Diagnosis of Gallstones – NIDDK

How do doctors diagnose gallstones?

Doctors use your medical history, a physical exam, and lab and imaging tests to diagnose gallstones.

A health care professional will ask you about your symptoms. He or she will ask if you have a history of health conditions or health concerns that make you more likely to get gallstones. The health care professional also may ask if you have a family history of gallstones and what you typically eat. During a physical exam, the health care professional examines your body and checks for pain in your abdomen.

A health care professional will ask if you have a history of health conditions that make you more likely to get gallstones.

What tests do health care professionals use to diagnose gallstones?

Health care professionals may use lab or imaging tests to diagnose gallstones.

Lab tests

A health care professional may take a blood sample from you and send the sample to a lab to test. The blood test can show signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or liver.

Imaging tests

Health care professionals use imaging tests to find gallstones. A technician performs these tests in your doctor’s office, an outpatient center, or a hospital. A radiologist reads and reports on the images. You usually don’t need anesthesia or a medicine to keep you calm for most of these tests. However, a doctor may give you anesthesia or a medicine to keep you calm for endoscopic retrograde cholangiopancreatography (ERCP).

Ultrasound. Ultrasound is the best imaging test for finding gallstones. Ultrasound uses a device called a transducer, which bounces safe, painless sound waves off your organs to create an image or picture of their structure. If you have gallstones, they will be seen in the image. Sometimes, health care professionals find silent gallstones when you don’t have any symptoms.

Computed tomography (CT) scan. CT scans use a combination of x-rays and computer technology to create images of your pancreas, gallbladder, and bile ducts. CT scans can show gallstones, or complications such as infection and blockage of the gallbladder or bile ducts. However, CT scans also can miss gallstones that you may have.

Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed images of your organs and soft tissues without x-rays. MRIs can show gallstones in the ducts of the biliary tract.

MRIs can show gallstones in the ducts of the biliary tract.

Cholescintigraphy. Cholescintigraphy—also called a hydroxyl iminodiacetic acid scan, HIDA scan, or hepatobiliary scan—uses a safe radioactive material to produce pictures of your biliary tract. You’ll lie on a table while a health care professional injects a small amount of the radioactive material into a vein in your arm. The health care professional may also inject a substance that causes your gallbladder to squeeze. A special camera takes pictures of the radioactive material as it moves through your biliary tract. Doctors use cholescintigraphy to diagnose abnormal contractions of your gallbladder or a blockage in the bile ducts.

Endoscopic retrograde cholangiopancreatography (ERCP). ERCP combines upper gastroendoscopy and x-rays to treat problems of your bile and pancreatic ducts. ERCP helps the health care professional locate the affected bile duct and the gallstones. This test is more invasive—or involves more instruments inside your body—than other tests. Doctors use it selectively, usually to remove a gallstone that is stuck in the common bile duct.

Gallbladder Imaging – StatPearls – NCBI Bookshelf

Mark W. Jones; Sarang Kashyap; Troy Ferguson.

Author Information and Affiliations

Last Update: September 19, 2022.

Introduction

There are several variations and etiologies of gallbladder disease. Chronic and acute cholecystitis are the two ways this condition can present. Calculous and acalculous (with or without gallstones or cholelithiasis) are also variants of this disease. The most common form of gallbladder disease is chronic cholecystitis with cholelithiasis. Up to 15% of the population of the United States has asymptomatic gallstones. On the other hand, 15% of all cases of cholecystitis are acalculous or without stones.

Twenty to 25 million Americans have gallstones. Annually, more than 750,000 individuals undergo cholecystectomy in the United States. Many factors have been linked to gallbladder disease. Female gender, obesity, hormone exposure, diabetes, liver disease, age older than 40 years, and drastic weight loss are just a few factors that are associated with a higher incidence of gallbladder disease and gallstones.

Symptoms of cholecystitis must be distinguished from other conditions such as irritable bowel, peptic ulcer disease, gastroesophageal reflux disease, and cardiac issues.

Cases of chronic cholecystitis present as progressing right upper abdominal pain with bloating, food intolerances (especially greasy and spicy foods), increased gas, nausea, and vomiting. Pain in the midback or shoulder may also occur. This pain could be present for years until correctly diagnosed. Cases of acute cholecystitis have similar symptoms only more severe. Often, symptoms are mistaken for cardiac issues. The finding of right upper abdominal pain with deep palpation, Murphy’s sign, is usually classic for this disease. Often, there is a specific dietary event leading to the acute attack, “I ate pork chops and gravy last night.” The most important and useful test when diagnosing acute or chronic cholecystitis is a thorough history and physical exam performed by an experienced practitioner who is familiar with gallbladder disease.

Gallbladder cancer is somewhat rare, annually affecting 3 out of 100,000 individuals in the United States. It may present with symptoms similar to cholecystitis or may be asymptomatic until it becomes advanced.http://www.ncbi.nlm.nih.gov/pubmed/28991561

Anatomy

Acute and chronic cholecystitis is caused by either a mechanical blockage of the biliary system, usually of the cystic duct, or by a functional hypokinetic condition of the gallbladder.

