Diagnosis and Tests for Gallstones

Gallstones are diagnosed with a clinical history, an examination and imaging. Tests also check whether a stone has caused complications.

First step: history and examination

A doctor asks about pain after meals, its location and duration, fever and jaundice. Pressing under the right ribs may cause pain or a sudden pause in breathing (Murphy's sign), which suggests gallbladder inflammation.

Imaging

• Ultrasound of the abdomen: the first and usual test. It is safe, painless and detects most gallbladder stones. It should be done after several hours of fasting.
• CT scan: used when the diagnosis is unclear or complications are suspected
• MRCP: an MRI that shows stones in the bile ducts
• EUS (endoscopic ultrasound): detects very small stones or sludge
• HIDA scan: checks how well the gallbladder empties

Blood tests

• Complete blood count: raised white cells suggest infection
• Liver function tests: raised bilirubin or enzymes suggest a duct blockage
• Amylase and lipase: raised in pancreatitis

Procedure for duct stones

ERCP is a scope procedure that can both confirm and remove stones from the bile duct.

Key point

Upper belly pain should not be self-diagnosed. Heartburn, ulcers, liver and heart conditions can feel similar. Seek a same-day review for fever, jaundice or severe pain.

Preparing for the scan

Fast for 6 to 8 hours before an abdominal ultrasound so the gallbladder is full and easy to see. Carry old reports and a list of medicines to the appointment.