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.

Diagnostic Tests for Gallbladder Disease

The gallbladder — a sac located near the liver that serves as a storage space for bile — can be stricken with various problems, such as gallbladder cancer or inflammation (called cholecystitis).

Gallstones are also a common gallbladder problem, and infection can occur if the gallbladder remains blocked by a gallstone or continues to be inflamed.

Gallbladder disease is the term used to describe many of these maladies that can plague the gallbladder. But in many forms of gallbladder disease, a person may have no symptoms — up to 90 percent of people with gallstones, for example, don’t have any symptoms at all. So how can gallbladder disease be diagnosed?

Gallbladder Disease: When Diagnostic Tests Are Needed

Your doctor isn’t going to test you for something that you’re not complaining about, so generally, the only time diagnostic tests for gallbladder problems are done is when a person experiences symptoms. Warning signs of gallbladder problems include:

• Bouts of severe pain in the right upper abdomen and sometimes the right chest or back
• Pain after eating, particularly high-fat foods, or at night
• Fever, with shaking and chills, especially if occurring with, or after, abdominal pain
• Nausea and perhaps vomiting
• Heartburn and indigestion
• A feeling of fullness in the abdomen, or excess gas

If you don’t have symptoms, that doesn’t mean your gallbladder is perfectly normal. Often, doctors will spot signs of gallbladder problems during diagnostic testing for some other symptom or health condition.

Gallbladder Disease: Eliminating Other Causes

If you have some combination of these symptoms, your doctor probably will start by asking detailed questions about them. He may ask for more details about the pain — what it feels like, when it happens, and where in your belly it hurts. Your doctor will also ask questions to look for other possible causes of abdominal pain, like:

• Irritable bowel syndrome (IBS)
• Crohn’s disease or ulcerative colitis
• Cancer or inflammation of the pancreas
• Kidney stones or urinary tract infections
• Pneumonia (when it involves the lower part of the right lung, it can be confused with gallbladder discomfort)
• Viral hepatitis
• Appendicitis
• Gastroesophageal reflux or ulcers in the stomach
• Diverticulitis or diverticulosis — conditions affecting the lining of the colon

Gallbladder Disease: Diagnostic Imaging Tests

After asking questions about your symptoms, doing a physical exam, and eliminating some causes from the list of possibilities, your doctor probably will perform some imaging tests to look at your gallbladder.

Imaging tests used to diagnose gallbladder problems include:

• An ultrasound. This is the most commonly used of the diagnostic tests for gallbladder problems. While very effective in diagnosing even very small gallstones, it can’t always clearly diagnose cholecystitis (inflammation of the gallbladder).
• X-rays. An abdominal X-ray can spot gas and some types of gallstones containing calcium. Some X-ray types require that a patient swallow a dye or have dye injected into the body so the X-ray can capture a clearer picture of the gallbladder.
• Computed tomography (CT) scan. This imaging test uses a computer and X-rays to spot gallbladder problems, but isn’t the most effective method of diagnosing gallstones. CT scans can help spot ruptures (tears in the gallbladder wall) and infections inside the gallbladder or its bile ducts.
• Magnetic resonance imaging (MRI) . Regular MRI, or another type called magnetic resonance cholangiography (MRC), can help diagnose stones in the bile ducts. MRC uses regular MRI imaging technology plus a dye administered into the bile duct. This test is very useful for diagnosing biliary tract (gallbladder and surrounding ducts) cancer, but may not be able to spot tiny stones or persistent infections.
• Endoscopic retrograde cholangiopancreatography (ERCP) . This test uses an endoscope (a tube fitted with a tiny camera and light) that is inserted into the throat, down through the stomach, and into the small intestine. This test can help spot gallstones or problems in the bile ducts of the gallbladder — it’s considered the “gold standard” when it comes to diagnosing stones blocking bile ducts, and allows for removal (using a small basket-like device) during the test. But there is a risk of complications, so the test is typically only given to people who are thought to be very likely to have stones blocking the bile ducts.
• Cholescintigraphy (also called DISIDA, HIDA scan, or gallbladder radionuclide scan). A small amount of radioactive dye is administered, and then a scanning device is used to track the dye as it moves into the gallbladder. This screening method can spot a blocked duct and acute inflammation, but not chronic gallbladder inflammation or gallstones.

