The doctor will first try to find out the causes of the pain described by the patient by means of a specific question (anamnesis). He will probably ask the following questions: The doctor will now make a clinical diagnosis of the patient’s abdomen. In addition to checking the pain caused by pressure, the so-called Murphy’s sign should be mentioned: after the patient exhales, the doctor will, for diagnosis, press the area on the abdomen where the gallbladder is located deeply and allow the patient to inhale again.
If the patient stops breathing in and complains of pain, this indicates a gallstone in the gallbladder (Murphy’s sign is positive).
- When do the symptoms appear?
- Does the pain occur mainly after and primarily after eating high-fat food?
- Does the pain occur at night while lying down?
- Is there nausea and vomiting?
- Does the pain radiate?
- Where is the pain located?
- Is the pain wavelike?
Next, the doctor will perform an ultrasound examination of the abdomen. This is an accurate and safe method of stone diagnosis.
The gallstone or gallstones appear as a white structure with a subsequent acoustic shadow. During the ultrasound examination, the doctor can also determine whether the gall bladder or the ducts are thickened. This would indicate an inflammation of the gall bladder (cholecystitis) or the bile ducts (cholangitis).
A so-called high-frequency signal analysis can be used to determine whether the stone is a cholesterol stone and whether it is calcified. A computer tomography can also be performed to explain the composition of the stone. In order to rule out the possibility of an inflammatory process when diagnosing gallstones, a blood test should be carried out on the patient.
This examination should mainly examine the white blood cells (leukocytes) and the inflammatory proteins (CRP), whose increase would be typical of an inflammatory process. Liver and bile values should also be investigated (gamma GT, alkaline phosphatase). Endoscopic retrograde cholangio-pancreaticography (ERCP) is another method of diagnosis, especially in cases of outflow problems caused by gallstones.
Here, a tube with a camera at its tip is inserted into the stomach and then into the duodenum. From there, the tube is inserted into the bile duct, where it can be examined to determine whether a gallstone is present. If a contrast medium is injected through the advanced instrument into the bile duct and an X-ray image is then taken, gallstones can be detected that are obstructing the flow of the contrast medium. An ultrasound probe at the beginning of the tube can also be used to obtain an even more precise image of the gall bladder and the bile duct system.
