If your healthcare provider thinks you may have gallstones, you may have further tests—most likely imaging tests, such as an ultrasound or a computed tomography (CT) scan. This is to confirm their suspicions and potentially help rule out any other conditions that might play a role, such as kidney infections, irritable bowel syndrome or chronic pancreatitis. Below are the tests and procedures commonly used to diagnose and evaluate gallbladder and biliary disease.
You may have some blood tests to check your liver, pancreas, bile ducts, or gallbladder for infection or inflammation. The test can also reveal complications of gallstones, such as pancreatitis or jaundice, and rule out other conditions with similar symptoms.
Seeing pictures of what’s going on in the gallbladder and bile ducts is a key factor in making an accurate diagnosis. Your healthcare provider may use many imaging tests to diagnose gallstones and rule out other conditions.
Ultrasound uses sound waves to visualize the bile ducts, liver, and pancreas. When gallstones are present, they can appear in the gallbladder or bile duct. It is considered the test of choice for symptoms of biliary colic, and the first test a health care provider considers when they suspect gallstones.
Ultrasound has few risks and is the most common and best test for diagnosing gallstones.
In obese patients or those who have recently eaten, ultrasound may not detect gallstones.
Endoscopic ultrasound uses a scope with ultrasound at the end of the instrument. A special ultrasound range is delivered to the intestine, where medical professionals can obtain an internal visualization of the bile ducts, gallbladder, and pancreatic ducts.
The use of endoscopic ultrasound requires special training and is sometimes used to locate bile duct stones that may be missed by conventional ultrasound. Other uses of endoscopic ultrasound include the diagnosis of pancreatic and bile duct cancers.
Computed tomography (CT) scan
Although a CT scan can identify gallstones, it is usually not as effective as an ultrasound. CT scans can also diagnose cancers of the liver and pancreas. This test is the preferred method for assessing the severity of pancreatitis.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP is another type of endoscopy that uses X-rays to access the bile and pancreatic ducts. ERCP can also remove gallstones found during surgery from the bile or pancreatic ducts. This test is quite invasive.
Magnetic resonance cholangiopancreatography (MRCP)
MRCP uses magnetic resonance imaging (MRI) equipment that uses special computer software to create images of the bile and pancreatic ducts. This non-invasive test does this in a similar way to ERCP, without the need for an inner scope. When MRCP shows abnormal results, further evaluation (by ERCP) or treatment (by surgery) is required.
Hydroxyiminodiacetic acid (HIDA) scan
Also called a hepatobiliary scan or cholangiogram, it uses radioactive material injected into a vein to show pictures of the bile ducts taken by a special camera. You may also get a substance that contracts your gallbladder, so scans can detect it too. This test is usually used to see if your bile ducts are blocked or your gallbladder is not contracting the way it should.
Your treatment may depend on the results of imaging tests. If your gallstones are detected on imaging but you are not experiencing symptoms, your healthcare provider may recommend that you wait to see if symptoms develop. Gallstones without symptoms, also called asymptomatic gallstones, usually do not require treatment.
Sometimes symptoms of gallstones can overlap with other conditions. Therefore, your healthcare provider needs to rule out these other conditions before diagnosing you with gallstones. The laboratory and imaging tests discussed above can help differentiate between these conditions.
Some conditions that have epigastric-like symptoms and must be considered along with gallstones include:
- chronic pancreatitis
- irritable bowel syndrome
- ischemic heart disease
- Gastroesophageal reflux disease
- peptic ulcer disease
- kidney infection
- Ureteral stones (ureteral stones)
- Functional gallbladder disease, where you have pain in your gallbladder but no gallstones
- Dysfunction of the sphincter of Oddi, which can cause cholestatic pain
In addition to gallstones, there may be conditions unrelated to gallstones; for example, you may have both irritable bowel syndrome and gallstones.
Because gallstones can reason For other health problems, people with untreated gallstones may also be diagnosed with associated complications, including acute cholecystitis (inflammation of the gallbladder), common bile duct stones (gallstones stuck in one of the bile ducts), acute pancreatitis, and acute cholangitis (bile duct infection).
If your healthcare provider thinks you may have one of these other conditions, or in addition to gallstones, he or she may perform additional tests.
Frequently Asked Questions
What does gallstones feel like?
The accumulation of gallstones can cause persistent pain in the upper right abdomen. This pain can radiate to your back or right shoulder. You may also experience nausea and vomiting. In many cases, gallstones are not enough to cause a problem; but if symptoms do occur, be sure to contact a healthcare provider for immediate treatment.
Can a blood test detect gallstones?
No, a blood test by itself cannot detect gallstones. To check for the presence of gallstones, imaging tests, such as a CT scan or ultrasound, may be needed. However, blood samples may still be taken to test for signs of infection or inflammation in the gallbladder, bile ducts, liver, or pancreas.
Can you have gallstones without a gallbladder?
Yes, because stones can form in the common bile duct, you can have gallstones without a gallbladder. When gallstones get stuck in the bile duct, they are called choledocholithiasis. These stones are more likely to cause infection than stones that form in the gallbladder.
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