Gallstones most often cause mechanical anatomic blockages of the biliary outlet. Other etiologies responsible for mechanical obstruction are neoplasms, external compression, and stenosis of the bile duct.

Functional obstructions are caused by the hypokinetic emptying of the gallbladder from situations of decreased stimulus to the gallbladder such as in fasting states, critical illnesses, and nerve disruption associated with vagotomies, and gastric surgeries.[1]

Plain Films

There are several diagnostic tests used make the determination of gallbladder disease. A simple abdominal x-ray can be used to identify calcified gallstones. Because only 10% of all gallstones are calcified, this imaging study has limited usefulness. Porcelain gallbladders can also be seen in plain x-rays. This condition is somewhat uncommon and results from calcification of the gallbladder wall. In 1924, two American surgeons developed the oral cholecystogram or OCG. The OCG is done by administering iopanoic acid by mouth. This is an iodine-based material that is absorbed by the intestines and concentrated in the gallbladder. When it combines with bile salts, it becomes a very radio-opaque liquid present within the gallbladder. This will outline any gallstones present in the gallbladder. The intervenous cholangiogram was developed in 1954. It was chiefly used to evaluate the bile ducts and to look for stones or strictures within these bile ducts. An iodine-based dye is injected intravenously. It is then concentrated in the liver and excreted into the bile ducts. The intervenous cholangiogram was a poor test to evaluate the actual gallbladder because sometimes the gallbladder was bypassed entirely as the dye went directly from the bile ducts into the small bowel. Both the oral cholecystogram and the intravenous cholecystogram are seldom used today.

Computed Tomography

Acute gallbladder disease, gallstones, polyps, and occasionally, gallbladder sludge, can be diagnosed with a CT scan. The scan is most often done when the patient is undergoing an initial workup in the emergency department, and the specific diagnosis is unclear. Pericholic fluid and a thickened gallbladder wall may be seen in cases of acute cholecystitis. Chronic cholecystitis may have nonspecific findings of a thickened gallbladder wall. Gallstones and gallbladder sludge may also be identified with a CT scan.

The CT scan is probably the most useful test when doing a workup for suspected gallbladder cancer. This test is noninvasive and can evaluate the size of the tumor, areas or metastasis, and whether or not there is a gross direct extension into the liver.[2]

Magnetic Resonance

MRIs may identify the same findings as a CT scan. An MRCP (magnetic resonance cholangiopancreatogram) is a noninvasive imaging study useful when evaluating the biliary ducts. It can detect bile duct stones, strictures and neoplasms as small as several millimeters. An endoscopic retrograde cholangiopancreatogram (ERCP) is an invasive procedure that is also used to diagnose stones, strictures, and neoplasms of the biliary system. This procedure can also be used to treat and make a more definitive diagnosis by using biopsies, placing stents and removing retained bile duct stones. This does, however, add the risk of iatrogenic complications such as pancreatitis. Endoscopic ultrasonography is another procedure that allows good visualization of the bile ducts and pancreatic head.[2]

Ultrasonography

The best diagnostic test to confirm gallbladder disease is the abdominal ultrasound. It is noninvasive and is 90% to 95% accurate in detecting gallstones. Pericholic fluid and thickened gallbladder walls can also be identified as in acute cholecystitis. Gallbladder sludge and occasionally common bile duct stones can also be seen with abdominal ultrasounds.

The gallbladder ultrasound may also be useful in detecting possible gallbladder neoplasms.

The EUS or endoscopic ultrasound is not a first-line test for diagnosing gallbladder disease. There is no place for it as a diagnostic tool for cholecystitis. It is useful when evaluating and staging tumors of the gallbladder, pancreas, and bile ducts. Biopsies can also be done for tissue diagnosis.[3]

Nuclear Medicine

If acute cholecystitis is suspected and there is a negative gallbladder ultrasound, then a hepatobiliary iminodiacetic acid or HIDA scan is indicated. This is done by injecting technetium Tc 99m intravenously. It is taken up by the liver and excreted into the biliary system. If there is no filling of the gallbladder, then this would indicate complete mechanical or functional blockage of the cystic duct. This finding is close to 100% accurate for diagnosing acute cholecystitis. If a patient has characteristic symptoms of nonacute cholecystitis or biliary cholic and the gallbladder ultrasound is negative, they could have chronic acalculous cholecystitis. This is a functional problem caused by the hypokinetic emptying of the gallbladder. The best diagnostic test for this condition is a HIDA scan with KINAVAC (cholecystokinin-CCK). Tc 99m is administered as with a routine HIDA scan. Once the gallbladder is visualized, then the KINAVAC is administered intravenously. This simulates eating and causes the gallbladder to contract and empty. The percent that the gallbladder empties, called ejection fraction (EF), is measured digitally. An ejection fraction of below 30-35% is considered abnormal and possibly indicative of acalculous cholecystitis. Documented reproduction of symptoms with administration of the KINAVAC may also be indicative of gallbladder disease. Some studies have shown a 95% accuracy rate in detecting acalculous cholecystitis with a low EF in a HIDA scan. Other studies found that the accuracy of a HIDA scan may be altered in the presence of other ailments, especially other gastrointestinal (GI) conditions.http://www.ncbi.nlm.nih.gov/pubmed/28861635

Clinical Significance

Correct imaging tests are vital when diagnosing cholecystitis or carcinoma of the gallbladder because a missed diagnosis could lead to a significant increase in patient morbidity and mortality. Various indications and knowledge of the appropriate tests to be ordered as well as obsolete tests are crucial when dealing with gallbladder disease.

