Diagnosis and Treatment of Gallstones


Ultrasound is a sensitive diagnosis tool and can detect nearly 90 percent of stones in your gallbladder. It also offers excellent visualization of the gallbladder wall thickness and the condition of ducts, which can also help doctors to detect infection (cholecystitis). When the handheld device is glided over your abdomen, sound waves bounce off very well on solid objects, such as gallstones. Sound echoes induce electric impulses, which create images of organs and solid objects inside your body inside the monitor. If you’re suspected to have gallstones after an ultrasound diagnosis, additional tests may be needed:

Endoscopic Ultrasonography

It is more accurate than common external ultrasound. An endoscopic probe is inserted into the digestive tract, so the doctor can get finer images, because sound waves are bounced off directly from the target area at close range with minimal obstruction.

HIDA (Cholescintigraph) Scan

It can diagnose abnormal gallbladder contraction. Also if common ultrasound method can’t provide adequate visualization, due to severe infection, HIDA can scan pass through the obstruction. It works well on people who have gallbladder surgery previously or those with poor gladder emptying.

CT (Computerized tomographic) Scan

Although most of the time, it can only provides image on half of the gallstone, CT Scan is necessary to detect any complications on pancreas or liver.

ERCP (Endoscopic retrograde cholangiopancreatography)

It is often used to evaluate common cases of bile duct stones.

MRCP (Magnetic resonance cholangiopancreatography)

It is often used to visualize pancreatic ducts, pancreas, biliary tree and gallbladder.



About 500,000 Americans have cholecystectomy annually or gallbladder removal surgery. It is the most common treatment for symptomatic gallstones. People who have pain due to gallstones are strong candidate for gallbladder removal. Those with sickle-cell disease or chronic anemia and are vulnerable to gallbladder cancer may also need to undergo cholecystectomy. People can still live well without gallbladder, because bile will flow directly to the small intestines, due to the absence of a storage site (gallbladder). However, on very few people (about 1 percent), the presence of bile in the small intestine can cause diarrhea.

Gallbladder removal is usually performed using laparoscopic techniques. With this approach, patients will have less pain and risk of complication because no abdominal muscles are cut. A few small incisions are made on the abdomen and; miniature video camera and surgical instruments are inserted. The surgeon can see magnified images using the camera, to see tissues and organs more clearly. While watching the video monitor, he uses the surgical instruments to cut the gallbladder and remove it from the liver ducts and related structures. After the cystic duct is cut, the gallbladder is removed through the tiny incisions. However, scar tissue may obstruct the laparoscopic procedure, as the result an open surgery may be necessary. Patients are often released one day after the surgery, followed by one week of restricted activities at home or at work.

Open abdominal surgery is required on patients with infected gallbladder or with other complications. An open abdominal surgery requires a 5 to 8 inch incision to remove the gallbladder. It is considered a major surgery and patients can stay for about a week in the hospital, followed by one month of reduced activity at home. Complication can occur after a surgery, the most common is bile duct injury, which causes bile leakage, which is painful and can be fatal. Mild injuries can heal eventually with longer recovery period, however more serious injury may require another surgery. To prevent complications and speed up the healing process, patients should follow the doctor’s advices with regard to follow-up care, activity and diet.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Gallstones located in the bile ducts can be removed efficiently with ERCP. During the procedure, patients are asked to swallow an endoscope, a lighted, flexible, long tube connected to a TV monitor and computer. The surgeon guides the instrument through the digestive tract and when the endoscope reaches the small intestines, a special dye is released to illuminate the biliary ducts temporarily. When the target area is identified, the endoscope cuts the affected duct. All solid objects, including stones enter a small bucket and removed along with the endoscope, however, after an ERCP procedure patient may elect to have their gallbladder removed using laparoscopic cholecystectomy to prevent future problems. In some cases, years after cholecystectomy, gallstones can still appear in the duct, which means another ERCP procedure is required.

Dissolving the Stones

On one common scenario, an elderly had respiratory and cardiac problems, he felt discomfort on the upper abdomen after meals and an ultrasound examination detected many tiny non-calcified cholesterol gallstones. Because, he has an overall poor condition, the doctor prescribed ursodiol and low-fat diet. After two years, the ultrasound exam no longer detects gallstones as the treatment has successfully dissolved the stones.

If the gallbladder still works perfectly, the doctor may recommend a treatment to dissolve the gallstones. Ursodiol (Actigall) is effective for crushing small, uncalcified gallstones as long as the gallbladder is healthy. The medication is composed chiefly of bile salt that can dissolve small cholesterol stones. However, this treatment is ineffective for treating larger gallstones or calcified stones. Patients are asked to take ursodiol 2 or 3 times a day, the dosage depends on the body weight and the treatment should be continued for a couple of months after an ultrasound exam detects no stones. In more than a third of the cases, stones dissolve completely after six months, and the doctor will require regular examination to determine whether the treatment is going to the right direction. The drug may cause mild diarrhea on certain people. The treatment can have no effect on some people and stones can re-form if patients refuse to complete the treatment. Ursodiol treatment is favored by doctors if surgery is risky, or if the gallstones are small. It can also be administered to high-risk individuals, such as those who undergo a rapid-weight-loss program. To be effective, the cystic duct must allow the drug to enter the gallbladder.

Diet Changes

No diet changes can dissolve gallstones, but a proper diet can reduce the severity and frequency of attack. Patients are urged to lose weight whenever possible and follow low-cholesterol, low-fat diet, to put less pressure on the gallbladder, so it will contract less. Fiber-rich foods intake is advised to lower cholesterol level in the bile, which reduce the possibility of gallstone enlargement or new gallstone formation. Bile chemical composition can be changed through diet alone and halting gallstones growth is possible, on rare cases, smaller gallstones can even shrink. When trying to lower triglycerides and reduce carbohydrate intake, you should avoid starchy foods such as potatoes, bread and pasta.

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