The gallbladder — a sac located near the liver that serves as a storage space for bile — can be stricken with various problems, such as gallbladder cancer or inflammation (called cholecystitis). Gallstones are also a common gallbladder problem, and infection can occur if the gallbladder remains blocked by a gallstone or continues to be inflamed.
Gallbladder disease is the term used to describe many of these maladies that can plague the gallbladder. But in many forms of gallbladder disease, a person may have no symptoms — up to 90 percent of people with gallstones, for example, don’t have any symptoms at all. So how can gallbladder disease be diagnosed?
Upon hearing the patient’s symptoms, the health care practitioner will probably suspect gallstones. Because the symptoms of gallbladder disease can resemble those of other serious conditions, he or she will ask the patient questions and examine them to try to confirm this diagnosis and rule out other conditions.
There is no blood test that can identify gallstones.
Blood will be taken for tests that can help to determine if the gallbladder is obstructed, if the liver or pancreas is inflamed or not functioning properly, or if the patient has an infection.
If you are a woman, the blood may also be tested to check for a possible pregnancy,
Urine may be tested to rule out kidney infection. Kidney infections can cause abdominal pain similar to that caused by gallstones.
Ultrasound is the best test to examine the gallbladder for stones.
Ultrasound uses painless sound waves to create images of organs.
Ultrasound examinations are very good at seeing abnormalities in the biliary system, including stones or signs of inflammation or infection.
This is the same technique used to look at a fetus in a pregnant woman.
Finding gallstones by ultrasound does not diagnose gallbladder disease. The doctor has to correlate the ultrasound findings with the patient’s symptoms.
Gallbladder Disease: When Diagnostic Tests Are Needed
Your doctor isn’t going to test you for something that you’re not complaining about, so generally, the only time diagnostic tests for gallbladder problems are done is when a person experiences symptoms. Warning signs of gallbladder problems include:
- Bouts of severe pain in the right upper abdomen and sometimes the right chest or back
- Pain after eating, particularly high-fat foods, or at night
- Fever, with shaking and chills, especially if occurring with, or after, abdominal pain
- Nausea and perhaps vomiting
- Heartburn and indigestion
- A feeling of fullness in the abdomen, or excess gas
If you don’t have symptoms, that doesn’t mean your gallbladder is perfectly normal. Often, doctors will spot signs of gallbladder problems during diagnostic testing for some other symptom or health condition.
Gallbladder Disease: Eliminating Other Causes
If you have some combination of these symptoms, your doctor probably will start by asking detailed questions about them. He may ask for more details about the pain — what it feels like, when it happens, and where in your belly it hurts.
Your doctor will also ask questions to look for other possible causes of abdominal pain, like:
- Irritable bowel syndrome (IBS)
- Crohn’s disease or ulcerative colitis
- Cancer or inflammation of the pancreas
- Kidney stones or urinary tract infections
- Pneumonia (when it involves the lower part of the right lung, it can be confused with gallbladder discomfort)
- Viral hepatitis
- Gastroesophageal reflux or ulcers in the stomach
- Diverticulitis or diverticulosis — conditions affecting the lining of the colon
Gallbladder Disease: Diagnostic Imaging Tests
After asking questions about your symptoms, doing a physical exam, and eliminating some causes from the list of possibilities, your doctor probably will perform some imaging tests to look at your gallbladder.
Imaging tests used to diagnose gallbladder problems include:
An ultrasound. This is the most commonly used of the diagnostic tests for gallbladder problems. While very effective in diagnosing even very small gallstones, it can’t always clearly diagnose cholecystitis (inflammation of the gallbladder).
X-rays. An abdominal X-ray can spot gas and some types of gallstones containing calcium. Some X-ray types require that a patient swallow a dye or have dye injected into the body so the X-ray can capture a clearer picture of the gallbladder.
Computed tomography (CT) scan. This imaging test uses a computer and X-rays to spot gallbladder problems, but isn’t the most effective method of diagnosing gallstones.
CT scans can help spot ruptures (tears in the gallbladder wall) and infections inside the gallbladder or its bile ducts.
This test is similar to an X-ray, however more detailed. It shows the gallbladder and the biliary ducts and can detect gallstones, blockages, and other complications.
Magnetic resonance imaging
Magnetic resonance imaging (MRI) . Regular MRI, or another type called magnetic resonance cholangiography (MRC), can help diagnose stones in the bile ducts.
MRC uses regular MRI imaging technology plus a dye administered into the bile duct. This test is very useful for diagnosing biliary tract (gallbladder and surrounding ducts) cancer, but may not be able to spot tiny stones or persistent infections.
Endoscopic retrograde cholangiopancreatography (ERCP)
A thin, flexible endoscope is used to view parts of the patient’s biliary system. The patient is sedated, and the tube is passed through the mouth and stomach and into the small intestine.
The device then injects a temporary dye into the biliary ducts. The dye makes it easy to see any stones in the ducts when X-rays are taken. Sometimes a stone can be removed during this procedure.
This test uses an endoscope (a tube fitted with a tiny camera and light) that is inserted into the throat, down through the stomach, and into the small intestine.
This test can help spot gallstones or problems in the bile ducts of the gallbladder — it’s considered the “gold standard” when it comes to diagnosing stones blocking bile ducts, and allows for removal (using a small basket-like device) during the test.
But there is a risk of complications, so the test is typically only given to people who are thought to be very likely to have stones blocking the bile ducts.
Cholescintigraphy (also called DISIDA, HIDA scan, or gallbladder radionuclide scan). A small amount of radioactive dye is administered, and then a scanning device is used to track the dye as it moves into the gallbladder.
This screening method can spot a blocked duct and acute inflammation, but not chronic gallbladder inflammation or gallstones.
This is a test in which a solution is injected into an IV line in the patient’s arm. The liquid is absorbed by the liver, then passed on to be stored in the gallbladder (much like bile).
The solution contains a harmless radioactive marker, which is seen by a special camera. If the gallbladder is inflamed or blocked by gallstones, none of the marker is seen in the gallbladder.
Gallstones Self-Care at Home
After a diagnosis of gallstones, the patient may choose not to have surgery or may not be able to have surgery right away. There are measures the patient can take to relieve the symptoms to include:
- intake of only clear liquids to give the gallbladder a rest,
- avoid fatty or greasy meals, and
- take acetaminophen (Tylenol, etc.) for pain.
Call a health care practitioner if symptoms worsen or if new symptoms appear. Abdominal pain with vomiting, fever, or jaundice warrants an immediate visit to a doctor’s office or a hospital emergency department.
When to Seek Medical Care for Gallstones
If a person has an episode or recurring episodes of abdominal pain 30 minutes to one hour following meals, call a health care practitioner for an appointment.
Go to a hospital emergency department if the person has this abdominal pain with any of the following conditions:
- the abdominal pain cannot be controlled with over-the-counter pain medication;
- the person begins vomiting or develops a fever, chills, or sweats; or
- the person has jaundice.