Tests used to diagnose gallbladder problems

Tests used to diagnose gallbladder problems

CT Scans | MRI | Ultrasound | X-rays

Specific signs and symptoms may indicate an issue in your gallbladder. Since the gallbladder is an internal organ, your health professional will most likely order diagnostic imaging tests to identify the problem. Several different tests for gallbladder issues are available depending on the suspected condition. It’s wise to learn about various gallbladder imaging tests — but first, you’ll need to understand what your gallbladder is and what concerns are possible.

Jump to Sections:

• What is the gallbladder?
• What are potential gallbladder problems?
• Signs of gallbladder problems
• How to test for gallbladder problems

What is the gallbladder?

Your gallbladder is an organ in your abdomen that stores stomach bile. This combination of fluids, fats and cholesterol breaks down the food you eat and allows your bloodstream to absorb vitamins and nutrients. In that way, your gallbladder is a vital part of the digestive process.

What are potential gallbladder problems?

Common gallbladder diseases and other issues include the following.

• Inflammation: Also called cholecystitis, inflammation can be acute or chronic.
• Gallstones: Gallstones are hardened deposits of cholesterol that can block the gallbladder’s channels or lead to infection. If a gallstone travels into the intestine, it can be life-threatening. Gallstones are common — up to 25 million Americans have this health concern.
• Bile duct infection: If you have a blockage in your bile duct, you may develop an infection.
• Polyps: Polyps are benign growths that pose a risk of developing into cancer.
• Porcelain gallbladder: A porcelain gallbladder has calcium-stiffened walls and can increase the risk of developing cancer.

Signs of gallbladder problems

If you experience one or more of the following symptoms, you could have an issue with your gallbladder:

• Severe pain in the right upper abdomen, right side of your chest or back
• Pain after eating, especially after eating high-fat foods
• Fever, along with shaking, chills and abdominal pain
• Indigestion or heartburn
• Nausea or vomiting
• Excess gas

Keep in mind, many of these symptoms could apply to other conditions, such as Crohn’s disease, appendicitis, ulcers or kidney stones. You’ll need to meet with your health provider, who will order tests to rule out different possibilities. The suspected concern will affect how a physician diagnoses gallbladder disease.

How to test for gallbladder problems

Many different methods are available for gallbladder diagnostics. Your health provider will order various tests depending on the suspected concerns. Typical tests for gallbladder issues include the following, but other tests may also be helpful.

Ultrasound

An ultrasound is a form of diagnostic sonography using high-frequency sound waves. It’s a non-invasive and painless way to test for gallbladder problems. It will reveal gallstones, including tiny ones. However, it is not a preferred method for diagnosing inflammation-related issues.

Before you undergo an ultrasound for gallbladder issues, the technologist might ask you to fast overnight or longer. For the test, you’ll lie face-up so they can apply a specialized gel to your abdomen. The gel prevents air pockets from forming between the reading device — also called a transducer — and your skin. The technologist will then move the transducer across your abdomen so it can capture images. If the results are unclear, further tests might be necessary.

X-ray

An x-ray uses electromagnetic radiation to create black-and-white images of the inside of your body. Your health provider may order an x-ray if they suspect gas buildup, calcified gallstones or porcelain gallbladder concerns. You could need other tests along with an x-ray.

The procedure for getting an x-ray can vary. In some cases, you may need to swallow a substance called iopanoic acid or receive it as an injection. The iopanoic acid will become concentrated in your gallbladder. As it mixes with the bile salts, it stands out on an x-ray. However, an x-ray is only helpful for finding calcified gallstones, so you might need other tests to find non-calcified gallstones. Only about 10% of gallstones are calcified.

Computed tomography scan

A computer tomography scan can help identify tears in the gallbladder wall or infections. However, other methods are more effective at finding gallstones. A CT scan involves a narrow beam of x-rays rotated around the body. It results in cross-sectional images showing more detailed information than you can achieve with a traditional x-ray. The computer can stack the cross-sections together to create a complete three-dimensional picture.

