What are the causes of gallstones? What are the symptoms of gallstone disease? How is gallstone disease diagnosed? What are the treatment options for gallstone disease?

Gallstone Disease: An Overview

Gallstone disease is a common disorder affecting the biliary system, the body’s system responsible for transporting bile. Gallstones are solid, pebble-like masses that form in the gallbladder or the biliary tract, the ducts leading from the liver to the small intestine. These stones are formed when the bile hardens, and they can be caused by an excess of cholesterol, bile salts, or bilirubin.

Types of Gallstones

There are two main types of gallstones:

Cholesterol Stones

Cholesterol stones are yellow-green in color and are predominantly found in women and obese individuals. They account for 80 percent of all gallstones and are the most common type in the United States.

Pigment Stones

Pigment stones are black or brown and tend to develop in patients who have other liver conditions, such as cirrhosis or biliary tract infections.

Gallstone Disease Symptoms

Many people with gallstones do not experience any symptoms. However, when symptoms do occur, they are often due to complications such as inflammation, infection, or obstruction. The main symptom of gallstone disease is biliary colic, a constant abdominal pain that usually appears suddenly and builds quickly to a peak. This pain is typically located in the right upper side of the abdomen and can last anywhere from 15 minutes to several hours. It is often aggravated by meals, especially those high in fat.

Other symptoms of gallstone disease may include:

• Fatty food intolerance
• Vomiting
• Right shoulder pain
• Flatulence
• Sweating
• Yellowing of the skin or eyes
• Clay-colored stool

Gallstone Disease Diagnosis

Diagnosing gallstone disease begins with a comprehensive physical exam during which the patient describes their symptoms and medical history. While the physical exam may be completely normal, the doctor may be able to feel the gallbladder or detect abdominal tenderness. Additional diagnostic procedures may include:

Laboratory Tests

Blood tests will check liver function. If there are complications from gallstones, the tests will be abnormal.

Imaging Scans

Gallstones, especially those that are asymptomatic, are often discovered accidentally during an imaging scan for another problem. Imaging scans used to detect gallstones include:

• Ultrasound: An abdominal ultrasound is the best non-invasive test for detecting gallstones in the gallbladder.
• CT scan: A CT scan can detect complications of gallstone disease, such as excess fluid, gas in the gallbladder wall, gallbladder perforations, and abscesses.
• MRI and MRCP: An MRI with special software (MRCP) can help detect gallstones and bile duct stones and evaluate the gallbladder for the presence of cholecystitis (inflammation).
• Cholescintigraphy: This test involves the administration of a radioactive substance that is absorbed by the liver and secreted into the gallbladder and bile ducts, allowing for the detection of acute gallbladder inflammation.

Endoscopic Diagnosis

Endoscopic procedures, such as ERCP (endoscopic retrograde cholangiopancreatography) and EUS (endoscopic ultrasound), can be used to visualize the biliary system and detect gallstones, particularly those located in the common bile duct.

Gallstone Disease Treatment

The treatment for gallstone disease depends on the severity of the condition and the presence of complications. In many cases, asymptomatic gallstones may not require immediate treatment, and the patient may be monitored for any changes in their condition. However, if the gallstones are causing symptoms or complications, various treatment options may be considered, including:

• Cholecystectomy (surgical removal of the gallbladder)
• Medications to dissolve gallstones
• Extracorporeal shock wave lithotripsy (ESWL) to break up large stones
• Endoscopic procedures to remove stones from the bile ducts

The choice of treatment will depend on the individual patient’s medical history, the severity of their condition, and the availability of specific treatment options.

Preventing Gallstone Disease

While some risk factors for gallstone disease, such as age, gender, and genetics, cannot be controlled, there are several steps individuals can take to reduce their risk of developing gallstones:

• Maintaining a healthy weight through diet and exercise
• Limiting the consumption of high-fat and high-cholesterol foods
• Avoiding rapid weight loss, which can increase the risk of gallstone formation
• Consuming a diet rich in fiber, which can help prevent the formation of gallstones
• Staying hydrated by drinking plenty of water

By understanding the causes, symptoms, and diagnostic tools available for gallstone disease, individuals can work with their healthcare providers to identify and manage this common condition effectively.

