How to test the gallbladder: Diagnosis of Gallstones – NIDDK
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.
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.
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
- 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?
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!
About health: how to determine the stagnation of bile in the body was told to patients at the “School of Health” Tsivilskaya Central District Hospital
At the initial stages, bile stasis is easily corrected, but if the situation is started, the matter can end even with an emergency operation.
Probably everyone is familiar with the feeling: you eat a piece of fatty food, but the feeling remains that you overeat. There is heaviness in the right side, the food seems to be not digested for a long time. This is one of the symptoms of stagnation of bile.
Together with Maria Alekseeva, , a doctor for ultrasound diagnostics at the Tsivilsky Central District Hospital , at the “School of Health” for patients, we analyzed the main signs of trouble in the gallbladder and found out how it can be treated.
Signs of bile stasis:
- aching and pulling pain in the right side after exercise;
- feeling of discomfort in the right side – as if something were blocking or squeezing there;
- right pain when bending and turning;
- when sitting for a long time in the wrong position, the right hand begins to ache, pain appears in the right shoulder blade;
- dryness or bitterness in the mouth, slight changes in skin tone.
Innocent at first glance, stagnation of bile can turn into a big disaster.
Cholestasis (stagnation of bile) ranks third among diseases and pathologies of the digestive tract and is getting younger from year to year.
It affects people of retirement age, women over 40, pregnant women, office workers and schoolchildren (long restriction in movement and incorrect posture at the desk).
Bile is a secretion product of liver cells. It is produced in the liver, then through the hepatic and bile ducts it enters the gallbladder, where it accumulates. As soon as food enters the oral cavity and the digestion process begins, bile enters the intestine (duodenum), where it neutralizes hydrochloric acid residues, breaks down fats (emulsifies to the desired condition so that they can be absorbed into the blood), helps the body absorb fat-soluble vitamins A, E, D, K, disinfects food and removes excess pathogenic bacteria in the small intestine, participates in other enzymatic reactions for the full digestion of food and absorption of nutrients. For example, it activates lipase (pancreatic enzyme).
When digestion does not occur, bile accumulates in the gallbladder, a small pear-shaped organ located at the right intercostal arch.
If for some reason bile stagnates and does not enter the intestines, this leads to disruption of the entire digestion process. Cholestasis can lead not only to dysfunction of the gastrointestinal tract, but also to serious diseases associated with metabolic disorders: beriberi, osteoporosis, cholelithiasis, cholecystitis, in severe cases – cirrhosis of the liver (accumulation of bile, its increased concentration changes and recycles liver cells) and can also lead to diabetes. Therefore, this state cannot be started.
To prevent stagnation of bile, doctor Maria Mikhailovna, a specialist of the first category, warned patients about what to remember.
The stagnation of bile is partly facilitated by the liver itself, which produces bile, and the ducts through which it moves, and the gallbladder.
To avoid problems, bile should always be liquid, not viscous or jelly-like.
Bile is a highly concentrated secret, when it is in a stationary state for a long time, a precipitate begins to form, first in the form of flakes, then they form stones. Do not forget that bile is secreted at every meal and the role of proper regular nutrition is very important in preventing the formation of stones!
Bile moves through ducts surrounded by muscles. It will not be superfluous to remember that any stress leads to spasm, including muscle spasm, which can lead to a banal clamping of the ducts themselves and their inlet and outlet sphincters. Bile can get stuck in the ducts. Therefore, eating should always be in a calm atmosphere and in the right posture: give yourself pleasure – have breakfast, lunch and dinner beautifully.
The formed bile stasis can be recognized by the following features:
- dull pain in right hypochondrium;
- frequent belching;
- enlarged liver;
- dark urine and light stools;
- constipation or diarrhea;
- bad breath;
- chronic fatigue, drowsiness;
- bitterness in the mouth;
- persistent pruritus;
- yellow color of the skin and whites of the eyes.
At the first signs of congestion, it is better to have an ultrasound immediately. If you feel unwell, you should consult a doctor. With prolonged stagnation, both sand and stones in the gallbladder can form, and with any stimulation of the movement of bile, the movement of stones can also be provoked. If the stone is small, then albeit with pain, it will come out of the duct, and a large one can block the duct. And in this case, an emergency operation is indicated.
An accurate diagnosis of bile stasis requires additional examination and treatment:
- Ultrasound of the liver and bile ducts. It will help to assess the extent of the lesion and the presence of stones. The presence of bile sediment will indicate that the bile is thick and viscous, difficult to move through the bile ducts, and therefore can stagnate. The accumulation of bile in the ducts causes an increase in the liver in volume.
- General blood and urine tests will help assess the general condition of the body.