Gallstones: diagnosis
‘Silent’ gallstones, or gallstones that do not cause any symptoms, are sometimes detected incidentally during other procedures such as ultrasounds, X-rays, or CT scans. They do not always require treatment or surgical intervention.
If you develop symptoms that suggest you have gallstones, your doctor will take a history and perform a physical examination to check your skin and eyes for jaundice and your abdomen for tenderness.
Gallstones blocking the bile ducts may result in a combination of abdominal pain, jaundice and fever. This suggests a diagnosis of cholangitis (inflammation of a bile duct), a condition requiring urgent medical attention.
As a number of other conditions, such as pancreatitis (inflammation of the pancreas), hepatitis (inflammation of the liver), irritable bowel syndrome and gastric ulcers, may produce symptoms similar to those of gallstones, your doctor may also need to request additional tests to make a definitive diagnosis. Some examples of these tests are described below.
Blood tests
Blood tests may be used to check for infection, jaundice or obstruction. These are indicated by high levels of bilirubin (a yellowish pigment found in bile and produced in the liver) or alkaline phosphatase, a liver enzyme.
Ultrasound
Ultrasound scanning is the most common technique used to confirm the presence of gallstones. It is a quick and painless procedure that uses high-frequency sound waves, sent through a hand-held device that is moved across the abdomen. The echoes as the sound waves bounce off the gallbladder and other organs are converted to electrical impulses that show a picture on a monitor.
Cholangiography
Cholangiography is a procedure where dye is injected into the body, and a series of X-rays taken to reveal any obstructions in the gallbladder ducts. The dye can be injected intravenously, or through the skin into the ducts around the liver. The resulting radiographic record is called a cholangiogram.
Cholecystography
Cholecystography is a procedure where dye is either injected into the body or taken as a pill (oral cholecystography) and a series of X-rays is then taken to reveal the structure of the gallbladder and its movement. Any obstruction of the cystic duct will also show up. The radiographic record obtained is called a cholecystogram. Oral cholecystography has largely been replaced by ultrasound for the diagnosis of gallstones.
Endoscopic retrograde cholangiopancreatography
Occasionally an investigation called endoscopic retrograde cholangiopancreatography (ERCP) is performed if a gallstone is suspected to be lodged in the bile duct and cannot be detected using ultrasound. This procedure involves looking at the bile duct through a small flexible tube called an endoscope, which is inserted into the mouth and directed carefully through the oesophagus and stomach, down into the duodenum (the first part of the small intestine), where the opening of the bile duct can be seen. A dye is then injected through the tube and into the bile duct to demonstrate any blockages that may be present.
Sometimes a sphincterotomy is carried out during the ERCP. This involves passing a small instrument through the endoscope and making a tiny cut in the lower part of the bile duct. This will allow the surgeon to remove any stones by catching them in a tiny basket and removing them through the endoscope.
The type of diagnostic technique used will depend on the situation. Diagnosis is usually 98 per cent reliable, but some false-positive results, where there are in fact no gallstones present, can occur in a few cases.
Last Reviewed: 14 October 2009
- 1. Greenberger NJ, Paumgartner G. Diseases of the Gallbladder and Bile Ducts. Ch 305. In: Fauci AS, Braunwald E, Kasper DL, et al, eds. Harrison's principles of internal medicine. 17e. New York: McGraw Hill. Available from: http://www.accessmedicine.com/resourceTOC.aspx?resourceID=4 (accessed Nov 2009).
2. National Digestive Diseases Information Clearinghouse. Gallstone [website]. July 2007. Available from: http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/ (accessed Nov 2009).
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