Radionuclide scanning has been virtually replaced by ultrasonography for emergency department patients with right upper quadrant pain. Technectium-99m-labeled iminodiacetic acid (IDA) is injected intravenously, is taken up by hepatocytes, is secreted into the bile canaliculi, and then flows into the small bowel. Normally there is a small amount of reflux into the cystic duct and gallbladder, but in cholecystitis the cystic duct is frequently occluded. The gallbladder, hepatic duct, and common duct should be visualized within 1 h of IDA administration, but total test time may be several hours.
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