Thursday, April 06, 2006

The Diagnosis of Gallbladder Disease

Although there is a considerable overlap in symptoms between gallbladder disease and other common gastrointestinal diseases, the history of a patient's symptoms and a thorough physical exam will often provide clues as to the presence of gallbladder disease. In addition, this information may uncover complications of gallbladder disease or may suggest other causes of the patient's symptoms.
Pain is the most common symptom associated with gallbladder disease. This pain is most often in the mid-upper or right upper portion of the abdomen and sometimes radiates to the back. Frequently it occurs several hours after a heavy meal. The pain will usually subside after several hours. Persistent, unrelenting pain can be a sign of acute cholecystitis or infection of the gallbladder. The attacks of pain are often associated with nausea with or without actual vomiting.
Some patients have little if any pain, but suffer frequent indigestion, heartburn or a bloated feeling. These, however, are non-specific symptoms and be caused by other conditions other than gallstones, in which case removal of the gallbladder will not relieve these symptoms. Fever and jaundice often indicate complications of gallbladder disease and dictate emergency treatment.
Although gallbladder disease can affect anyone, certain people are more likely to be afflicted. Women are affected more often than men. Gallstones are also more likely to occur in those patients who are overweight and after the age of forty.
However, there are certainly plenty of exceptions to the stereotype of overweight female gallbladder patient in her forty's. Gallbladder disease can affect people of all ages, although it is rare in children. It can affect men and thin people as well as overweight females. Pregnancy increases the risk of developing gallstones, and those with close relatives with gallbladder disease are more often affected.
Once gallbladder disease is suspected further tests are obtained to help confirm the diagnosis as well as to detect possible complications of gallbladder disease and other disease conditions. These, in turn, may affect the recommended plan of treatment.
Gallbladder ultrasound is the most frequent study used to diagnose gallstones. The study utilizes a device that emits painless high-frequency sound waves. Echoes from the sound waves are electronically processed to create an image of internal organs.
Under certain circumstances other imaging studies such as a oral cholecystogram or biliary scan may be helpful in diagnosing gallbladder disease.
The oral cholecystogram has been mostly replaced by the gallbladder ultrasound. This study consists of x-rays of the gallbladder obtained after pills containing an opaque dye are taken by mouth. The oral cholecystogram can sometimes be helpful in diagnosing chronic or recurring gallbladder problems when gallbladder ultrasound is normal.
The biliary scan can demonstrate blockage of the cystic duct which occurs with acute cholecystitis. A radionuclide dye is injected intra-venously and under normal conditions is excreted in the bile and concentrated in the gallbladder as seen here.
With blockage of the cystsic duct, the dye is seen in the liver, bile ducts, and intestine, but not in the gallbladder. If the gallbaldder is visualized, acute cholecystitis is very unlikely.
Blood tests are used to assess liver and pancreas function. Abnormalities in these test may suggest a stone in the common bile duct or sometimes suggest a cause of symptoms other than gallbladder disease. If a stone in the common bile duct is suspected, an ERCP is usually recommended prior to surgery. During this procedure a scope is passed through the mouth into the duodenum and dye injected into the bile duct and x-rays taken. If stones are seen in the bile duct they can usually be removed by widening the outlet of the bile duct and extracting the stones with instruments passed through the scope.
Many gallbladder type symptoms can be caused by other problems such as gastritis, peptic ulcer or hiatal hernia. An upper GI x-ray or upper GI endoscopy where the esophagus, stomach and duodenum are actually visualized with a flexible scope may be useful in evaluating these possibilities.
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