Table of ContentsView AllTable of ContentsMedical HistoryPhysical ExaminationLabsImagingDifferential DiagnosisFrequently Asked QuestionsNext in Gallbladder Disease GuideHow Gallbladder Disease Is Treated
Table of ContentsView All
View All
Table of Contents
Medical History
Physical Examination
Labs
Imaging
Differential Diagnosis
Frequently Asked Questions
Next in Gallbladder Disease Guide
The term “gallbladder disease” encompasses medical conditions that affect the gallbladder, like gallstones, acute or chroniccholecystitis(gallbladder inflammation resulting from gallstones), and gallbladder cancer.
While symptom review, physical examination, and blood work all play a role in the diagnosis of gallbladder disease, obtaining anabdominal ultrasound(and possibly other imaging tests) is the most important aspect of the diagnostic process.
© Verywell, 2018
If your healthcare provider suspects gallbladder disease, he will inquire about yoursymptomsand whether you or any family members have ever had any gallbladder problems.
Examples of potential questions include:
Gallbladder Disease Healthcare Provider Discussion GuideGet our printable guide for your next healthcare provider’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
Download PDF
Email AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Sign Up
Thank you, {{form.email}}, for signing up.
There was an error. Please try again.
Next, your healthcare provider will perform a physical examination, focusing first on your vital signs. People with acutecholecystitismay have a fever and a high heart rate.
During an abdominal exam, your healthcare provider will note whether or not a finding called “guarding” is present. The abdominal wall muscles of a person with acute cholecystitis may tense up and spasm to “guard” inflamed organs when the abdomen is pressed upon.
Lastly, during the physical exam, your healthcare provider will perform a maneuver called “Murphy’s sign.” With this test a person is asked to take a deep breath in, allowing the gallbladder to move down so the healthcare provider can press on it. If a person experiences significant pain during this test (called a positive “Murphy sign”), it suggests he or she may have gallbladder disease.
People with gallbladder disease often have an elevatedwhite blood cell count. Your white blood cells are your infection-fighting cells and when elevated signal some sort of inflammation or infection in the body. In addition to an elevated white blood cell count, a person may have elevatedliver function tests.
While there may be a mild increase in liver enzymes, an elevation in the bilirubin level (also part of the liver function blood test) suggests a possible complication of gallbladder disease (for example, if a gallstone is impacted in the bile duct and/or there is an infection of the bile duct).
If your healthcare provider suspectsgallbladder cancerbased on imaging tests (for example, ultrasound, CT scan, or MRI), he may order tumor marker blood tests, like CEA or CA 19-9. These markers, however, may also be elevated in the presence of other cancers, so they aren’t a direct indication of gallbladder cancer. More often than not, these tumor markers are used to follow a person’s response to cancer treatment (if elevated initially).
While a medical history, physical examination, and labs may support a diagnosis of gallbladder disease, imaging is needed to confirm a diagnosis.In other words, the gallbladder needs to be visualized, and this is most often done with an ultrasound.
Ultrasound
Anultrasoundis a quick and usually painless imaging test that uses sound waves to produce an image of the gallbladder. In addition to gallstones, gallbladder wall thickening or swelling and gallbladder polyps or masses may be seen.
During an ultrasound, the technician can also perform a “sonographic Murphy’s sign.” During this maneuver, the ultrasound transducer is pressed on the gallbladder while the patient takes a deep breath. If positive, the person will experience pain when the gallbladder is pressed down upon.
HIDA Scan
If the gallbladder cannot be visualized the test is “positive” because it means that there is some sort of obstruction (often from a gallstone, but possibly from a tumor) in the cystic duct, which is a tube that transports bile from the gallbladder to the common bile duct.
Computed Tomography (CT) Scan
Acomputed tomography (CT) scanof your abdomen may also reveal signs of gallbladder disease, like gallbladder wall swelling or fat stranding. It can be particularly useful for diagnosing rare, life-threatening complications of acute cholecystitis, like gallbladder perforation (when a hole develops in the gallbladder) or emphysematous cholecystitis (in which there is an infection of the gallbladder wall from gas-forming bacteria).
