Find and eliminate the stone: diagnosis of gallstone disease

Millions of people around the world have experienced all the "charm" of sensations that accompany biliary colic, which occurs with cholelithiasis. Thousands more live for years, not even suspecting that a stone is calmly floating in their gallbladder, which at the most unexpected moment can make itself felt in the form of acute cholecystitis or more serious complications of gallstone disease. To prevent all the unpleasant consequences of this disease, it is necessary to diagnose gallstone disease in a timely manner and remove the stone from the gallbladder cavity as soon as possible.

What information can blistering symptoms provide

Surprisingly, but true: even during an attack of renal colic, many patients can independently try to eliminate pain, mistaking them for the result of overeating, for example, and seek medical help already with a complicated course of gallstone disease. In order to detect an acute attack of biliary colic in time and provide the patient with qualified medical care, there are so-called “bubble” symptoms that even the patient himself can check. There are five main vesical symptoms:

1. Ortner's symptom: if the edge of the right costal arch is tapped with the edge of the palm, the patient will feel pain in this area.
2. Murphy's symptom: palpation in the projection of the gallbladder on a deep breath will also provoke pain.
3. Kera's symptom: pain also occurs when tapping with a bent index finger at the projection point of the gallbladder on the abdominal wall.
4. Mussy's symptom: when pressing with fingers between the legs of the sternocleidomastoid muscle, pain also occurs in the right hypochondrium.
5. Courvoisier's symptom: the gallbladder will be determined by palpation as a smooth and practically painless mass.

Non-invasive diagnostic methods for gallstone disease

Instrumental methods for diagnosing cholelithiasis are divided into invasive and non-invasive methods. The main non-invasive methods are ultrasound, plain radiography and computed tomography of the abdominal organs. Ultrasound examination of the hepatobiliary system is the gold standard for diagnosing cholelithiasis; in 98% of cases, this method is sufficient to confirm the diagnosis. A stone in the gallbladder during ultrasound is visualized as a round echo-positive crescent-shaped formation with an acoustic "track". In addition, when the patient's position changes, the calculus will also move in the gallbladder cavity. Plain radiography and computed tomography provide information on the composition of the stone in the gallbladder,

Invasive methods for diagnosing cholelithiasis

Invasive diagnostic methods are often used in complex cases, when it is difficult to establish a reliable diagnosis and differential diagnosis is necessary. There are three main methods of invasive diagnosis of gallstone disease:

percutaneous transhepatic cholangiography - this method involves performing a puncture of the intrahepatic bile duct under ultrasound control;
endoscopic retrograde cholangiography is performed by endoscopic cannulation of the major duodenal papilla and injection of a contrast agent into the common bile duct, followed by x-ray examination.
intraoperative cholangiography is performed already during surgery and consists in the direct injection of contrast into the bile ducts.

In most cases, already vesicular symptoms and ultrasound are enough to establish a reliable diagnosis and start effective treatment. Otherwise, the above additional diagnostic methods will help establish the diagnosis of gallstone disease.