How Are Gallstones Diagnosed?

Accurate diagnosis is very important because gallstone symptoms are similar to those of several serious diseases.

They include heart attacks, ulcers, appendicitis, pancreatitis, hiatal hernia, and hepatitis.

Doctors may suspect gallstones based on a person's symptoms, especially in someone who is at high risk for gallbladder disease. A simple physical examination in the doctor's office may also suggest gallbladder disease. The doctor, for instance, usually presses gently with his fingers just below the ribs on the right side of the chest. That area often is tender in people with gallbladder disease. Blood tests also can show signs of obstructed ducts.

Two tests can diagnose most cases of gallbladder disease with great accuracy, an abdominal ultrasound and oral cholecystogram (OCG) or cholescintigraphy.

Ultrasound

An abdominal ultrasound scan uses sound waves to produce images of internal organs. The sound has a pitch, or frequency, so high that humans can't hear it. Sound waves are sent into the abdomen through a hand-held probe that a technician glides over the abdominal area.

The sound waves bounce off the gallbladder, liver, pancreas, and other organs and return to the probe. The machine converts these sound-wave "echoes" into images that can be seen on a TV monitor. Gallstones usually produce a strong echo, and are clearly visible on the monitor.

An ultrasound scan can provide a great deal of information about a person's condition by:

• Confirming whether gallstones are present

• Showing how many stones are present, and their size

• Seeing whether the stones are in the gallbladder or the ducts

Ultrasound scans

• Are painless

• Do not involve x-rays or use of radioactive materials

• Have no known damaging effects on the body

• Can be repeated safely as many times as needed

For further information about ultrasound, go to Ultrasound.

Oral Cholecystogram Or Cholescintigraphy

An oral cholecystogram (OCG) or cholescintigraphy involves receiving an injection of an iodine x-ray dye into a vein, or taking iodine pills. X-rays then are taken of the gallbladder to see whether it contracts normally or stones are present.

Diagnosing Stones In The Common Bile Duct

Diagnosing stones that have passed into the common bile duct can be more difficult. It may require tests that involve putting x-ray dye into the bile ducts. The tests, which are necessary in only a small percentage of people with gallstones are:

• ERCP (Endoscopic retrograde cholangiopancreatography) involves swallowing a thin, flexible tube, or endoscope, that the doctor gently moves through the gastrointestinal tract to the small intestine. He releases a special dye into the small intestine, and it stains the gallbladder's ducts. Any stones present in the ducts then can be seen on an x-ray.

• PTC (Percutaneous transhepatic cholangiography) involves injecting x-ray dye into the bile ducts with a needle that is passed through the liver.