Gallstone Disease | Johns Hopkins Medicine

Gallstone disease is the most common disorder affecting the biliary system, the body’s system of transporting bile. Gallstones are solid, pebble-like masses that form in the gallbladder or the biliary tract (the ducts leading from the liver to the small intestine). They form when the bile hardens and are caused by an excess of cholesterol, bile salts or bilirubin.

Types of Gallstones

There are two types of gallstones:

• Cholesterol stones: These are yellow-green stones, predominately found in women and obese people. Cholesterol stones account for 80 percent of gallstones. This is the most common type in the United States.
• Pigment stones: These may be black or brown and tend to develop in patients who have other liver conditions, such as cirrhosis or biliary tract infections.

Gallstone Disease Symptoms

Many people with gallstones do not experience any symptoms. Often, symptoms only appear when there are complications. The complications may be caused by inflammation, infection or obstruction.

The main symptom of gallstone disease is biliary colic. Biliary colic appears suddenly and builds quickly to a peak. It is a constant abdominal pain, usually in the right upper side of the abdomen, lasting anywhere from 15 minutes to several hours. This pain is usually aggravated by meals, especially fatty food.

Biliary colic may also include:

• Fatty food intolerance
• Vomiting
• Right shoulder pain
• Flatulence
• Sweating
• Yellowing of the skin or eyes
• Clay-colored stool

Gallstone Disease Diagnosis

A diagnosis of gallstone disease begins with a comprehensive physical exam during which you describe your symptoms and medical history. Often, the physical exam will be completely normal. Sometimes, your doctor can feel the gallbladder, and there may be some abdominal tenderness. Other diagnostic procedures include:

• Laboratory tests
• Imaging scans
• Endoscopic diagnosis

Laboratory Tests

Blood tests will check your liver function. If there are complications from gallstones, the tests will be abnormal.

Imaging Scans

Gallstones, especially those that are asymptomatic, are often discovered accidentally during an imaging scan for another problem. If you need an imaging scan based on your history and physical exam, there are a number of procedures available. Imaging scans use different technologies to determine the presence and location of gallstones.

• Ultrasound: An abdominal ultrasound is the best noninvasive test for detecting gallstones in the gallbladder. An ultrasound uses sound waves to create images of your organs. It is a simple, safe and painless procedure that provides accurate information about the presence of gallstones.
• CT scan: A CT scan is a powerful X-ray. It can detect complications of gallstone disease, such as excess fluid, gas in the gallbladder wall, gallbladder perforations and abscesses (collections of pus in the body). A CT scan may help determine if you need urgent surgical intervention.
• MRI and magnetic resonance cholangiopancreatography (MRCP): An MRI uses strong magnetic waves to create a detailed picture. An MRCP uses MRI imaging with special software to help detect gallstones and bile duct stones and evaluate the gallbladder for presence of cholecystitis (inflammation).
• Cholecystingraphy: You receive an intravenous radioactive substance, which your liver absorbs and then is secreted into the gallbladder and bile ducts. Scans are then taken that can accurately detect acute inflammation of the gallbladder.

Endoscopic Diagnosis

An endoscope is a thin, flexible, lighted tube inserted into your mouth. It reaches your esophagus, stomach and small intestine. Using the endoscope, you doctor can visualize your biliary system.

Endoscopic Retrograde Cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred method for detecting gallstones in the common bile duct. Because the endoscope is in position, stones can be removed during an ERCP. During this procedure:

• A special side-viewing endoscope called a duodenoscope is used.
• This scope is specially designed to allow the placement of necessary accessories into the bile and pancreatic duct and remove bile duct stones.
• A catheter is used to inject dye into the ducts.
• An X-ray is taken to obtain images of your pancreatic and biliary ducts.

Endoscopic Ultrasound

Endoscopic ultrasound (EUS) uses both an endoscopy and an ultrasound to evaluate and diagnose digestive tract disorders, and together they produce detailed images of your bile duct and gallbladder. Unlike an ERCP, an EUS cannot be used to remove gallstones. However, it is an accurate diagnostic tool and presents a lower risk of complications than ERCP.