Gallbladder Disease: Blood and Urine Tests

A blood test may also be performed to help diagnose gallbladder disease. A complete blood count, or CBC, can help confirm an infection if there is a high white blood cell count. Other specific blood tests can also reveal high bilirubin levels (the cause of jaundice, a complication of gallbladder problems) or elevated enzymes suggesting an obstruction in the gallbladder.

Urine tests may also be performed to help diagnose problems with the gallbladder by looking for abnormal levels of chemicals like amylase, which is an enzyme that aids in the digestion of carbohydrates, and lipase, another enzyme that helps break down fats.

Even if signs and symptoms are not directly suggesting gallbladder disease, your doctor has many ways to visualize the gallbladder. With these tests, your gallbladder disease can usually be promptly diagnosed — and just as importantly, properly treated.

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How to check the gallbladder, what tests to take?

05/31/2021

In most cases, when patients come to me, interviewing them, I hear the diagnoses and pathologies that accompany the patient throughout life and are related to the gallbladder.

What is the gallbladder, what is it for and what does it cause?

The gallbladder is, relatively speaking, a “depot” for bile, formed by the liver, then it gets to it for “maturation” – there it concentrates (due to a decrease in the amount of fluid – dehydration is possible up to 10 times!) And waits for a signal if it needs to stand out for inclusion in the digestive system.
The control of the synchronous contraction of the gallbladder, bile ducts and the valve that regulates the supply of bile to the duodenum occurs due to the nervous and humoral (hormones) systems.
A healthy person produces about 2 liters of bile per day. Of course, with a gallbladder volume of up to 90-120 ml, filling it 20 times and reducing it is not very rational. Therefore, bile does not always accumulate in the bladder, but is also released in parallel into the intestine at a rate of several drops per minute. This immediately helps to solve several issues. Bile is an excellent antiseptic and regulates the normal composition of microflora in the intestine. It is a stimulant of peristalsis and thus will help maintain normal bowel contractility. With the help of bile, incl. metabolic products that are not very properly stored in the body, and therefore, bile also performs an excretory function.
But when we ate, bile secretion increases significantly, as it takes part in the primary processing of fats (the so-called “emulsification” – the dissolution of fats). Only after this, the lipase enzyme secreted by the pancreas can digest fats.

But there are a number of conditions (sometimes mythical) when there are problems with the work of the biliary system.
The mythical problem is the shape of the gallbladder and any “obstacles” that prevent the gallbladder from working, but we have everything in a row – “kinks”, “constrictions”, “curvature” and others. According to modern concepts, the shape of the gallbladder does not affect its function, but the presence of these problems is simply a 3D visualization of the gallbladder itself, which, like any organ, can change its shape. Yes, there are a number of conditions when, after an independent recovery from acute inflammation of the gallbladder, its deformation took place, but this is such a liquid state that, in extreme cases, several such people can be identified in Ukraine.
Billiard dysfunction is one of the most common functional disorders of the biliary system, and is associated with asynchrony of the gallbladder, ducts and valve apparatus. Usually it is manifested by heaviness, pain, discomfort in the right hypochondrium after a meal and can last up to 30 minutes, and it is possible to pass until the next meal. In this case, it is imperative to consult a doctor to rule out an organic pathology of the biliary tract – inflammation, calculi (stones).
It is not worth it to independently examine the function of the gallbladder (without a doctor’s referral to undergo an examination) or self-medicate (take the so-called “choleretic”) is not worth it, since self-interpretation of the results of examinations or taking medications is contraindicated in certain diseases, we can miss a serious illness or worsen gallbladder problem.
First of all, when any health problems arise, you should contact your family doctor, who, if necessary, will refer you to a gastroenterologist. In the presence of private medicine, it is possible to get an appointment with a gastroenterologist without a referral from your family doctor.
Further, the doctor, if there is a suspicion of a violation of the biliary system, prescribes an additional examination. Basic in this situation:

• Abdominal ultrasound
• Liver tests
• Blood alpha-amylase, blood lipase (since the pancreas has a common duct system with bile ducts)
• Complete blood count, C-reactive protein.