To receive a CT scan, you’ll lie on a bed that will move through a large, round machine. A tube will rotate around you, sending x-rays through your body and transmitting the resulting images to a computer. Each rotation creates one full cross-section. The technologist can observe each two-dimensional cross-section and the entire three-dimensional image to find abnormalities.

Magnetic resonance imaging

Another way to identify gallbladder concerns is through magnetic resonance imaging. It’s an effective way to find stones or growths in your bile ducts, but it might not pick up on small stones or infections. In some cases, an MRI can serve as a follow-up test after an ultrasound.

An MRI scan is similar to a CT scan. It also creates three-dimensional images, but it uses magnets and radiofrequency rather than x-rays. An MRI generates a magnetic field around your body, which causes the protons in your cells to move. As your protons realign, the MRI machine captures images. You may receive an injection containing the element gadolinium, which makes your protons move faster for a sharper image.

During an MRI, you have to stay still to avoid blurring the images. If you have a condition that prevents you from lying still on your back, or if you have an iron-containing implant, an MRI might not be an option for you.

What is the best test for gallbladder issues?

The best diagnostic test for gallbladder problems will depend on the concern at hand. If your health professional suspects a gallbladder issue, they might order several different tests. Many patients require multiple tests to verify findings. For example, your doctor might first order an ultrasound, followed by an MRI.

Request gallbladder diagnostic imaging with Envision Imaging

If you’re experiencing pain in your upper abdomen, indigestion or other signs of gallbladder issues, you may need to undergo image testing. Most tests are quick, non-invasive and painless. If you require diagnostic imaging, consider Envision Imaging. We offer world-class imaging services with individualized and compassionate care. Our goal is to provide affordable operational excellence, which is why we accept a wide range of insurance plans.

At Envision Imaging, we understand the circumstances surrounding diagnostic imaging can be stressful. We always focus on providing a pleasant experience along with our quality care. Learn more about our services, and find a location near you for gallbladder diagnostic imaging.

Call To Schedule Your Appointment

Sources:

1. https://www.ncbi.nlm.nih.gov/books/NBK470366/ x2
2. https://www. envrad.com/services/ultrasound-sonogram/
3. https://www.envrad.com/services/x-ray/
4. https://www.envrad.com/services/ct-scans/
5. https://www.nibib.nih.gov/science-education/science-topics/computed-tomography-ct
6. https://www.nibib.nih.gov/science-education/science-topics/magnetic-resonance-imaging-mri
7. https://www.envrad.com/services/mri-scans/
8. https://www.envrad.com/about-us/why-choose-us/
9. https://www.envrad.com/locations/

Sources not cited:

1. https://www.everydayhealth.com/gallbladder/diagnostic-tests-for-gallbladder-disease.aspx

Tests for Gallbladder Cancer | Diagnosing Gallbladder Cancer

Some gallbladder cancers are found after the gallbladder has been removed because of gallstones or to treat chronic (long-term) inflammation. Gallbladders removed for those reasons are always looked at under a microscope to see if there’s cancer cells in them.

Most gallbladder cancers, though, aren’t found until a person goes to a doctor because they have symptoms.

Medical history and physical exam

If there’s reason to suspect you might have gallbladder cancer, your doctor will want to take a complete medical history to check for risk factors and to learn more about your symptoms.

Your doctor will examine you to look for signs of gallbladder cancer and other health problems. The exam will focus mostly on the abdomen (belly) to check for any lumps, tenderness, or fluid build-up. The skin and the white part of the eyes will be checked for jaundice (a yellowish color). Sometimes, cancer of the gallbladder spreads to lymph nodes, causing a lump that can be felt beneath the skin. Lymph nodes above the collarbone and in several other locations may be checked.

If symptoms and/or the physical exam suggest you might have gallbladder cancer, tests will be done. These might include lab tests, imaging tests, and other procedures.