Symptoms, Causes, Treatment, and More

Gallstones are deposits of digestive fluid made of solidified substances found in bile, like cholesterol. They are common and may or may not produce symptoms. People with symptoms usually need to have their gallbladders taken out.

Read on to learn more about gallstones, the symptoms they can cause, and how to treat them.

Your gallbladder is a small organ in your upper right abdomen, right below your liver. It’s a pouch that stores bile, a green-yellow liquid that helps digestion. Issues with your gallbladder typically occur when something is blocking its bile duct—like a gallstone.

Most gallstones are created when substances found in bile, like cholesterol, harden. Gallstones are very common and routinely asymptomatic.

However, about 10 percent of people who are diagnosed with gallstones will develop noticeable symptoms within 5 years.

Photo: Bruce Blaus | Wikimedia Commons | https://commons.wikimedia.org/wiki/File:Gallstones.png

Gallstones can lead to pain in the upper right abdomen or the center of your stomach. You may experience gallbladder pain from time to time after you eat foods that are high in fat, such as fried foods, but the pain can occur at almost any time.

Pain caused by gallstone issues usually lasts for only a few hours, but it can feel severe.

If gallstones are left untreated or unidentified, the symptoms may increase to include:

• a high temperature
• rapid heartbeat
• yellowing of the skin and whites of the eyes (jaundice)
• itchy skin
• diarrhea
• chills
• confusion
• a loss of appetite

These symptoms can be signs of a gallbladder infection, or inflammation of the gallbladder, liver, or pancreas.

Because gallstone symptoms may mimic the symptoms of other serious issues like appendicitis and pancreatitis, no matter what, if you’re dealing with one or more of these issues — it’s time to see a doctor or get yourself to the ER.

If you need help finding a urologist, then check out our FindCare tool here.

Asymptomatic gallstones

Gallstones themselves don’t cause pain. Rather, pain occurs when gallstones block the movement of bile from the gallbladder.

According to the American College of Gastroenterology, about 80 percent of people who have gallstones have “silent gallstones.” This means they don’t experience pain or have symptoms. In these cases, your doctor may discover the gallstones from X-rays or during abdominal surgery.

The actual cause of gallstones is thought to be due to a chemical imbalance of bile inside of the gallbladder. While researchers still aren’t clear about what exactly causes that imbalance to happen, there are a few possible reasons:

Too much cholesterol in your bile

Having too much cholesterol in your bile can lead to yellow cholesterol stones. These hard stones may develop if your liver makes more cholesterol than your bile can dissolve.

Too much bilirubin in your bile

Bilirubin is a chemical produced during the normal breakdown of red blood cells. After it’s created, it passes through the liver and is eventually excreted out of the body.

Some conditions, such as liver damage and certain blood disorders, cause your liver to produce more bilirubin than it should. Pigment gallstones form when your gallbladder can’t break down the excess bilirubin. These hard stones are often dark brown or black.

Concentrated bile due to a full gallbladder

Your gallbladder needs to be able to empty its bile to function properly. If it fails to empty its bile content, the bile becomes overly concentrated, which can cause stones to form.

Most of the time, you won’t need treatment for gallstones unless they cause you pain. Sometimes you can pass gallstones without even noticing. If you’re in pain, your doctor will likely recommend surgery. In rare cases, medication may be used.

If you’re at high risk for surgery complications, there are a few nonsurgical ways to attempt to treat gallstones. However, if surgery isn’t performed, your gallstones may come back — even with additional treatment. This means you may need to keep an eye on your condition for the majority of your life.

Surgery

Cholecystectomy, which is surgery to remove the gallbladder, is one of the most common operations performed on adults in the United States. Because the gallbladder isn’t an essential organ, it’s possible to live a healthy life without it.

There are two types of cholecystectomy:

• Laparoscopic cholecystectomy. This is a common surgery that requires general anesthesia. The surgeon will usually make three or four incisions in your abdomen. They’ll then insert a small, lighted device into one of the incisions, check for stones, and carefully remove your gallbladder. You can usually go home on the day of the procedure or the day after if you have no complications.
• Open cholecystectomy.This surgery is typically performed when the gallbladder is inflamed, infected, or scarred. This surgery may also happen if problems occur during a laparoscopic cholecystectomy.

