Abdominal pain is the main symptom of gallstone disease, and it is not difficult to make a preliminary self-diagnosis based on the characteristics and pattern of abdominal pain.
Characteristics of gallbladder stones.
(i) The pain is mostly in the right upper abdomen and can be vague, dull, distending or colicky.
(ii) There are often dietary triggers, and the onset of pain has been preceded by a high-fat, high-fat diet.
(iii) the pain may be recurrent and there may be pain in the right shoulder or scapula.
④ pressure pain under the right upper abdominal rib cage.
⑤ Most often occur above 40, more women than men, and mostly in obese patients.
Characteristics of common bile duct stones.
① painful site in the epigastrium or under the glabella, which may be dull and distended or paroxysmal colic.
② often accompanied by chills, tremors, and fever.
③Some patients may have dark yellow urine, yellow eyes, and yellow skin staining all over the body.
(iv) There is often pressure pain to the right of the subxiphoid process, and there is also often snap pain in the liver area.
⑤ Most often occur in young adults, and the proportion of men and women is similar.
Features of intrahepatic bile duct stones.
① pain in the liver area or in the shoulder, scapula or chest and back.
② Mostly dull pain and distension, rarely colic.
③Some patients may have chills and fever.
④Symptoms are often recurrent and gradually worsen.
⑤ There may be snapping pain in the liver area.
Based on the above characteristics and patterns, preliminary self-judgment can be made, and a definite diagnosis should be made by going to the hospital for further examination. In addition to the general physical examination, some necessary imaging examinations should be done. Since gallstone disease is a complex disease, sometimes a single examination alone cannot clarify the distribution of stones and other lesions caused by the disease, and several examinations are needed to analyze and complement each other, so it is important to choose the appropriate imaging examination. Therefore, it is important to choose the appropriate imaging test. The following is a brief description of the commonly used tests for reference.
Ultrasound examination
It is a non-invasive test, cheap, simple, easy to perform, with high diagnostic rate and can be followed up, and is the first test for biliary tract diseases. It can detect whether the gallbladder is enlarged, whether the gallbladder wall is thickened, whether there is inflammatory reaction, whether there are stones in the gallbladder, the size and shape of stones and their specific location in the gallbladder; whether the intrahepatic bile duct and common bile duct are dilated and whether there are stone shadows, as well as the size, number and location of stones. Because ultrasound examination is easily affected by gas, it is advisable to examine after 6 hours of fasting.
CT examination
It is a non-invasive examination, with high resolution, not affected by gas, and can obtain very clear images, which is more accurate in locating stones, and is a very valuable examination method. The drawback is that it is significantly more expensive than ultrasound, and the normal CT scan is 1 cm in size, so stones less than 1 cm in diameter may be missed.
MRI
MRI is also a non-invasive test, but it is expensive and not routinely performed. It can be used to obtain three different axial views and to image the biliary tract, which can replace direct cholangiography to some extent. Therefore, it is important in determining the presence or absence of biliary obstruction or identifying the cause of obstruction.
X-ray abdominal plain film examination
About 20-30% of patients with gallbladder stones can show a stone shadow in the gallbladder area, and when calcification of the gallbladder occurs in chronic cholecystitis, it can show the outline of gallbladder calcification. This test is only meaningful in a few patients and is not a routine test.
Cholangiography.
① oral cholangiography and intravenous cholangiography, because it is disturbed by many factors, or does not develop or does not develop clearly, the image is not clear; now basically not used for gallstone disease examination.
Direct cholangiography: including percutaneous hepatic cholangiography (PTC) and transoral fiberoptic endoscopic retrograde cholangiography (ERCP), both of which can obtain a clear image of the entire intra- and extra-hepatic biliary system, clearly showing the size, number and distribution of gallstones, and can understand the presence of biliary stenosis, dilatation, obstruction, compression, displacement and other conditions, providing clinicians with a reliable qualitative and localized diagnostic basis. For patients with obstructive jaundice, it is also possible to carry out drainage of the bile duct at the same time as the examination to achieve the purpose of biliary decompression and jaundice reduction. The disadvantage is that PTC is an invasive test with complications such as bleeding, bile leak and infection, and it is not easy to puncture successfully when the intrahepatic bile ducts are not dilated; ERCP requires certain technical conditions and equipment, and some patients may have complications such as pancreatitis, biliary tract infection or aggravation of infection and liver function damage, and there is a certain failure rate.
Confirmation of the diagnosis of biliary tract disease involves both qualitative localization and a complete set of imaging data is necessary to establish whether surgical treatment is needed and to determine what surgical procedure to perform. One test alone is often not enough and often requires a combination of tests to complement each other; however, unnecessary duplication should also be avoided to avoid increasing the burden on the patient. In the above-mentioned examinations, the principle is: choose non-invasive examinations (such as ultrasound, CT or MRI) first, and then determine whether to choose examinations with damage, or combined examinations, according to the results of non-invasive examinations and the needs of the disease.