CHOLECYSTOKININ
Ferring
Diagnostic Cholecystokinetic
Action And Clinical Pharmacology: Cholecystokinin (CCK) is a natural polypeptide, formed in the APUD cells of the proximal mucosa of the small intestine. It stimulates secretion of pancreatic digestive enzymes, the flow of bile and the secretion from the glands of Brunner. It stimulates contraction of the gallbladder, inhibits contraction of the lower esophageal sphincter and the sphincter of Oddi and increases motility of the stomach and intestine.
When injected i.v., cholecystokinin induces contraction of the contrast-filled gallbladder with good visualization of the bile ducts within 1 to 3 minutes, providing more immediate results than an egg fat meal. The effect persists for more than 2 hours. Choledochal concrement is also often expelled. If contrast medium does not penetrate into the duodenum an organic process should be suspected.
Bile collected by means of an indwelling duodenal catheter gives information about the presence of chronic cholecystitis, infection or cancer. Exfoliative cytology on the duodenal contents ad modum Papanicolaou represents a valuable addition to cancer diagnosis for demonstration of malignant processes in a gallbladder and bile ducts and, to some extent, primary processes in the liver. The gallbladder and stomach can be examined at the same time.
Indications And Clinical Uses: Cholecystography, preoperative cholangiography, secondary cholangiography, roentgenological studies of the small bowel, diagnosis of pancreatic insufficiency (complement to the secretin test).
To induce contraction of the gallbladder and relaxation of the sphincter of Oddi. During routine oral cholecystography, or preoperative cholangiography, cholecystokinin can be used to provide an evaluation of the contraction pattern of the gallbladder, filling of the bile ducts, flow of contrast medium into the duodenum, and localization of gallstones in the lower common bile duct in connection with cholecystectomy and/or bile duct surgery.
To increase small bowel motility during radiological investigation. Cholecystokinin can reduce transit time and flocculation of a barium meal.
To stimulate the output of enzymes in conjunction with secretin. Cholecystokinin can aid in the diagnosis of pancreatic insufficiency in the secretin-cholecystokinin test.
Contra-Indications: None known. tag_WarningWarnings
Manufacturers’ Warnings In Clinical States: As a result of the effect of CCK on the gallbladder and the motility of the intestine, stomach-ache and a feeling of discomfort in the epigastrium may occur. If CCK is given too rapidly flushing may occur.
Precautions: None.
Adverse Reactions: No adverse reactions to CCK have so far been reported (see Warnings).
Symptoms And Treatment Of Overdose: Symptoms and Treatment: If cholecystokinin is given too rapidly flushing may occur. This side effect is rare provided the directions are followed. tag_DosageDosage
Dosage And Administration: The contents of 1 bottle of cholecystokinin should be dissolved in 7.5 mL of physiological saline, giving a concentration of 10 Ivy dog units (IDU)/mL. Discard any unused portion of the reconstituted solution.
Cholecystography: For an ordinary cholecystokinin test the contents of one 75 IDU bottle of cholecystokinin should be dissolved in 7.5 mL of physiological saline and 1 IDU/kg body weight (0.1 mL) should be given by slow i.v. injection. Contraction of the gallbladder and filling of the bile ducts with “contrast bile” normally occurs within 1 to 3 minutes. The patient should be given contrast medium on the evening before the examination and fluoroscopy should be carried out before the x-ray examination. If the gallbladder is visible, cholecystokinin should be injected and x-ray films taken in the normal way. An advantage of the technique is that x-ray of the stomach may be carried out simultaneously as there is no interference from undigested food.
Preoperative Cholangiography: About 40 units (4 mL) of cholecystokinin solution should be injected i.v. immediately before the cholangiography. After about 1 minute, contrast medium should be injected into the common bile duct and x-ray plates taken in the normal way. As cholecystokinin increases enzyme activity in the pancreas, the amylase values should be monitored for the following 3 days.
Secondary Cholangiography: If concrement residues remain after the operation, 75 units should be given i.v. each day for 1 week and cholangiography should be performed in connection with the last cholecystokinin injection. If required, the treatment may be repeated for a further week. The amylase values should be monitored.
Roentgenological Studies of the Small Bowel: CCK can be used to facilitate the transit of the barium meal through the small bowel. After ingestion of 200 to 300 mL of barium mixture, the patient should lie on his right side for 10 to 15 minutes. If fluoroscopic control shows that most of the contrast medium has passed into the first part of the jejunum, 0.5 to 1 IDU CCK/kg body weight is injected slowly i.v. The examination is usually completed within 15 minutes, permitting fluoroscopy during the whole procedure if necessary.
Diagnosis of Pancreatic Insufficiency: As a complement to the secretin test, 0.5 to 1 IDU CCK/kg body weight administered as slow i.v. injection.
Availability And Storage: Each injection bottle contains: cholecystokinin 75 IDU, L-cysteine 0.4 mg, L-cysteine HCl 0.1 mg and mannitol 20 mg. Packs of 1. The lyophilized powder should be stored at -20°C.
CHOLECYSTOKININ Ferring Diagnostic Cholecystokinetic
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