You may experience loose or watery stools after gallbladder removal. Removing a gallbladder involves rerouting the bile from the liver to the small intestine. Bile no longer goes through the gallbladder and it becomes less concentrated. The immediate result is a laxative effect that can cause diarrhea, but this issue should resolve on its own for most people.

Nonsurgical treatments

If surgery can’t be performed, such as if the patient is a much older individual, there are a few other ways doctors can try to get rid of your gallstones.

• Oral dissolution therapy typically includes using the medications ursodiol (Actigall) and chenodiol (Chenix) to break up gallstones. These medications contain bile acids, which work to break up the stones. This treatment is best suited for breaking up cholesterol stones and can take many months or years to work completely.
• Shock wave lithotripsy is another option. A lithotripter is a machine that generates shock waves that pass through a person. These shock waves can break gallstones into smaller pieces.
• Percutaneous drainage of the gallbladder involves placing a sterile needle into the gallbladder to aspirate (draw out) bile. A tube is then inserted to help with additional drainage. This procedure isn’t typically a first line of defense and tends to be an option for individuals who may not be suited for other procedures.

Some risk factors for gallstones are related to diet, while other factors are not as controllable. Uncontrollable risk factors are things like age, race, sex, and family history.

Lifestyle risk factors

• living with obesity
• a diet high in fat or cholesterol and low in fiber
• undergoing rapid weight loss
• living with type 2 diabetes

Genetic risk factors

• being born female
• being of Native American or Mexican descent
• having a family history of gallstones
• being 60 years or older

Medical risk factors

• living with cirrhosis
• being pregnant
• taking certain medications to lower cholesterol
• taking medications with a high estrogen content (like certain birth controls)

While some medications may increase your risk of gallstones, don’t stop taking them unless you have discussed it with your doctor and have their approval.

Your doctor will perform a physical examination that includes checking your eyes and skin for visible changes in color. A yellowish tint may be a sign of jaundice, the result of too much bilirubin in your body.

The exam may involve using diagnostic tests that help your doctor see inside your body. These tests include:

• Ultrasound. An ultrasound produces images of your abdomen. It’s the preferred imaging method to confirm that you have gallstone disease. It can also show abnormalities associated with acute cholecystitis.
• Abdominal CT scan. This imaging test takes pictures of your liver and abdominal region.
• Gallbladder radionuclide scan. This important scan takes about one hour to complete. A specialist injects a radioactive substance into your veins. The substance travels through your blood to the liver and gallbladder. On a scan, it can reveal evidence to suggest infection or blockage of the bile ducts from stones.
• Blood tests. Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also help determine how well your liver is functioning.

To help improve your condition and reduce your risk of gallstones, try these tips:

• Eat fewer refined carbs (like cookies and white bread) and less sugar.
• Increase your intake of healthy fats, like fish oil and olive oil, which may help your gallbladder contract and empty on a regular basis.
• Eat the proper amount of fiber per day (women need about 25 grams a day, men need about 38 grams a day).
• Get some sort of physical activity every day.
• Keep yourself properly hydrated.

If you plan to lose weight, do it slowly. Rapid weight loss may increase your risk of gallstones and other health problems.

While there is no foolproof way to completely prevent gallstones, cholesterol seems to play a major role in their formation. If you have a family history of gallstones, your doctor may advise you to limit foods with a high saturated fat content. Some of these foods include:

• fatty meat, like sausage and bacon
• cakes and cookies
• lard and cream
• certain cheeses

Because people living with obesity are more predisposed to gallstones, keeping your weight within a moderate range is another way to limit the possibility of their formation.

If your doctor has diagnosed you with gallstones and decides you need surgery to remove them or your gallbladder, the outlook is often positive. In most cases of stone removal, stones don’t return.

If you aren’t able to have surgery and decide to take medication to dissolve the stones, the gallstones can return, so you and your doctor will need to monitor your progress.