Determining the function of the gallbladder by functional load is not a protocol study, but rather a historical diagnostic method and is indicative for the doctor. The doctor cannot rely on this examination as a determining one, since it is very conditional and subjective.
It is important to remember that the diagnosis is not made via the Internet or the similarity of symptoms with the illness of a work colleague. Diagnosis is the result of a complex search and comparison of patient complaints, examination results and response to treatment.

We wish you good health!

05/31/2021

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Diseases of the gallbladder – pathology, symptoms

The gallbladder is a small reservoir for bile located on the visceral surface of the liver in the region of the right hypochondrium. The bladder is about 10 cm long.

The main functions of bile include:

1. Fatty acid metabolism: without adequate excretion and utilization of bile, a person may have problems digesting fats and fat-soluble vitamins such as vitamins A, D, E, K .
2. Excretion: The job of the liver is to deactivate the toxins that bile takes in and removes through the digestive tract.
3. Destruction of microbial flora: poor bile production can cause increased bacterial fermentation and an increase in bacteria in the small intestine.
4. Blood sugar metabolism: bile is essential for the breakdown of fatty acids and normalization of fat metabolism, bile receptors, FXR and TGR5 help regulate lipid and carbohydrate metabolism.

Pathologies of the gallbladder

The most common pathologies affecting the gallbladder are:

1. Gallstone disease (GSD). Substances contained in bile can crystallize, forming stones (calculi). Stones of small sizes do not cause serious discomfort, but with an increase in the size of a person, pain, spasms, and nausea begin to bother. Also, pain is preceded by physical activity, a deep breath. The pain syndrome in cholelithiasis begins suddenly and passes just as quickly.
2. Cholecystitis. More often, cholecystitis is the result of gallstone disease. Inflammation causes severe pain in the right hypochondrium and epigastric region, fever. Rarely, pain will spread to the entire abdomen and intensify when lying on the left side. Exacerbation of chronic cholecystitis is characterized by severe cutting pains, nausea, vomiting with bile, pallor or yellowness of the skin. With recurrence of cholecystitis, surgical treatment is indicated in conjunction with drug therapy.
3. Cancer of the gallbladder. This lesion is quite rare. It can be diagnosed in the later stages, when a vivid clinical picture appears. The symptoms of cancer are similar to those of gallstone disease.
4. Gangrene or abscess of the gallbladder.
5. Congenital defect of the gallbladder.
6. Sclerosing cholangitis (damage to the bile ducts with further development of liver failure).

Symptoms

A common symptom of gallbladder disease is pain, or biliary colic. As a rule, the patient experiences constant squeezing or cutting pain in the upper right side of the abdomen, which may radiate to the upper back. Some patients experience chest pain, nausea, and vomiting. Strengthening of the pain syndrome is observed when eating fatty foods, fried or smoked.

It is not uncommon for people with gallstones to develop inflammation of the gallbladder (acute cholecystitis) when stones block the bile duct. The symptoms are similar to those of cholelithiasis, but are more severe and prolonged.

Clinical presentation of cholecystitis includes pain in the upper right abdomen, which may last for several days and is aggravated by inhalation. Approximately one third of patients experience vomiting, fever, chills, and nausea.

When the disease passes into the chronic stage, a scar may form on the bladder. In this case, the patient is noted for constant diarrhea, constipation or diarrhea, nausea in the morning, discomfort in the abdomen after eating.