Magnetic Resonance Cholangiopancreatography (MRCP)
Thisnon-invasive imaging testallows a healthcare provider to evaluate the bile ducts both inside and outside the liver. It may be used to diagnose a stone in the common bile duct (a condition called choledocholithiasis).
Endoscopic Retrograde Cholangiopancreatography (ERCP)
AnERCPis both a diagnostic and potentially therapeutic test. During anERCP, a gastroenterologist (a doctor who specializes in digestive system diseases) will place a thin, flexible camera called an endoscope into a person’s mouth, down the esophagus, past the stomach, and into the small intestine.
A person is sedated during this procedure so there is no discomfort. Then, through the endoscope, a small tube is passed into the common bile duct. Contrast dye is injected into this small tube to light up the bile duct system, which can be seen through x-rays.
From an ERCP, a gallstone that is blocking the bile ducts can be visualized and removed at the same time. Narrowing of the bile ducts can also be seen with an ERCP, and a stent can be placed to keep the duct open. Lastly, during an ERCP, the healthcare provider can take a tissue sample (called a biopsy) of any suspicious polyps or masses.
Examples of liver problems that may cause pain in the right upper side of the abdomen include:
Other than pain in the right upper part of the abdomen, a person with gallbladder disease may experience pain in the upper middle region of the abdomen (called epigastric pain).
Other potential causes of epigastric pain include:
If gallbladder disease is suspected, the healthcare provider may look for the “Murphy sign.” This involves touching the area above the gallbladder as you inhale and hold your breath. Pain during the maneuver is a sign of gallbladder disease. Other signs may include fever,tachycardia(rapid heartbeat), and jaundice.
Blood tests cannot diagnose gallbladder disease, but they check for abnormalities suggestive of gallstones,biliary dyskinesia, and other forms of gallbladder disease. The tests typically include:
There are several non-invasive imaging tests healthcare providers can use to diagnose gallbladder disease:Abdominal ultrasound, used to detect gallstones, polyps, masses, or abnormal changes to the gallbladder or liverHepatobiliary iminodiacetic acid (HIDA) scan, used to examine the duct system of the gallbladder and liverComputed tomography (CT) scan, useful in detecting complications of gallbladder inflammation, such as perforation or infection
There are several non-invasive imaging tests healthcare providers can use to diagnose gallbladder disease:
An abdominal ultrasound is one of the primary methods of diagnosis. Not only is it non-invasive, but it has an accuracy of around 95% in detecting gallstones 2 millimeters (mm) or larger and is 80% accurate in detecting acute gallbladder inflammation (cholecystitis).
Endoscopic retrograde cholangiopancreatography (ERCP)is a procedure in which a flexible scope is fed into the mouth, past the stomach, and into the intestine to view thebiliary system. Once positioned,contrast dyeis used to visualize the system on an X-ray. If a gallstone is found, a special tool can be fed through the scope to remove it.
