How are gallstones diagnosed?

The type of technique used to diagnose gallstones depends on the situation. Diagnosis is usually 98% reliable, but false-positive results - where there are in fact no gallstones present - can occur in a few cases.

Blood tests may be used to check for infection, jaundice or obstruction in the bile ducts.

Ultrasound is the most common technique used to confirm gallstones. It is quick and painless and uses high-frequency sound waves, sent through a hand-held device that is moved across your abdomen. The echoes from sound waves bouncing off the gallbladder and other organs are converted to electrical impulses that create a picture on a video monitor.

Cholangiography is a procedure where dye is injected directly into the main bile ducts and a series of x-rays are taken to reveal any obstructions or lesions in the ducts.

Cholecystography is a procedure where dye is injected into your body and a series of x-rays taken to reveal the structure of your gallbladder and its movement. Any obstruction of another duct, the cystic duct, will also show up.

Endoscopic retrograde cholangiopancreatography (ERCP) is an investigation your doctor may request if it is suspected that a gallstone may be lodged in the main bile duct and it cannot be detected using ultrasound. This procedure involves looking at the bile duct through a flexible  tube called an endoscope, which is inserted into your mouth and directed carefully through your oesophagus and stomach. It is then maneouvered into your duodenum, where the opening of the bile duct can be seen. A dye is injected through the tube into the bile duct to check if any blockages are present.

Sometimes, a sphincterotomy is carried out during the ERCP. This involves passing an instrument through the endoscope and making a small cut in the lower part of the bile duct, which you should not feel. This should allow the surgeon to remove any stones, catching them in a tiny basket.

How are gallstones treated?

Surgery

Surgical removal of the gallbladder is the most common way of treating gallstones – you can live without it. Unlike kidney stones, which are very hard, gallstones cannot be destroyed by sound waves. It is also difficult to dissolve them with medication – it tends to cause severe diarrhoea – and stones will often reform.

The procedure to remove the gallbladder is called a cholecystectomy and is mostly performed laparoscopically. This type of ‘keyhole surgery’ usually involves four small incisions for the narrow camera and instruments to enter the abdomen. Laparoscopic surgery generally means a quick recovery and minimal pain and scarring. You can usually go home on the day of the operation or the morning after and any pain can be treated with paracetamol or anti-inflammatory medications.

Once the gallbladder has been removed, most people make a full recovery and function normally. However, about 4% of people become intolerant to fatty foods and may have to eliminate them from their diet.

Gallbladder removal animation

Diet

Some people find eating a low-fat diet controls their symptoms of gallstones. However, if you have a fever, constant nausea or vomiting, or if you have jaundice (yellow eyes or skin), seek medical attention.

The Internet

Remedies are touted on the internet as being able to ‘cure’ or ‘pass’ gallstones. These usually involve drinking large amounts of oil and lemon juice. They do not work. Any ‘success’ is because the symptoms from gallstones can be very infrequent, leading to the belief that a ‘cure’ has been achieved – until the next attack of pain.

Also see our topics Gallstones - what are they? and  Choosing a surgeon

Original material provided by everybody. Reviewed in September 2008 by Andrew Bowker, Laparoscopy Auckland.