Blood tests

Tests of liver and gallbladder function

Lab tests might be done to find out how much bilirubin is in your blood. Bilirubin is the chemical that causes jaundice. Problems in the gallbladder, bile ducts, or liver can raise the blood level of bilirubin.

The doctor may also do tests for albumin, liver enzymes (alkaline phosphatase, AST, ALT, and GGT), and certain other substances in your blood. These may be called liver function tests. They can help diagnose liver, bile duct, or gallbladder disease.

Tumor markers

Tumor markers are substances made by cancer cells that can sometimes be found in the blood. People with gallbladder cancer may have high blood levels of the markers called CEA and CA 19-9. Usually the blood levels of these markers are high only when the cancer is in an advanced stage . These markers are not specific for gallbladder cancer – that is, other cancers or even some other health conditions also can make them go up.

These tests can sometimes be useful after a person is diagnosed with gallbladder cancer. If the levels of these markers are found to be high, they can be followed over time to help tell how well treatment is working.

Imaging tests

Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. Imaging tests can be done for a number of reasons, including:

• To look for suspicious areas that might be cancer
• To help a doctor guide a biopsy needle into a suspicious area to take a sample for testing
• To learn how far cancer has spread
• To help make treatment decisions
• To help find out if treatment is working
• To look for signs of the cancer coming back after treatment

People who have (or might have) gallbladder cancer may have one or more of these tests:

Ultrasound

Ultrasound uses sound waves and their echoes to create images of the inside of the body. A small instrument called a transducer gives off sound waves and picks up their echoes as they bounce off organs inside the body. The echoes are converted by a computer into an image on a screen.

Abdominal ultrasound: This is often the first imaging test done in people who have symptoms like jaundice or pain in the right upper part of their abdomen (belly). This is an easy test to have and it doesn’t use radiation. You simply lie on a table while a technician moves the transducer on the skin over the right upper abdomen.

This type of ultrasound can also be used to guide a needle into a suspicious area or lymph node so that cells can be removed (biopsied) and looked at under a microscope. This is called an ultrasound-guided needle biopsy.

Endoscopic or laparoscopic ultrasound: In these techniques, the doctor puts the ultrasound transducer inside the body and closer to the gallbladder. This gives more detailed images than a standard ultrasound. The transducer is on the end of a thin, lighted tube that has a camera on it. The tube is either passed through the mouth, down through the stomach, and near the gallbladder (endoscopic ultrasound) or through a small surgical cut on your belly (laparoscopic ultrasound).

If there’s a tumor, ultrasound might help the doctor see if and how far it has spread into the gallbladder wall, which helps in planning for surgery. Ultrasound may be able to show if nearby lymph nodes are enlarged, which can be a sign that cancer has reached them.

Computed tomography (CT) scan

A CT scan uses x-rays to make detailed cross-sectional images of your body. It can be used to

• Help diagnose gallbladder cancer by showing tumors in the area.
• Help stage the cancer (find out how far it has spread). CT scans can show the organs near the gallbladder (especially the liver), as well as lymph nodes and distant organs the cancer might have spread to.
• A type of CT known as CT angiography can be used to look at the blood vessels near the gallbladder. This can help determine if surgery is an option.
• Guide a biopsy needle into a suspected tumor. This is called a CT-guided needle biopsy. To do it, you stay on the CT scanning table while the doctor advances a biopsy needle through your skin and toward the mass. CT scans are repeated until the needle is inside the mass. A small amount of tissue (a sample) is then taken out through the needle.

Magnetic resonance imaging (MRI) scan

Like CT scans, MRI scans show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. A contrast material called gadolinium may be injected into a vein before the scan to see details better.

MRI scans provide a great deal of detail and can be very helpful in looking at the gallbladder and nearby bile ducts and other organs. Sometimes they can help tell a benign (non-cancer) tumor from one that’s cancer. Special types of MRI scans can also be used in people who may have gallbladder cancer:

• MR cholangiopancreatography (MRCP) can be used to look at the bile ducts and is described below in the section on cholangiography.
• MR angiography (MRA) looks at blood vessels and is also covered in the next section on angiography..

