Gallstones (cont.)

Medical Author:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Gallstones Diagnosis

Upon hearing the patient's symptoms, the health care practitioner will probably suspect gallstones. Because the symptoms of gallbladder disease can resemble those of other serious conditions, he or she will ask the patient questions and examine them to try to confirm this diagnosis and rule out other conditions.

There is no blood test that can identify gallstones.

• Blood will be taken for tests that can help to determine if the gallbladder is obstructed, if the liver or pancreas is inflamed or not functioning properly, or if the patient has an infection.
  
  
• If you are a woman, the blood may also be tested to check for a possible pregnancy,
  
  
• Urine may be tested to rule out kidney infection. Kidney infections can cause abdominal pain similar to that caused by gallstones.

Ultrasound is the best test to examine the gallbladder for stones.

• Ultrasound uses painless sound waves to create images of organs.
  
  
• Ultrasound examinations are very good at seeing abnormalities in the biliary system, including stones or signs of inflammation or infection.
  
  
• This is the same technique used to look at a fetus in a pregnant woman.
  
  
• Finding gallstones by ultrasound does not diagnose gallbladder disease. The doctor has to correlate the ultrasound findings with the patient's symptoms.

An alternative to ultrasound is an oral cholecystogram (OCG).

• An X-ray is taken of the gallbladder after the patient swallow pills containing a safe, temporary dye.
  
  
• The dye helps the gallbladder and gallstones show up better on the X-ray.

Both ultrasound and OCG can detect gallstones in the gallbladder about 95% of the time.

• Ultrasound is usually the first choice because it is completely noninvasive and involves no exposure to radiation.
  
  
• If either test gives an uncertain result, another test usually is necessary.

These tests are the alternatives to ultrasound and OCG. They are better choices if gallstones have left the gallbladder and moved into the ducts.

• Cholescintigraphy (HIDA scan): This is a test in which a solution is injected into an IV line in the patient's arm. The liquid is absorbed by the liver, then passed on to be stored in the gallbladder (much like bile). The solution contains a harmless radioactive marker, which is seen by a special camera. If the gallbladder is inflamed or blocked by gallstones, none of the marker is seen in the gallbladder.
  
  
• CT scan: This test is similar to an X-ray, however more detailed. It shows the gallbladder and the biliary ducts and can detect gallstones, blockages, and other complications.
  
  
• Endoscopic retrograde cholangiopancreatography (ERCP): A thin, flexible endoscope is used to view parts of the patient's biliary system. The patient is sedated, and the tube is passed through the mouth and stomach and into the small intestine. The device then injects a temporary dye into the biliary ducts. The dye makes it easy to see any stones in the ducts when X-rays are taken. Sometimes a stone can be removed during this procedure.

A chest X-ray may be performed to make sure there are no other reasons for the abdominal pain.

• Sometimes problems in the chest (such as pneumonia ) can cause pain in the upper abdomen.
  
  
• Occasionally the chest X-ray can also show stones in the gallbladder.

As most gallstones are asymptomatic, many times gallstones are diagnosed when the patient undergoes a test for another reason.