If your gallstones aren’t causing symptoms, you will most likely not need to do anything. Still, you may want to make lifestyle changes to prevent them from getting bigger and causing problems.

Cholelithiasis – Clinic 29

Gallstone disease (GSD) is a disease in which stones form in the gallbladder or bile ducts. Gallstone disease has been known since ancient times. Galen also discovered gallstones during the autopsy of corpses. Mentions of cholelithiasis are found in the writings of doctors of the Renaissance. Currently, every tenth inhabitant of our planet suffers from gallstone disease, and this disease of civilization is becoming a social problem.

Causes of cholelithiasis

Gallstone disease in both adults and children is a multifactorial disease. The main factors are:

• Power failure
• Poor quality drinking water
• Heredity
• Physical inactivity
• Bad habits
• Disruption of intestinal microflora
• Stress
• Uncontrolled intake of drugs, etc., that is, all those factors that lead to metabolic disorders, especially cholesterol metabolism.

Leading links in the process of stone formation: stagnation of bile in the gallbladder and an increase in the concentration of salts in bile due to metabolic disorders.

Can provoke gallstone disease:

• overeating, starvation, irregular meals;
• sedentary lifestyle, especially sedentary work;
• pregnancy;
• taking hormonal contraceptives;
• obesity;
• biliary dyskinesia;
• diseases of the pancreas.

Clinical picture

There are three variants of the clinical picture of cholelithiasis:

• asymptomatic lithiasis;
• clinical manifestation, manifested by abdominal pain and dyspeptic disorders;
• gallstone colic.

Asymptomatic stone carrying is assumed when there are no complaints, and stones in the gallbladder (ducts) are an incidental diagnostic finding, more often on ultrasound. Unfortunately, the stones do not dissolve by themselves, and the disease will manifest itself in other forms over time.

Abdominal pain and dyspeptic disorders are the main complaints. In adults, pain is usually in the right hypochondrium, more often in the form of a feeling of heaviness and is provoked by a violation of the diet (overeating, fatty, fried foods). The nature of the pain depends on the size of the stones. Dull, drawing, vague pains are characteristic of patients with single stones or large stones. Multiple, small, easily moving stones, as a rule, give acute paroxysmal pain – gallstone colic.

Sometimes a small stone passes from the gallbladder into the bile ducts. In this case, an attack of gallstone disease occurs: there is a sharp pain in the right hypochondrium or in the upper abdomen. It can “give” to the right collarbone, right arm or back under the shoulder blade. In this case, bitterness appears in the mouth, nausea and vomiting, which does not bring relief, the sclera of the eyes may turn yellow. If the stone (with a relatively small size) was able to bypass the ducts and fall into the duodenum, the attack stops on its own, and the stone comes out with feces. Otherwise, there is a blockage of the biliary tract and there is a danger of developing acute cholecystitis and mechanical (subhepatic) jaundice. In this case, in addition to the typical picture of colic, yellowness of the skin, discolored stools, and dark urine appear. Pain can spread to other areas of the upper abdomen, often there are “girdle” pains – a sign of blockage not only of the biliary tract, but also of the pancreatic duct. Obturation (blockage) of the excretory ducts is a very dangerous condition!

Diagnosis of cholelithiasis

Diagnosis is based on the clinical picture, on examination of the patient – the doctor can determine tenderness at specific points, on changes in blood and urine tests in the presence of inflammation in the gallbladder and / or a violation of the outflow of bile. Ultrasound reveals formations in the gallbladder, but with symptoms of severe cholecystitis (inflammation), stones may not be visible, ultrasound does not always detect stones that have entered the ducts. Then X-ray methods of research are used: retrograde cholecystopancreatography (RCPG) is the most common method.

Treatment of cholelithiasis

The tactics of treatment of cholelithiasis is determined by the clinical picture, the position of the stones and the timing of the patient’s request for medical help. Non-surgical methods of treatment are rarely used, mainly in children during the period of hormonal instability, in adults in the preoperative period. In case of cholelithiasis, it is prescribed:

• diet with the exception of fatty, fried, smoked, spicy. Food should be fractional, without overeating. Particular importance is attached to the use of vegetables and fruits, wheat bran and other foods containing dietary fiber. They bind bile acids in the intestine, which promotes their synthesis in the liver.
• motor mode: we avoid both hypodynamia and excessive physical exertion. Walking, table tennis, billiards are shown.
• Cholagogue preparations, herbs and tubes are contraindicated!