Cholangiography

A cholangiogram is an imaging test that looks at the bile ducts to see if they are blocked, narrowed, or dilated (widened). This can help show if someone might have a tumor that’s blocking a duct. It can also be used to help plan surgery. There are several types of cholangiograms, each of which has different pros and cons.

Magnetic resonance cholangiopancreatography (MRCP): This is a way to get images of the bile ducts using the same type of machine used for standard MRIs. Neither an endoscope or an IV contrast material is used, unlike other types of cholangiograms. Because it’s non-invasive (nothing is put in your body), doctors often use MRCP if they just need images of the bile ducts. This test can’t be used to get biopsy samples of tumors or to place stents (small tubes) in the ducts to keep them open.

Endoscopic retrograde cholangiopancreatography (ERCP): In this procedure, a doctor passes a long, flexible tube (endoscope) down your throat, through your stomach, and into the first part of the small intestine. This is usually done while you are sedated (given medicine to make you sleepy). A small catheter (tube) is passed out of the end of the endoscope and into the common bile duct. A small amount of contrast dye is injected through the catheter. The dye helps outline the bile ducts and pancreatic duct as x-rays are taken. The images can show narrowing or blockage of these ducts. This test is more invasive than MRCP, but it has the advantage of allowing the doctor to take samples of cells or fluid for testing. ERCP can also be used to put a stent (a small tube) into a duct to help keep it open.

Percutaneous transhepatic cholangiography (PTC): To do this procedure, the doctor puts a thin, hollow needle through the skin of your belly and into a bile duct inside the liver. You will get medicine through an IV line to make you sleepy before the test. A local anesthetic is also used to numb the area before putting the needle. A contrast dye is then injected through the needle, and x-rays are taken as it passes through the bile ducts. Like ERCP, this test can also be used to take samples of fluid or tissues or to put a stent (small tube) into a duct to help keep it open. Because it’s more invasive, PTC is not usually used unless ERCP has already been tried or can’t be done for some reason.

Angiography

Angiography or an angiogram is an x-ray test used to look at blood vessels. A thin plastic tube called a catheter is threaded into an artery and a small amount of contrast dye is injected to outline blood vessels. Then x-rays are taken. The images show if blood flow in an area is blocked anywhere or affected by a tumor, as well as any abnormal blood vessels in the area. The test can also show if a gallbladder cancer has grown through the walls of certain blood vessels. This information is mainly used to help surgeons decide whether a cancer can be removed and to help plan the operation.

Angiography can also be done with a CT scan (CT angiography) or an MRI (MR angiography). These tend to be used more often because they give information about the blood vessels without the need for a catheter. You may still need an IV line so that a contrast dye can be injected into the bloodstream during the imaging.

Laparoscopy

Laparoscopy is a type of surgery. The doctor puts a thin tube with a light and a small video camera on the end (a laparoscope) into a small incision (cut) in the front of your abdomen (belly) to look at the gallbladder, liver, and other nearby organs and tissues. (Sometimes more than one cut is made.) This is usually done in the operating room while drugs are used to put you into a deep sleep and not feel pain (general anesthesia) during the surgery.

Laparoscopy can help doctors plan surgery or other treatments, and can help determine the stage (extent) of the cancer. If needed, doctors can also put special instruments in through the incisions to take out biopsy samples for testing.

Laparoscopy is often used to take out your gallbladder. This operation is called a laparoscopic cholecystectomy. If gallbladder cancer is found or suspected during that operation, surgeons usually change to an open cholecystectomy (removal of the gallbladder through a larger cut in the abdomen). The open method lets the surgeon see more and may lower the chance of releasing cancer cells into the abdomen when the gallbladder is removed. The use of the open procedure depends on the size of the cancer and whether surgery can remove it all.

Biopsy

During a biopsy, the doctor removes a tissue sample to be looked at with a microscope to see if cancer (or some other disease) is present. For most types of cancer, a biopsy is needed to make a diagnosis. Biopsies are also used to help find out how far the cancer has spread. This is important when choosing the best treatment plan.

