Gallstones

Gallstones

Signs and Symptoms
Diagnosis
Treatment

Diagnosis

First your doctor will ask about your medical history, perform a physical examination and possibly blood and urine tests to check for gallstones. In order to make a definite diagnosis, the following imagining tests are commonly used.

• X-rays -- Gallstones only show up on regular X-rays 10 percent of the time, so in order to make them appear, you will ingest a dye-containing pill. This procedure is very effective and called an oral cholecystogram (OCG).

• Ultrasound -- This painless and safe test uses sound waves to produce images of your gallstones that appear on a video screen.

• Magnetic Resonance Cholangiopancreatography (MRCP) -- This is a newer, noninvasive imaging method, based on magnetic resonance imaging (MRI), which provides views of the biliary ducts in multiple planes. It is a definitive diagnosis test for gallstones in the bile ducts, but not in the gallbladder.

• Endoscopic Retrograde Cholangiopancreatography (ERCP) -- When gallstones have entered the bile duct, they are very difficult to diagnose using ultrasound or X-rays. In these instances, a test called an endoscopic retrograde cholangiopancreatography (ERCP) is used to locate and remove stones in the ducts. This procedure uses an endoscope -- a long, flexible, lighted tube connected to a computer and TV monitor. Your doctor will guide the endoscope through your stomach and into the small intestine. Then a special dye that temporarily stains the ducts in the biliary system is injected. The process of taking these X-rays is known as cholangiopancreatography.

  ERCP combines endoscopy and a method of X-ray imaging called fluoroscopy to obtain pictures of the ducts that drain your liver, gall bladder and pancreas. When obstructions or lesions are seen, they often can be diagnosed and treated at the time of your procedure when performed by trained experts. ERCP is a complex procedure, however, and carries increased risks over standard endoscopy and colonoscopy. It is important to understand these risks and the indications for this test, as well as possible alternatives to this procedure.

• Endoscopic Ultrasound (EUS) -- EUS involves passing a thin, flexible tube called an endoscope through the mouth or the anus to exam the lining and walls of the upper and lower gastrointestinal tract and nearby organs such as the pancreas and gall bladder. The endoscope is equipped with a small ultrasound transducer that produces sounds waves that create a viewable image of the digestive track. When combined with fine needle aspiration, EUS becomes a state-of-the-art, minimally invasive alternative to exploratory surgery to remove tissue samples from abdominal and other organs. It also may be used to determine the cause of symptoms such as abdominal pain, to evaluate a growth, to diagnose diseases of the pancreas, bile duct and gall bladder when other tests are inconclusive and to determine the extent of certain cancers of the lungs or digestive tract.

Reviewed by health care specialists at UCSF Medical Center.
Last updated February 14, 2008