The small gallbladder: hepatic spill phenomenon

Ninety percent of patients with serum bilirubins above 4 mg/100 ml will not excrete cholangiographic contrast media.(1) Because of their clinically evident icterus, these patients are easily identified and decreased hepatic function can be expected. The anicteric patient with marginal hepatic reserve presents more difficulty in clinical identification. Significant impairment may not be evident until cholangiographic examination (often performed for presumed gallbladder disease) shows increased renal excretion of contrast. Appreciation of this radiographic manifestation of impaired hepatic reserve may be a useful adjuvant to clinical diagnosis.