But a biopsy isn’t always done before surgery to remove a gallbladder tumor. Doctors are often concerned that sticking a needle into the tumor or otherwise disturbing it without completely removing it might allow cancer cells to spread.

If imaging tests show a tumor in the gallbladder and there are no clear signs that it has spread, the doctor may decide to proceed directly to surgery and treat the tumor as a gallbladder cancer. (See Surgery for Gallbladder Cancer.) In this case, the gallbladder is checked for cancer after it’s been removed.

In other cases, a doctor may feel that a biopsy of a suspicious area in the gallbladder is the best way to know for sure if it’s cancer. For example, imaging tests may show that a tumor has spread or grown too large to be removed completely by surgery. Many gallbladder cancers are not removable by the time they’re first found.

Types of biopsies

There are many ways to take biopsy samples of the gallbladder.

During cholangiography: If ERCP or PTC is being done, a sample of bile may be collected during the procedure to look for cancer cells in the fluid.

During laparoscopy: As noted earlier, biopsy samples can be taken during laparoscopy. Laparoscopy lets the doctor see the surface of the gallbladder and nearby areas and then take small pieces of tissue from any suspicious areas.

Needle biopsy: If the cancer is too big or has spread to much to be removed with surgery, a needle biopsy may be done to confirm the diagnosis and help guide treatment. For this test, a thin, hollow needle is put in through the skin and into the tumor without making a cut in the skin. (The skin is numbed first with a local anesthetic.) The needle is usually guided into place using ultrasound or CT scans. When the images show that the needle is in the tumor, cells and/or fluid are drawn into the needle and sent to the lab to be tested.

In most cases, this is done as a fine needle aspiration (FNA) biopsy, which uses a very thin needle attached to a syringe to suck out (aspirate) a sample of cells.Sometimes, the FNA doesn’t get enough cells for a definite diagnosis, so a core needle biopsy, which uses a slightly larger needle to get a bigger sample, may be done.

For more information on biopsies and how samples are tested, see Testing Biopsy and Cytology Specimens for Cancer.

Blood test for Echinococcus ᐈ (Echinococcus granulosus), IgG antibodies

Description of the test:

Echinococcus (Echinococcus granulosus), IgG antibodies – a test to determine if there are antibodies to the Echinococcus parasite in the patient’s blood – tapeworm, the larvae of which infect the human body. They provoke the development of a serious disease – echinococcosis.

Man is an intermediate host for the tapeworm, mature individuals parasitize in animals (most often dogs, foxes, wolves and jackals, less often cats). In the body of an intermediate host (except for humans, it can be livestock), worm eggs enter with soil particles on insufficiently processed products. Echinococcus eggs can also be found on animal fur.

After ingestion of Echinococcus eggs by humans, larvae hatch from them in the intestines, penetrating into the bloodstream through the mucous membranes of the digestive tract. With the bloodstream, the larvae are carried throughout the body, settling, most often, in the liver, although there are cases of their detection in the lungs, brain, heart and kidneys.

In the affected organ, larvae form a slowly growing bubble (echinococcal cyst), which can reach 20 centimeters in diameter. The disease can occur in a single chamber (one large bubble is formed) or a rarer multi-chamber form (many small cysts appear). Due to the slow growth rate of cysts, the disease develops slowly, and the first symptoms may appear several years after infection.

The body reacts to infection with the parasite by producing antibodies IgM and IgG, the latter are of clinical importance in diagnosis. Class G antibodies appear 1.5-2 months after infection and remain in the body for a long time.

Indications for prescription

The test can be prescribed by a general practitioner, infectious disease specialist, allergist, gastroenterologist, neurologist or surgeon.

Indications for examination are the symptoms of echinococcosis, which vary greatly, depending on which organ was affected by the parasite:

• pain in the right hypochondrium – an early symptom of liver echinococcosis;
• chest pain, cough, shortness of breath – may indicate lung damage;
• headache, vomiting, dizziness are the first signs of cerebral echinococcosis.

