Diagnosing gallstones

Gallstones are often discovered by chance during investigations of unrelated conditions.

They are commonly detected during:

  • blood tests – tests that show abnormal liver function may indicate gallstones
  • ultrasound scans – where high frequency sound waves are used to create an image of part of the inside of the body
  • imaging scans, such as CT and MRI scans – see below

Occasionally, gallstones are detected during abdominal X-rays; only gallstones containing a lot of calcium show up clearly on X-ray.

If you are experiencing symptoms that could be associated with gallstone disease, your GP will want to know whether this is due to biliary colic (which does not require urgent treatment) or a more serious form of gallbladder disease, such as inflammation of your gallbladder (which may require urgent treatment).

They will ask you about your symptoms and may also carry out a simple test known as the Murphy’s sign test. You breathe in and your GP gently taps your abdomen near the location of your gallbladder. If the tapping causes pain, it usually indicates that your gallbladder is inflamed.

Gallstones can be confirmed using an ultrasound scan. You may also have blood taken for a liver function test. This is a type of blood test that assesses the state of your liver. If gallstones have moved into your bile duct, the normal functioning of your liver will be disrupted.

If your symptoms suggest that you have biliary colic then you will be referred for a routine ultrasound.

If your symptoms suggest that you have a more severe form of gallbladder disease then you may be admitted to hospital on the same day for an ultrasound scan or another investigation.

Cholangiography

When gallstones are diagnosed, a procedure called a cholangiography will give further information about the condition of your gallbladder.

A cholangiography uses a dye that shows up on X-rays. The dye is inserted into your bile ducts either at operation (operative cholangiogram) or using a flexible, fibre-optic camera (endoscope). This procedure is called endoscopic retrograde cholangiopancreatolography (ERCP).

After the dye has been introduced, X-ray images are taken. They will reveal any abnormality in your bile or pancreatic systems. If your gallbladder and bile systems are working normally, the dye will be absorbed in the places it’s meant to go (your liver, bile ducts, intestines and gallbladder).

MRI scans

A magnetic resonance imaging (MRI) scan, which uses strong magnetic fields to produce a detailed image of the inside of the body. MRI scanners tend to be used if a bile duct stone is suspected.

CT scan

X-rays are taken from many different angles and the images processed to show the body in slices. This is known as a computer topography (CT) scan.

This can show up gallstones as an incidental finding or may be used to investigate a complication of gallstones such as acute pancreatitis. This test is often done as an emergency to diagnose severe abdominal pain.

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