How Gallstones Are Diagnosed

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If your doctor thinks you might have gallstones, you will likely have further testing—most likely imaging, like an ultrasound or computerized tomography (CT) scan. This is to confirm his or her suspicions and to potentially help rule out any other conditions that could instead be at play, such as a kidney infection, irritable bowel syndrome, or chronic pancreatitis. Here’s a look at tests and procedures commonly used to diagnose and evaluate gallbladder and biliary tract disorders.

gallstones diagnosis
Illustration by Joshua Seong. © Verywell, 2018. 

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A blood test won't diagnose gallstones and will likely be normal if you have an uncomplicated case, but you may have some blood work done anyway to check for infection or inflammation of your liver, pancreas, bile ducts, or gallbladder. Tests can also show complications from gallstones, such as pancreatitis or jaundice, as well as rule out other illnesses with similar symptoms.

Imaging

Seeing a picture of what's going on in your gallbladder and bile ducts is the key element to making an accurate diagnosis. There are a number of imaging tests that your doctor may use to diagnose gallstones as well as to rule out other conditions. 

Ultrasound

Ultrasound uses sound waves to visualize the bile ducts, liver, and pancreas. When gallstones are present, they are seen in either the gallbladder or bile ducts. It is considered the go-to test for symptoms of bilary colic and is the first test considered if a doctor suspects gallstones.

Little risk is associated with the ultrasound test, and it's the most common and best test for diagnosing gallstones. The ultrasound may not pick up gallstones in obese patients or in patients who have recently eaten.

Endoscopic Ultrasound

An endoscopic ultrasound utilizes a scope that has an ultrasound on the end of the instrument. The special ultrasound scope is passed down into the intestines where medical professionals can get an internal visualization of the bile ducts, gallbladder, and pancreas ducts.

Special training is required to use the endoscopic ultrasound, which is sometimes used to locate bile duct stones that may be missed by regular ultrasound. Other uses for the endoscopic ultrasound include the diagnosis of pancreatic cancer and cancer of the bile ducts.

Computerized Tomography (CT) Scan

While the CT scan may identify gallstones, it's usually not as effective as the ultrasound. A CT scan can also diagnose cancer in the liver and pancreas. This test is the preferred method of assessing the severity of pancreatitis.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is another type of endoscope test performed with x-rays that allows access to the bile ducts and pancreas ducts. The ERCP also enables gallstones that are discovered during the procedure to be removed from the bile ducts or the pancreas ducts. This test is fairly invasive.

Magnetic Resonance Cholangiopancreatography (MRCP)

MRCP utilizes magnetic resonance imaging (MRI) equipment that uses special computer software to create images of the bile ducts and pancreas ducts. This noninvasive test does this in a way that is similar to ERCP without the need for an internal scope. When MRCP reveals abnormal results, further evaluation (with ERCP) or treatment (with surgery) is necessary.

Hydroxyl Iminodiacetic Acid (HIDA) Scan

Also known as a hepatobiliary scan or cholescintigraphy, this uses radioactive material injected into your vein to show pictures of your biliary tract taken by a special camera. You may also be given a substance that makes your gallbladder contract so the scan can pick that up as well. This test is usually used to see if your bile ducts are blocked or your gallbladder isn't contracting the way it should be.

Your treatment will likely depend on the results of your imaging tests. If your gallstones were detected via imaging, but without presenting symptoms, your doctor might advise you to wait and see if symptoms develop. Gallstones without symptoms, also known as silent gallstones, usually do not require treatment.

Differential Diagnoses

Sometimes symptoms of gallstones can overlap with other conditions. Because of this, your doctor will need to rule these other disorders out before diagnosing you with gallstones. The lab and imaging tests discussed above can help distinguish these conditions from one another. 

Some of the disorders that have similar upper abdominal symptoms and must be considered along with gallstones include:

  • Hepatitis
  • Chronic pancreatitis
  • Irritable bowel syndrome
  • Ischemic heart disease
  • Gastroesophageal reflux disease
  • Peptic ulcer disease
  • Kidney infection
  • Ureteral stones (stones in your ureter)
  • Functional gallbladder disorder, which is when you have pain in your gallbladder but no gallstones
  • Sphincter of Oddi dysfunction, which can cause pain from the back up of bile

It is possible to have some of these conditions in addition and unrelated to gallstones; you can have both irritable bowel syndrome and gallstone, for example.

And because gallstones can cause additional health concerns, it's possible for someone whose gallstones have gone untreated to be simultaneously diagnosed with a related complication, including acute cholecystitis (gallbladder inflammation), choledocholithiasis (when a gallstone gets stuck in one of the bile ducts), acute pancreatitis, and acute cholangitis (an infection in the bile ducts).

Your doctor may do additional testing if he or she thinks you may have one of these other disorders alongside or rather than gallstones.

How Gallstones Are Treated
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