The parasite can also infect the kidneys, spleen, gallbladder, bones and spinal cord, so the symptoms of parasite development are varied.

The analysis is also used as a preventive measure for people who have constant contact with animals: veterinarians, livestock specialists, hunters, shepherds, etc.

The value of the results of the analysis for antibodies to echinococcus

The result of the analysis is displayed as a positivity index, if this indicator is less than 0.8, then the analysis is negative, if more than 1.0, it is positive. Intermediate values ​​are questionable and require retesting.

A negative result indicates that the patient either does not have echinococcus, or too little time has passed since the infection for an immune response. Reduced immunity, as well as the localization of the parasite in the brain, can also provoke a false negative result.

A positive result indicates that the patient is infected, but infections and helminthiases can cause a false positive result.

Therefore, the diagnosis is always made only by a doctor, taking into account all examinations, anamnesis and the patient’s condition.

Test preparation: not required.

Material for research: blood from a vein.

Research method: ELISA.

Deadlines: 2 business days.

MFD Medical Group – Be healthy!

Published: 07 08 2010

Gallbladder stones

General
details

The gallbladder is a sac-like organ located in front of the liver.
reservoir for liquid bile, which is produced in the liver and is involved in
digestion of fats. Gallbladder stones form from crystals
cholesterol or, more rarely, from bile salts. The stones may be small, or
large, the size of a walnut.

Cholecystitis or biliary colic occurs when a stone in the gallbladder
bladder, clogs the bile duct, through which bile flows from the bile
bladder in the small intestine.

Cholelithiasis is a disease of the hepatobiliary
system, which is characterized by the formation of stones (calculi) in the gallbladder
bladder and bile ducts. It is believed that 10-15% of the adult population
there are stones in the gallbladder, even if there are no other manifestations of the disease.

Causes

which bile is produced.

Because bile
contains a large amount of cholesterol, with its stagnation and thickening, as well as
with an increase in the content of cholesterol in bile, its precipitation begins
crystals. Combining, such crystals form stones, consisting of
cholesterol and bile salts.

The causes of cholecystitis are:

– malnutrition: (the predominance of fatty, high-calorie foods in the diet,
products rich in cholesterol),
– a violation of the evacuation of bile from the gallbladder (due to impaired motility,
inflammatory changes in the gallbladder or bile ducts, etc.), which
leads to its stagnation, thickening and formation of stones.

The causative agents of the disease in most cases are microbes (intestinal
coli, streptococci, enterococci, staphylococci), which enter the bile
bubble from the intestine through the bile ducts. The emergence and development
diseases contribute to: gastritis (reduced secretory activity of the stomach).

Kinds
cholecystitis

The course of the disease can be acute and chronic .

Main features acute cholecystitis : paroxysmal
pain in the right side of the abdomen, radiating to the right shoulder, shoulder blade; nausea and
vomit; chills and fever; possible jaundice and itching of the skin
covers. Complications occur in 15-20% of cases of acute cholecystitis. To them
include a purulent inflammatory process around the gallbladder (abscess),
gangrene, perforation of the gallbladder with the development of inflammation in the abdomen and sepsis,
biliary fistulas that communicate the gallbladder with the intestines, stomach and even the kidney,
acute pancreatitis, obstructive jaundice. Dangerous complication of acute cholecystitis
– peritonitis.

Chronic cholecystitis may be acalculous and
calculous, from the Latin word “calculus”, which means “stone”. calculous
cholecystitis is one of the results of gallstone disease.
Chronic cholecystitis is manifested by nausea, dull pain in the right hypochondrium and
other unpleasant sensations that occur after eating.
Chronic cholecystitis can be a consequence of acute cholecystitis, but it can also occur
on one’s own.

