How to diagnose gallstones?
In cholelithiasis diagnosis, patients interview and examination usually bring enough information to make an initial assessment. However, it is very important to differentiate any epigastric pain from symptoms of other serious conditions, such as
- Myocardial infarction
- Aortic dissecting aneurysm
- Pleurisy inflammation
- Peptic ulcer disease
- Gastric ulcer perforation
- Acute or chronic pancreatitis
- Acute appendicitis
For a more detailed diagnosis, abdominal ultrasonography is commonly used. Other methods include: basic laboratory tests,
1.Interview and physical examination
What brings most gallstone sufferers to a doctor is usually a painful episode of gallstone attack (biliary colic). Other, mild symptoms should always be mentioned during an interview. The most indicative are: feeling of fullness, stifle sensation around the right hypochondrium region, increased tension of the abdominal integuments and in some cases enlarged, tender and palpable gallbladder. Routine tests in case gallstone disease and its complications include:
Chelmonski’ssign: a patient is asked to evaluate the pain level while the physician gently hits or “shakes” the right scapular area. Pain occurrence is considered an indication of gallbladder inflammation.
- Murphy’s sign: a patient is asked to breathe deeply while a physician is palpating the right subcostal region. Increased discomfort can be a sign of inflammation of the peritoneum.
- Charcot’s triad: during ascending cholangitis, a set of characteristic symptoms occur, consisting of severe colic pain, jaundice
andfever with chills.
- Reynold’s pentad: refers to symptoms of Charcot triad accompanied by two additional signs: consciousness disturbance and septic shock, which if left untreated- can lead to a patient’s death.
2. Laboratory tests
Tests from blood may be useful in case of gallstone disease complications such as cholecystitis when increased ESR and leukocytosis occur. Tests determine bilirubin levels and so-called cholestasis indicators, including alkaline phosphatase. These liver enzymes raised level may indicate that bile ducts are being clogged by gallstones.
3. Other Diagnostic Methods.
- Abdominal Cavity Ultrasonography- is the first-line diagnostic method in bile duct diseases. This method is practically free of contraindications and it’s effective at an estimated level of 95%. Ultrasound waves are used to examine the bile ducts, liver, and pancreas. It is safe for the patient and can be performed easily without restrictions (also for pregnant women and children). Ultrasonography allows to show deposits with a diameter larger than 3 mm and to assess the width and thickness of the gallbladder walls and bile ducts.
- Abdominal cavity X-ray-It allows confirming the presence of calcified deposits in the gallbladder. X-ray is not very common, as these types of stones occur in less than 20% of patients
- Endosonography (EUS) – a combination of ultrasound and endoscopy examination. This test is performed from the inside of the digestive tract using an ultrasound head located at the end of the endoscope. The direct proximity of the endosonographic head and tested area allows the use of an ultrasound wave with a higher frequency than in conventional ultrasound, resulting in a high-resolution image.
- Computed tomography (CT Scan) – used in the liver and pancreas tumors diagnosis, useful to assess its severity.
- ERCP (endoscopic retrograde cholangiopancreatography) – this diagnostic method allows access to the bile and pancreatic ducts. The endoscope is inserted through the oral cavity, then through the esophagus, stomach and duodenum to the bile ducts, where in addition to assessing their condition, it can be used to remove deposits blocking the flow of bile. This is a standard procedure before laparoscopic resection of the gallbladder.
Gallstone diagnosis- what’s next?
Gallstone disease diagnosis often comes with many doubts and an unpleasant feeling of uncertainty. Patients tend to worry whether the surgery is inevitable, can gallstones be dissolved and go away, or can you just live with gallstones without fear of serious complications, if symptoms are not severe.