How are gallstones diagnosed?
Many gallstones, especially silent stones, are discovered by accident during tests
for other problems. But when gallstones are suspected to be the cause of symptoms,
the doctor is likely to do an ultrasound exam. Ultrasound uses sound waves to create
images of organs. Sound waves are sent toward the gallbladder through a handheld
device that a technician glides over the abdomen. The sound waves bounce off the
gallbladder, liver, and other organs such as a pregnant uterus, and their echoes
make electrical impulses that create a picture of the organ on a video monitor.
If stones are present, the sound waves will bounce off them, too, showing their
location. Ultrasound is the most sensitive and specific test for gallstones.
Other tests may also be used.
- Computed tomography (CT) scan
This test may show the gallstones or complications.
- Cholescintigraphy (HIDA scan)
This test is used to diagnose abnormal contraction of the gallbladder or obstruction.
The patient is injected with a radioactive material that is taken up in the gallbladder,
which stimulates the gallbladder to contract.
- Endoscopic retrograde cholangiopancreatography (ERCP)
The doctor guides an endoscope through the patients’ stomach and into the small
intestine. The doctor then injects a special dye that temporarily stains the ducts
in the biliary system. ERCP is used to locate and remove stones in the ducts. Then
the affected bile duct is located and an instrument on the endoscope is used to
cut the duct. The stone is then captured in a tiny basket and removed with the endoscope.
- Blood tests
Blood tests may be used to look for signs of infection, obstruction, pancreatitis,
or jaundice.
Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable
bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis
is important.
What is the treatment?
Surgery
Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones.
(Asymptomatic gallstones usually do not need treatment.) Each year more than 500,000
Americans have gallbladder surgery. The surgery to remove the gallbladder is called
cholecystectomy.
The most common operation is called laparoscopic cholecystectomy. For this operation,
the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments
and a miniature video camera into the abdomen. The camera sends a magnified image
from inside the body to a video monitor, giving the surgeon a closeup view of the
organs and tissues. While watching the monitor, the surgeon uses the instruments
to carefully separate the gallbladder from the liver, ducts, and other structures.
Then the cystic duct is cut and the gallbladder removed through one of the small
incisions. Click here to view how the surgery is done.
Advantages to a Laparoscopic Gallbladder Removal (Cholecystectomy)
Because the abdominal muscles are not cut during laparoscopic surgery, patients
have less pain and fewer complications than they would have had after surgery using
a large incision across the abdomen. Recovery usually involves only one night in
the hospital, followed by several days of restricted activity at home.
Risks and Complications of Cholecystectomy Surgery
If the surgeon discovers any obstacles to the laparoscopic procedure, such as infection
or scarring from other operations, the operating team may have to switch to open
surgery. In some cases the obstacles are known before surgery, and an open surgery
is planned. It is called "open" surgery because the surgeon has to make a 5- to
8-inch incision in the abdomen to remove the gallbladder. This is a major surgery
and may require about a 2- to 7-day stay in the hospital and several more weeks
at home to recover. Open surgery is required in about 5 percent of gallbladder operations.
The most common complication in gallbladder surgery is injury to the bile ducts.
An injured common bile duct can leak bile and cause a painful and potentially dangerous
infection. Mild injuries can sometimes be treated nonsurgically. Major injury, however,
is more serious and requires additional surgery.
Occasionally, a person who has had a cholecystectomy is diagnosed with a gallstone
in the bile ducts weeks, months, or even years after the surgery. The two-step ERCP
procedure is usually successful in removing the stone.