Types
gallstones

There are two main types of gallstones: cholesterol and pigmented.
different in composition and pathogenesis. The former are the most common
their ratio to pigmented ones largely depends on the region and population.
The clinical syndromes caused by gallstones do not depend on the type
stone. The schematic arrangement of stones in the biliary tract is shown in Fig.

Fig. schematic
image of possible sites of localization of gallstones

1 – gallbladder, gallbladder neck, cystic stream
2 – common hepatic stream
3 – various parts of the common bile stream
4 – ampulla of Vater’s papilla
5 – intrahepatic bile ducts

Cholesterol stones. Consisting mainly of
cholesterol (the proportion of which is usually > 60%), mucin, bilirubinate, phosphate,
calcium carbonate and palmitate, as well as small amounts of other substances.
“Pure” (100%) cholesterol stones account for approximately 10-15% of all
cholesterol stones.

Some stones contain less than 60% cholesterol, but
have morphological and microstructural features of typical cholesterol
stones, they are called mixed stones.

The following factors have been found to be associated with high risk
formation of cholesterol stones:

• old age,
• female,
• obesity,
• pregnancy,
• rapid weight loss,
• malnutrition

Pigment stones. Composed primarily of bilirubin and
calcium salts. There are two types of pigment stones: black and brown.

Å
Black pigment stones . Consisting of bilirubinate
calcium and other compounds of bilirubin, mucin, calcium salts of phosphate and
carbonate and small amounts of other substances. are found almost
exclusively in the gallbladder and, rarely, in the bile ducts.

Conditions associated with the risk of developing this type of stone include:

• old age,
• liver cirrhosis,
• long-term total parenteral nutrition

Å
Brown pigment stones. Consists of bilirubinate
calcium, cholesterol, calcium palmitate and other substances. are found,
mainly in the bile ducts. Most patients with brown
bile duct stones are characterized by the presence of stasis and/or infection, such as
predisposing conditions. This type of stone can be found in 9 patients0085
many years after cholecystectomy.

Natural course of gallstone disease

Gallstone disease (GSD) is common throughout the world. She can leak
asymptomatic or lead to a wide range of clinical manifestations.

Asymptomatic
gallstones . Most people with gallstones
clinical symptoms have been absent for many years. Annually only
1-2% of them develop biliary pain, while the risk of complications remains very
low, so prophylactic cholecystectomy is not indicated for such persons.

Biliary pain

Most common pain
localized in epigastrium . It may radiate to the right
shoulder blades or right shoulder. Pain can vary in severity and
character. Described as pressing, stabbing, cramping, or feeling
gravity. Patients, feeling pain, cannot find a comfortable position for it.
decrease, and can move all the time. For some, against the background of an attack,
nausea and vomiting are rare.

Pain has
sudden onset and usually lasts from 15-30 minutes to 3-4 hours (sometimes up to 6-8
hours). After the pain attack passes, the patient has
for some time there is an unpleasant sensation in the abdomen.

Frequency.
Pain attacks can develop daily, once a week, month, year or
less often. In very rare cases, there is only one attack. In selected patients
the interval between episodes tends to remain the same for
long period of time.

However, this may
be…

Often only mild abdominal symptoms or
vague pain in the lower part of the chest or right upper quadrant of the abdomen.
A differential diagnosis should be made with the following diseases:

• peptic ulcer,
• pancreatitis,
• gastroesophageal reflux disease (GERD),
• angina,
• intestinal obstruction,
• liver diseases,
• irritable bowel syndrome (IBS),
• nephrolithiasis.

The term “chronic
cholecystitis” is used in clinical practice to describe recurrent attacks
biliary pain.

Diagnosis

Ultrasound (ultrasound) is used to diagnose gallstones
bladder On ultrasound, which has a 98% certainty, it is also possible to visualize
bile ducts, liver and pancreas and thus get
necessary additional information.

Diagnosis

Diagnosis of cholecystitis
confirmed by ultrasound, Other research methods
(for example, endoscopic retrograde cholangiopancreatography (ERCP),
percutaneous transhepatic cholangiography (PTCG) or intraoperative
cholangiography during cholecystectomy) are now rarely prescribed.

