I am having pain in my right side and have yellow eyes. Because I have a
history of gallstones, my doctor thinks the pain might be caused by a stone
blocking my bile duct. She would like to send me to a specialist to have tests
done to make sure. What kind of tests will be done?
The gallbladder is a small, pear-shaped organ positioned under the liver in
the upper right portion of the abdomen. Its main purpose is to collect bile, a
digestive agent produced by the liver. Gallbladder problems are usually the
result of gallstones, small masses that form in the gallbladder or the bile
duct. Gallstones might block the flow of bile from the gallbladder, causing it to
swell. Symptoms might include sharp abdominal pain, vomiting, and indigestion.
Gallbladder pain might start after a meal and it might be severe or steady. If left
untreated, symptoms might worsen.
To determine the source of your problem, your doctor will likely first
recommend a procedure known as an endoscopic retrograde cholangiopancreatography
(ERCP). The ERCP is used to diagnose disorders of the
gallbladder, pancreas, and liver. The ERCP can help your doctor determine the
cause of jaundice (yellow discoloration of the skin and eyes) and whether
surgery or other medical treatment is necessary. ERCP can also help your doctor
determine the cause of pain or the source of abnormal lab results when jaundice
is not present.
During the ERCP procedure, a doctor uses an endoscope (a long, thin,
flexible instrument about 1/2 inch in diameter) to take X-rays of the pancreatic
and bile ducts. Once the source of the problem is identified, the doctor might
then treat the abnormalities in one of several ways:
- A sphincterotomy might be performed. A sphincterotomy is a small incision in
the opening of the bile duct that can help small gallstones and bile to
drain appropriately.
- A stent can be placed. A stent is a plastic drainage tube that is placed
in the bile duct and allows it to drain.
- Gallstones can be removed.
When severe obstruction of the gallbladder occurs, removal is the only
option. Laparoscopic cholecystectomy is a minimally invasive surgical procedure
during which the gallbladder is completely removed. Any stones found in the common
duct are also removed during the surgery.
During laparoscopic surgery, a thin, telescope-like instrument called a
laparoscope is inserted through a small incision near your belly button. The
laparoscope is connected to a tiny video camera that projects a view of the
operative site onto video monitors located in the operating room. The abdomen is
inflated with carbon dioxide, a gas, to provide a better view of the operative
area. Three additional incisions are made near the laparoscope through which the
surgeon inserts special surgical instruments to remove the gallbladder.
If a gallstone is present in the common bile duct (CBD), a CBD exploration
might be performed. The doctor will make a small incision in the abdomen, locate
the CBD and inject a dye into the duct. The doctor will then take an X-ray that
will show where the stone or obstruction is located. The doctor will make an
incision in the bile duct and remove the stone(s). A tube might be inserted into the
duct and out of your abdomen to drain excess bile into a external bag. This bag
will remain in place from seven days to a few weeks, depending on your
condition. Usually the doctor will inject additional dye into the tube and take
an X-ray to make sure the duct is clear before the tube is removed.