Most gallstones do not show symptoms and are left alone. But if you suffer from gallstone disease that exhibits typical symptoms, your doctor will conduct certain diagnostic tests and choose the treatment option that best suits you.
Gallstones are diagnosed by conducting certain blood tests and imaging procedures on the patient.
- A complete blood count will indicate the presence of infection by an elevated white blood cell count
- Liver function tests will indicate the presence of inflammation of the liver by elevated levels of serum bilirubin and other enzymes ALT and AST
The ultrasound detects the presence of gallstones by passing high-frequency sound waves to create images of the inside of the body, which are visualized on the computer monitor.
Gallstones in the bile duct may sometimes be missed by the ultrasound. In such cases, the presence of symptoms and risk factors may prompt your doctor to conduct an abdominal MRI or cholangiography to confirm the presence or absence of gallstones.
MRI scan uses strong magnetic fields and radio waves to produce detailed images of the organs and tissues in the body inside of the body.
An MRI can detect gallstones that have been missed on the ultrasound especially those present in the bile ducts.
A procedure called a cholangiography can give further information in diagnosing gallstones.
The gastroenterologist passes an endoscope through the mouth and guides it into the duodenum for insertion into the common bile duct.
He then passes a dye through the bile duct and takes images, which reveal any abnormality in the lumen of the biliary tract.
If there is a blockage caused by a gallstone, it will show up and the doctor may remove it using the endoscope.
This procedure is known as an endoscopic retrograde cholangiopancreatography (ERCP).
Other imaging tests
Other additional tests may include
- oral cholecystography
- hepatobiliary iminodiacetic acid (HIDA) scan
- computerized tomography (CT)
- magnetic resonance cholangiopancreatography (MRCP)
Treatment options for gallstones
A small percentage of people with gall bladder disease suffer from symptoms of pain, inflammation, and infection. If these are left untreated, it can lead to complications such as cholecystitis, cholangitis, and pancreatitis. These can be painful and life-threatening and therefore, such cases warrant treatment.
Options to treat gallbladder include:
Cholecystectomy is surgery to remove the gallbladder. This surgery to remove the gallbladder is indicated because gallstones often recur. It does not affect your digestion since then bile flows into the small intestine directly from the liver.
However, post-surgery diarrhea is a frequent side effect but it is temporary. Open cholecystectomy is indicated if the patient develops certain complications associated with gallstones.
In this surgery, the surgeon makes an incision in the abdomen, and the patient may require a hospital stay of three to five days.
Indications for open cholecystectomy
- Gallbladder cancer
- Cholecystobiliary fistula
- Gallstone ileus
- Severe cardiopulmonary disease
- Bleeding disorders
In 90% of cases, gallbladder removal is performed laparoscopically. This is a minimally invasive procedure, causes less post-operative pain, and the patient recovers faster than the conventional cholecystectomy.
In this procedure, the surgeon makes several small incisions instead of one large one. He inserts the laparoscope, which is a narrow tube with a camera, through one incision to view the gallbladder on the TV screen.
He cuts the gallbladder free using either laser or electrocautery. He then removes the gallbladder with its stones through another incision.
A small number of people have diarrhea and flatulence after gallbladder removal because bile now flows into your duodenum more frequently as there is no gallbladder to store it. These changes in bowel habits are temporary.
Endoscopic retrograde cholangiopancreatography (ERCP)
Gallstones that are found in the bile ducts have to be removed even in the absence of symptoms. This is done by the procedure called endoscopic retrograde cholangiopancreatography (ERCP). It is a minimally invasive procedure option for removing gallstones.
The surgeon inserts the endoscope in the mouth, down the throat, through the stomach, into the duodenum where the common bile duct empties its bile. The endoscope is inserted retrograde into the bile duct to remove any blockages in the bile duct.
Medications to dissolve gallstones
Oral medications to remove gallstones without surgery can dissolve gallstones. But, this is a long treatment and may take months or possibly years. Secondly, gallstones recur when you stop treatment. Medications, therefore, are reserved for people who cannot undergo surgery for some reason.
Ursodiol (Actigall) and chenodiol (Chenix) contain bile acids that can break up gallstones. These medicines work best on small cholesterol stones. They may take months or years to break up all stones.