How to diagnose and identify gallstones?

The diagnosis of gallstones is usually made through a combination of physical signs, imaging studies, and laboratory tests, while differential diagnosis mainly relies on excluding other diseases that may cause similar symptoms, such as cholecystitis, pancreatitis, or peptic ulcer disease.

The diagnosis of gallstones is mainly based on the patient's symptoms and auxiliary examinations. Typical symptoms are paroxysmal colic in the right upper abdomen, sometimes accompanied by nausea, vomiting and jaundice. Among imaging examinations, abdominal B-ultrasound is the first choice because it can clearly show stones in the gallbladder and bile ducts with an accuracy rate of up to 95%. If combined bile duct stones are suspected, magnetic resonance pancreaticocholangiopancreatography (MRCP) can be used. This non-invasive examination can more clearly observe the condition of the bile duct. For difficult or complicated cases, endoscopic retrograde pancreaticocholangiopancreatography (ERCP) can not only be used for diagnosis, but also for the treatment of blocked bile ducts. Laboratory indicators such as blood routine, liver function and amylase levels can assist in the assessment of inflammation or bile duct obstruction.

For differential diagnosis, it is necessary to identify other causes of right upper abdominal pain. For example, cholecystitis is usually accompanied by persistent abdominal pain and fever, and a positive Murphy sign is found during physical examination; acute pancreatitis is manifested by acute upper abdominal pain radiating to the posterior waist, accompanied by significantly elevated serum amylase and lipase; and peptic ulcer may present as burning stomach pain that worsens after meals. Differentiation of these diseases requires a comprehensive judgment based on clinical symptoms, laboratory and imaging examinations.

After the diagnosis of gallstones, the treatment plan should be selected according to its type, location and symptoms. If the small stones are asymptomatic, no treatment is necessary, but if there are symptoms or complications, surgical intervention is required. For example, laparoscopic cholecystectomy is currently the most commonly used minimally invasive treatment method; for common bile duct stones, stones can be removed by ERCP; drug lithotripsy, such as oral ursodeoxycholic acid, is only suitable for patients who cannot undergo surgery and have small stones. Adjusting the diet is also crucial, avoiding a high-fat, high-cholesterol diet, eating more fiber-rich vegetables and fruits, and exercising appropriately to prevent stone recurrence.