About 15% stones
gallbladder can be detected on a plain radiograph of the abdominal organs
cavities.

Computer
tomography (CT) provides more extensive information than a survey image, but it
sensitivity in detecting gallstones is significantly lower compared to
ultrasound.

Oral
cholecystography is not often used, but can provide information about the condition
patency of the cystic duct and the composition of the stones, which is taken into account when
determination of indications for drug litholytic therapy.

In recent years, all
magnetic resonance cholangiography (MRC) is widely used as a method
study of the anatomy of the bile ducts and the detection of stones.

Treatment Options

Surgery.

It is currently believed that in asymptomatic gallstones
cholecystectomy should not be performed.

Removal of the gallbladder – cholecystectomy.
The figure shows a section for performing

open cholecystectomy (red line).

Laparoscopic
cholecystectomy is done through punctures in the abdominal wall. Operation
It is done under general anesthesia, which means that the patient does not feel pain.

Laparoscopic cholecystectomy is the treatment of choice for
symptomatic gallstones. In fact, at the initiative of many
patients, surgery is delayed for months or even years.

In 5% of cases instead of
planned laparoscopic cholecystectomy, usually due to dense adhesions or
other anatomical features, according to the decision of the surgeon, an open
cholecystectomy, after previous operations.

Others
treatment methods. for
treatment of cholelithiasis using extracorporeal shock wave lithotripsy. After
lithotripsy, stone fragments are dissolved by oral
litholytic therapy.

Percutaneous method
removal of gallbladder stones under fluoroscopy is rarely used.

Diet is prescribed for cholelithiasis.

During an exacerbation of the disease, the diet creates rest for the damaged organ, and in
state of remission, with a decrease in the function of the gallbladder, contributes to the strengthening
its contractile function and enhances the output of bile.

Proper nutrition can provide long-term remission (quiet period),
as a rule, and vice versa: violation of the diet, abuse of fatty and
spicy food, alcohol, cold dishes, carbonated drinks causes
exacerbation of the disease.

Food is taken 5-6 times a day. With cholecystitis, one of the main conditions in
organization of nutrition is the observance of the rhythm of eating. Food should be
frequent and small.

The most powerful choleretic agent is itself
taking food. Frequent small meals at the same time
promotes a better outflow of bile: it does not linger in the gallbladder. But
if you eat a lot at one time, the gallbladder can shrink intensely,
which will cause pain and other severe disorders.

cholelithiasis are allowed:

• lean meat, lean fish, milk, cottage cheese, cheese. The latter contain
  a lot of calcium, which is necessary for this disease;

• if eggs are tolerated – 3-4 pcs. per week, with intolerance – protein
  omelets;

• cereals, especially oatmeal, buckwheat;

• butter (it is easier to digest and absorb than other fats),
  vegetable fats. If butter causes pain and bitterness in the mouth, it
  add to the finished porridge (or other dish).
  Often this technique allows you to “deceive” the gallbladder, and an unpleasant reaction
  does not come. Butter must be added before serving the dish to the table.
  However, preference should be given to vegetable fats with good
  choleretic effect. If after taking any vegetable oil pain
  intensify, you will have to abandon this type and try another.
  It was noted that patients have individual tolerance to different
  varieties of oil – sunflower, olive, corn, cottonseed.

• vegetables (carrots, pumpkins, marrows, cauliflower), fruits and berries (grapes
  watermelon, strawberries, apples, prunes), juices from them, greens.
  Vegetables, fruits and berries promote the secretion of bile, eliminate constipation,
  reduce the ability of bile to form stones. If the disease proceeds with
  diarrhea, vegetables, berries, fruits are obtained in the form of diluted juices or
  wiped;

• juices from blueberries, pomegranates, bird cherry, etc.

At
cholelithiasis are excluded:

• fat, fatty meats, poultry, fish, fatty canned food, domestic meat
  organs (kidneys, liver, lungs, brains), etc.