Surgical treatment

If you have applied for a planned appointment outside the acute phase of gallstone disease, the stones are located only in the gallbladder, and not in the ducts, then you will perform a laparoscopic cholecystectomy (removal of the gallbladder). If stones are localized only in the gallbladder, radical surgery – cholecystectomy in most cases leads to a permanent cure for cholelithiasis. Cholecystectomy is a pathogenetically substantiated operation: the shock organ is removed, i.e. already a defective organ with impaired function and a constant source of infection. All this leads to an acceleration of the circulation of bile acids between the intestines and the liver, a decrease in the stone-forming properties of hepatic bile, and the prevention of the formation of gallstones.

If you delayed the operation for cholelithiasis or tried to “expel” the stones and there was an obstruction of the biliary tract. Such a situation can end with a laparotomy (large abdominal incision), sometimes even with the removal of part of the biliary tract and the imposition of various non-physiological, but vital, connections between organs for the outflow of bile.

Do not be afraid of the operation! The only radical way to treat gallstone disease is to remove the diseased gallbladder. Currently, a special technique has been developed for laparoscopic surgery (the operation is performed using several punctures of the abdominal wall). It is less traumatic, and the patient can get up on the day of the operation. The cosmetic effect is also important – the absence of seams on the body. This issue is especially of concern to girls, because no one wants past illnesses and operations to be read on his body.
After removal of the gallbladder, you can safely return to normal life and practically do not adhere to any diet.

Complications of cholelithiasis

– Infections. The most serious complication of acute cholecystitis caused by gallstones is infection, which occurs in about 20% of cases.

– Gangrene and abscess. Severe inflammation can cause abscess and necrosis (destruction) of tissue in the gallbladder, leading to gangrene. At high risk are men over 50 who have a history of cardiovascular disease.

– Perforation (rupture) of the gallbladder. An estimated 10% of cases of acute cholecystitis due to gallstones have gallbladder perforation, a life-threatening condition. In general, it occurs in people who have not sought help for too long, or in people who do not respond to treatment. Gallbladder perforation is most common in people with diabetes. After the wall of the gallbladder has been perforated, the pain may temporarily decrease. This dangerous delusion threatens with the development of peritonitis and the spread of infection into the abdominal cavity.

– Empyema. Pus in the gallbladder (empyema) occurs in 2 to 3% of patients with acute cholecystitis. Patients usually experience abdominal pain for more than 7 days. Physical examination often does not always immediately reveal the cause. Empyema can be life-threatening, especially if the infection spreads to other parts of the body.

– Fistula. In some cases, inflammation of the gallbladder spreads and leads to perforation of nearby organs, such as the small intestine. In such cases, a fistula is formed between the organs, which is a channel or opening. Sometimes, in such cases, gallstones may actually pass into the small intestine. This can be very serious and requires immediate surgery.

— Gallstone obstruction. Gallstone blockage of the bowel is known as gallstone ileus. It primarily occurs in patients over 65 years of age and can sometimes be fatal. Depending on where the stone is located, surgery may be required to remove it.

– Infection of the common bile duct (cholangitis). Infection of the common bile duct is a very dangerous serious disease. If antibiotics are given immediately, the infection is cured in 75% of patients. If cholangitis is not stopped, the infection can spread and become life-threatening.

– Pancreatitis. Common bile duct stones are responsible for most cases of pancreatitis (inflammation of the pancreas).

– Cancer of the gallbladder. Gallstones occur in about 80% of people with gallbladder cancer. There is a strong relationship between gallbladder cancer and gallstone disease, chronic cholecystitis, and inflammation. Symptoms of gallbladder cancer usually do not appear until the disease has reached the last stage, and may include weight loss, anemia, recurrent vomiting, and foreign body sensation in the abdomen. However, this cancer is very rare, even among people with gallstones.