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References

1.

Salazar MC, Brownson KE, Nadzam GS, Duffy A, Roberts KE. Gallbladder Agenesis: A Case Report. Yale J Biol Med. 2018 Sep;91(3):237-241. [PMC free article: PMC6153629] [PubMed: 30258310]

2.

de Savornin Lohman EAJ, de Bitter TJJ, van Laarhoven CJHM, Hermans JJ, de Haas RJ, de Reuver PR. The diagnostic accuracy of CT and MRI for the detection of lymph node metastases in gallbladder cancer: A systematic review and meta-analysis. Eur J Radiol. 2019 Jan;110:156-162. [PubMed: 30599854]

3.

Negrão de Figueiredo G, Mueller-Peltzer K, Zengel P, Armbruster M, Rübenthaler J, Clevert DA. Contrast-enhanced ultrasound (CEUS) and gallbladder diseases – A retrospective mono-center analysis of imaging findings with histopathological correlation. Clin Hemorheol Microcirc. 2019;71(2):151-158. [PubMed: 30584127]

Disclosure: Mark Jones declares no relevant financial relationships with ineligible companies.

Disclosure: Sarang Kashyap declares no relevant financial relationships with ineligible companies.

Disclosure: Troy Ferguson declares no relevant financial relationships with ineligible companies.

CT scan of the gallbladder – computed tomography of the gallbladder in Moscow: addresses, prices | Dikul Center

CT scan of the gallbladder – computed tomography of the gallbladder in Moscow: addresses, prices | Center of Dikul | Center Dikul

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Koimshidi Olga Alekseevna

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Sedov Viktor Alekseevich

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Lamonov Pavel Yurievich

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stomach, liver, kidneys, spleen, intestines, gallbladder

Computed tomography (CT) uses X-rays to take pictures of a section of the body and is based on the varying densities of the organs and tissues through which the X-rays pass during the scan.

This instrumental diagnostic method is especially informative in examining a patient with suspected cancer, since it gives a clear picture of the location of the tumor, its volume and size, as well as the presence and prevalence of individual metastases in other organs and body systems. Therefore, in most cases, a CT scan is prescribed by a doctor on a planned basis, to clarify the final diagnosis, in the presence of the results of a previous diagnosis (X-ray, ultrasound, MRI, laboratory tests).

Computed tomography (CT) of the abdominal organs , which is performed at the Spizhenko Clinic, is one of the best methods for diagnosing the condition of internal organs and systems, both benign and malignant tumors. On the obtained CT images, neoplasms in the parenchymal organs are clearly visible: the liver, pancreas, and spleen. Hollow structures are especially clearly visualized: the stomach, gallbladder, bile ducts, all sections of the intestine (thin and thick).

Despite the fact that CT better “distinguishes” inflammatory processes, cystic formations of dense and hollow organs, the tomography procedure using a contrast agent provides an accurate picture of pathological changes and tumors of minimal size (up to 0.6 mm) in the liver and spleen. CT with contrast allows you to see changes in the lymphatic structure of the abdominal cavity, intrahepatic bile ducts, as well as in the intestine – a hard-to-reach area for other types of diagnostics. Due to differences in tissue density, CT images perfectly visualize tumors of various structures in the pancreas and intestines.

CT determines the size and boundaries of tumors, the presence of metastases, the degree of prevalence and other parameters by which the stage of the disease is determined and the treatment process is planned.

How is a CT scan performed?

Computed tomography of the abdominal organs in the Spizhenko Clinic is performed on a modern tomograph Siemens SOMATOM go.up

No special preparation is required for a CT scan. During the examination, the patient lies motionless on a special tomography table, which slowly passes through the CT scanner in the form of a large ring.

The entire procedure of computed tomography at the Spizhenko Clinic (with patient positioning, contrast injection) takes from 10 minutes, depending on the location of the tumor, its size and the need for contrast agent injection.

Often, CT requires the introduction of a contrast agent to obtain a more accurate diagnosis of problem areas of the body. The contrast contains iodine and can be administered to the patient both orally and intravenously, and is prescribed only after the results of a biochemical blood test for creatinine and urea levels.

Scanning is not uncomfortable.

Contra-indication for CT scan is intolerance to iodine-containing preparations. In addition, there are limitations to CT diagnostics during pregnancy.

The cost of computed tomography of the abdominal organs in Kyiv

In our medical center, computed tomography is performed on the most modern model of a Siemens CT scanner in Ukraine, which allows diagnosing with submillimeter accuracy – up to 0.6 mm. The cost of a study in the clinic is commensurate with the prices for CT in other medical institutions in Kyiv and is:

• CT without contrast — 1405 UAH ;
• CT scan with contrast agent — 2605 UAH .