Gallstones - Diagnosing gallstones

As many people with gallstones do not have any symptoms, they are often discovered by chance during investigations of unrelated conditions.

If you have symptoms of gallstones, you should make an appointment with your GP so they can try to identify the problem.

Seeing your GP

Your GP will ask about your symptoms in detail and they may carry out a simple test known as the Murphy’s sign test to help determine if your gallbladder is inflamed (which may require urgent treatment).

During this test, your GP will place their hand or fingers on the upper-right area of your tummy and will ask you to breathe in. If you find this painful, it usually indicates that your gallbladder is inflamed.

Your GP may also recommend having blood tests to look for signs of infection, or to check if your liver is working normally. If gallstones have moved into your bile duct, the normal functioning of your liver will be disrupted.

If your symptoms or the results of these tests suggest you may have gallstones, your GP will usually refer you for further tests to confirm the diagnosis. You may be admitted to hospital for tests the same day if your symptoms suggest that you have a more severe form of gallbladder disease.

Further tests

Ultrasound scan

Gallstones can usually be confirmed using an ultrasound scan which uses high frequency sound waves to create an image of the inside of the body.

The type of ultrasound scan used for gallstones is similar to the scan used during pregnancy, where a small handheld device called a transducer is placed onto your skin and moved over your upper abdomen.

Sound waves are sent from the transducer, through your skin and into your body. They then bounce back off the body tissues, forming an image that is displayed on a monitor. This is a painless procedure that usually takes about 10-15 minutes to complete.

When gallstones are diagnosed, there may be some uncertainty about whether any stones have passed into the bile duct.

Bile duct stones are sometimes seen during an ultrasound scan, but if they are not visible and tests you have had suggest the bile duct may be affected (for example, a blood test was abnormal or the bile duct appeared wider than usual during the ultrasound scan), further investigations are needed. In most cases, this will involve an MRI scan or a cholangiogram (see below).

MRI scan

A magnetic resonance imaging (MRI) scan may be carried out to look for gallstones in the bile ducts. This type of scan uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

Cholangiography

A procedure called a cholangiography can give further information about the condition of your gallbladder.

A cholangiography uses a dye that shows up on X-rays. The dye may be injected into your bloodstream, inserted into your bile ducts during surgery to remove the gallbladder, or inserted into your bile ducts using an endoscope (a long, thin flexible tube with a camera at the end) that is passed through your mouth.

After the dye has been introduced, X-ray images are taken. They will reveal any abnormality in your bile or pancreatic systems. If your gallbladder and bile systems are working normally, the dye will be absorbed in the places it’s meant to go (your liver, bile ducts, intestines and gallbladder).

If a blockage is detected during this test, your doctor may try to remove it at this point using an endoscope. This is known as an endoscopic retrograde cholangio-pancreatography (ERCP). See treating gallstones for more information about ERCP.

CT scan

A computerised tomography (CT) scan may be carried out to look for a complication of gallstones such as acute pancreatitis. This type of scan involves taking a series of X-rays from many different angles.

CT scans are often done in an emergency to diagnose severe abdominal pain.