Low gallbladder ejection fraction | The amount of bile released from the gallbladder after the medication is given is measured. If it is less than 30%-35%, it may indicate chronic cholecystitis. |
| Presence of the chemical in other places | If the chemical is seen in other places outside the bile duct system, it may indicate a biliary leak. |
Whatever the result, your doctor will explain it to you thoroughly and advise you on what to do next.
Take-Home Message
- A HIDA scan is a very safe and painless test to check the function of your gallbladder and bile duct system.
- It is very important to follow the instructions given before the scan, especially regarding fasting and informing the doctor if you are pregnant or breastfeeding.
- The amount of radiation your body receives is very small. Don't worry unnecessarily about it.
- Drink plenty of water after the scan. If you are a breastfeeding mother, avoid breastfeeding your baby for 24 hours.
- Talk openly with your doctor about your test report and any questions you have about it.
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