Clinical Manifestations and Diagnosis of Gall Stone Disease

Approximately 80% of people with gall stones are asymptomatic. The presentation of gall bladder disease can be episodic pain when a brief cystic duct obstruction occurs or acute cholecystitis when the obstruction lasts longer and results in local and relatively extensive inflammation and edema. The complications include infection of the biliary system (cholangitis) and pancreatitis.

Symptoms and Signs

Pain related to the gall bladder is usually felt in the right upper quadrant or in the epigastrium. It may radiate to the back, going around the right flank. In some cases, it may radiate to the shoulder area or be felt in the chest. In acute cholecystitis, the pain is steady, as opposed to cramping or colicky. It typically occurs after a meal and may be accompanied by nausea and vomiting. Continuous obstruction of the cystic duct causes gall bladder distention and inflammation. Extension of the inflammation into the common bile duct area may cause edema and obstruction of the duct, resulting in jaundice. The physical signs of acute cholecystitis include right upper quadrant tenderness and Murphy's sign, which refers to severe right upper quadrant tenderness and inhibition of inspiration on deep palpation under the right subcostal margin.

Laboratory Findings

In acute cholecystitis, liver enzymes are normal or mildly elevated. Marked increase in liver enzymes should raise the possibility of bile duct obstruction concomitant with, or instead of, acute cholecystitis. In the case of bile duct obstruction, alanine amino-transferase and aspartate aminotransferase increase rapidly to levels 10 times normal and then decrease quickly toward normal, even if the obstruction persists. Alkaline phosphatase, on the other hand, will continue to increase unless the obstruction resolves. Mild to moderate leukocytosis is common in acute cholecystitis. Bile levels may increase if the obstruction lasts long enough.


Ultrasonography, with a sensitivity of 96%, is a major diagnostic tool in gall bladder disease. The sonographic evidence of acute cholecystitis includes gall bladder size, its wall thickness, and perichole-cystic fluid conformation. Among these signs, the latter is the most sensitive. Computed tomography is less sensitive and more expensive than ultrasono-graphy. Its main role is to rule out other intraabdominal processes. Magnetic resonance imaging has become an important means of detecting bile duct stones. Its sensitivity is approximately 85% for bile duct stones. Oral cholecystography has almost completely been replaced by ultrasonography. Endoscopic retrograde cholangiopancreatography (ERCP) is mostly used for its diagnostic and especially its therapeutic capability for removing bile duct stones. Hepatobiliary scintigraphy consists of the uptake by the gall bladder of an intravenously administered, 99mTc-labeled iminodiacetic acid derivative. The liver excretes the isotope into the bile ducts. A normal hepatobiliary scan using diisopropyliminodiacetic acid effectively rules out acute cholecystitis. If, on the other hand, the isotope does not appear in the bile ducts within 4h, the likelihood of acute cholecystitis is very high.

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Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.

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