Why be Diagnosed and Have Surgery?

By the time a patient is symptomatic from gallstones, gallbladder surgery is no longer optional. Not having gallbladder surgery or delaying surgery can lead to several problems. Gallstones can become stuck within the ducts of the gallbladder leading to acute inflammation. Chronic inflammation in the gallbladder can make a person more likely to develop gallbladder cancer. Gallstones can also become stuck in the tubes connecting the liver to the intestines leading to jaundice or pancreatitis.

Frequently, gallstones are discovered during tests for other health conditions. A physical examination is performed paying particular attention to the upper right portion of your abdomen. When gallstones are suspected to be the cause of symptoms, an ultrasound exam is the most sensitive and specific test for gallstones.

  • An ultrasound is a handheld device, which a technician glides over the abdomen, sending sound waves toward the gallbladder. The sound waves bounce off the gallbladder, liver, and other organs, and their echoes make electrical impulses, creating a picture of the gallbladder on a video monitor. If gallstones are present, the sound waves will bounce off them, too, showing their location. Other tests may also be performed. Ultrasound is the most common test ordered to detect gallstones. This test is harmless to the patient as well as pregnant patients in that there is no radiation involved.
  • The CT Scan (computerized tomography scan) is a noninvasive x-ray that produces cross-section images of the body. The test may show the gallstones or complications, such as infection and rupture of the gallbladder or bile ducts.
  • Cholescintigraphy (HIDA scan). The patient is injected with a small amount of non-harmful radioactive material that is absorbed by the gallbladder, which is then stimulated to contract. The test is used to diagnose abnormal contraction of the gallbladder or obstruction of the bile ducts.
  • An MRCP (magnetic resonance cholangiopancreatography) involves an MRI of the bile ducts to determine if the gallstones are obstructing the ducts.
  • An ERCP (endoscopic retrograde cholangiopancreatography) is used to locate and remove stones in the bile ducts. After lightly sedating you, the doctor inserts an endoscope—a long, flexible, lighted tube with a camera—down the throat, through the stomach, and into the small intestine. The endoscope is connected to a computer and video monitor. The doctor guides the endoscope and injects a special dye that helps the bile ducts appear better on the monitor. The endoscope helps the doctor locate the affected bile duct and the gallstone. The stone is captured in a tiny basket and removed with the endoscope.
  • Blood tests may also be performed if you have any fever or if your pain persists. A blood test will show signs of infection, obstruction, pancreatitis, or jaundice.

Because gallstone symptoms may be similar to those of a heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis, an accurate diagnosis is important.

Abdominal Surgery Specialists does not perform any of these tests in our office, but will order tests as necessary at an outside facility.

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