– Porcelain gallbladder. The gallbladder is called porcelain when its walls are calcified, i.e. coated with calcium. Porcelain gallbladder is associated with a very high risk of cancer. This condition may develop due to a chronic inflammatory response, which may, in fact, be responsible for the risk of developing cancer. The risk of developing cancer also depends on the presence of specific factors, such as partial calcification of the inner lining of the gallbladder.

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how to detect stones in the gallbladder using ultrasound

Gallstone disease (GSD) is a pathology associated with the formation of stones (calculi) in the lumen of the gallbladder or ducts. For a long time, stone formation may not manifest itself clinically in any way, symptoms appear only when the stone blocks the lumen of the duct and jaundice develops. In other cases, gallstones may be accompanied by subjective discomfort in the right hypochondrium, and sometimes cause an acute attack of cholecystitis.

Most stones become an incidental diagnostic finding during examination for other diseases, only a quarter of patients complain of periodic or acute abdominal pain. The simplest, but informative method for detecting calculi in the biliary tract is an ultrasound examination of the abdominal organs, which allows you to determine the condition of the gallbladder and ducts, as well as determine the size and location of stones.

Gallbladder and ducts: norm and pathology on ultrasound

On ultrasound, the gallbladder looks like an elongated pear-shaped pouch. Its position, shape and size are variable. In the structure of the organ, the bottom, body and neck are distinguished.

The thickness of the wall of the gallbladder is normally no more than 3 mm when examined on an empty stomach, and with tight filling with bile (after eating, especially fatty) – 1 mm. Its thickening may indicate the presence of an inflammatory process, the cause of which can be both diseases of the organ itself (acute or chronic cholecystitis) and other pathologies (heart failure, liver disease, decreased protein levels in the blood, etc.). An acute inflammatory process in the gallbladder is said to be in cases where a small amount of fluid is visualized around it, and the organ wall itself becomes heterogeneous, “loose”.

The neck of the bladder smoothly passes into the cystic duct, it later merges with the common hepatic duct and forms the common bile duct (choledochus, ductus choledochus). In turn, the choledochus opens into the lumen of the duodenum in the region of the major duodenal papilla, where bile enters. The normal diameter of the common bile duct in the initial sections is no more than 6 mm.

Gallstones form in the gallbladder due to changes in the composition of bile secreted. During ultrasound scanning, they are defined as bright structures, from which an acoustic shadow departs, while the bubble itself often increases in size, becomes stretched. The number, size and location of stones in the bladder can vary widely. In cases where the organ is 100% filled with calculi, they speak of a “disabled” gallbladder, i.e. he is no longer able to perform his functions.

Stones change their position in the bladder depending on the position of the patient’s body. To determine the displacement of the stone and conduct a differential diagnosis with a parietal polyp, the ultrasound doctor performs a study in several positions of the patient: lying on his back, on his left side. However, some stones can be tightly fixed to the wall of the gallbladder due to a pronounced inflammatory process around.

Especially dangerous are stones that are wedged into the neck or localized in the lumen of the common bile duct, this can cause obstructive jaundice – a condition in which the natural outflow of bile into the duodenum is disturbed and intoxication of the body with bilirubin occurs.

Preparation

Preparing for abdominal ultrasound.

3 days before the study, gas-forming foods should be excluded from the diet: brown bread, fresh vegetables and fruits, juices, legumes, dairy products, alcohol, carbonated drinks, sweet bakery products.

The last meal before the study should be light and no later than 8-12 hours before the procedure.

Do not drink liquids 3 hours before the examination.

If there is a problem with increased gas formation or constipation: 2 days before the ultrasound, we recommend taking the drug “Espumizan” (2 times a day, one capsule) or activated charcoal (2 times a day, 4 tablets). In case of constipation, 1 day before the examination, cleanse the intestines: put an enema or take a mild laxative, or put a glycerin suppository, or use the Microlax microclyster.

In case of an acute pain attack, the examination is carried out without any preparation.

Further tactics

If stones are found in the lumen of the gallbladder, you should consult a gastroenterologist.