How Gallbladder Disease Is Treated
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Cancer Society.Signs and Symptoms of Gallbladder Cancer.Costi R, Gnocchi A, Di Mario F, Sarli L.Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy.World J Gastroenterol. 2014;20(37):13382-401. doi:10.3748/wjg.v20.i37.13382Jones MW, Genova R, O’Rourke MC.Acute cholecystitis. In:StatPearls [Internet].American Cancer Society.Tests for Gallbladder Cancer.Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK.Surgical and nonsurgical management of gallstones.Am Fam Physician. 2014 May 15;89(10):795-802.Zakko SF, Afdhal NH. (2016).Acute cholecystitis: Pathogenesis, clinical features, and diagnosis. Chopra S, (ed). UptoDate, Waltham, MA: UpToDate Inc.Bittencourt PL, Couto CA, Ribeiro DD.Portal vein thrombosis and budd-Chiari syndrome. Clin Liver Dis. 2009;13(1):127-144. doi:10.1016/j.cld.2008.10.002Sanders G, Kingsnorth AN.Clinical Review: Gallstones.BMJ. 2007 Aug 11;335(7614):295-99. doi:10.1136/bmj.39267.452257.ADSekimoto R, Iwata K.Sensitivity of Murphy’s sign on the diagnosis of acute cholecystitis: is it really so insensitive?J Hepatobiliary Pancreat Sci. 2019;26(10). doi:10.1002/jhbp.657Jones MW, Kashyap S, Ferguson T.Gallbladder imaging. In:StatPearls [Internet].Pinto A, Reginelli A, Cagini L, et al.Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature.Crit Ultrasound J. 2013;5(S1):S11. doi:10.1186/2036-7902-5-S1-S11
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Cancer Society.Signs and Symptoms of Gallbladder Cancer.Costi R, Gnocchi A, Di Mario F, Sarli L.Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy.World J Gastroenterol. 2014;20(37):13382-401. doi:10.3748/wjg.v20.i37.13382Jones MW, Genova R, O’Rourke MC.Acute cholecystitis. In:StatPearls [Internet].American Cancer Society.Tests for Gallbladder Cancer.Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK.Surgical and nonsurgical management of gallstones.Am Fam Physician. 2014 May 15;89(10):795-802.Zakko SF, Afdhal NH. (2016).Acute cholecystitis: Pathogenesis, clinical features, and diagnosis. Chopra S, (ed). UptoDate, Waltham, MA: UpToDate Inc.Bittencourt PL, Couto CA, Ribeiro DD.Portal vein thrombosis and budd-Chiari syndrome. Clin Liver Dis. 2009;13(1):127-144. doi:10.1016/j.cld.2008.10.002Sanders G, Kingsnorth AN.Clinical Review: Gallstones.BMJ. 2007 Aug 11;335(7614):295-99. doi:10.1136/bmj.39267.452257.ADSekimoto R, Iwata K.Sensitivity of Murphy’s sign on the diagnosis of acute cholecystitis: is it really so insensitive?J Hepatobiliary Pancreat Sci. 2019;26(10). doi:10.1002/jhbp.657Jones MW, Kashyap S, Ferguson T.Gallbladder imaging. In:StatPearls [Internet].Pinto A, Reginelli A, Cagini L, et al.Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature.Crit Ultrasound J. 2013;5(S1):S11. doi:10.1186/2036-7902-5-S1-S11
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Cancer Society.Signs and Symptoms of Gallbladder Cancer.Costi R, Gnocchi A, Di Mario F, Sarli L.Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy.World J Gastroenterol. 2014;20(37):13382-401. doi:10.3748/wjg.v20.i37.13382Jones MW, Genova R, O’Rourke MC.Acute cholecystitis. In:StatPearls [Internet].American Cancer Society.Tests for Gallbladder Cancer.Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK.Surgical and nonsurgical management of gallstones.Am Fam Physician. 2014 May 15;89(10):795-802.Zakko SF, Afdhal NH. (2016).Acute cholecystitis: Pathogenesis, clinical features, and diagnosis. Chopra S, (ed). UptoDate, Waltham, MA: UpToDate Inc.Bittencourt PL, Couto CA, Ribeiro DD.Portal vein thrombosis and budd-Chiari syndrome. Clin Liver Dis. 2009;13(1):127-144. doi:10.1016/j.cld.2008.10.002Sanders G, Kingsnorth AN.Clinical Review: Gallstones.BMJ. 2007 Aug 11;335(7614):295-99. doi:10.1136/bmj.39267.452257.ADSekimoto R, Iwata K.Sensitivity of Murphy’s sign on the diagnosis of acute cholecystitis: is it really so insensitive?J Hepatobiliary Pancreat Sci. 2019;26(10). doi:10.1002/jhbp.657Jones MW, Kashyap S, Ferguson T.Gallbladder imaging. In:StatPearls [Internet].Pinto A, Reginelli A, Cagini L, et al.Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature.Crit Ultrasound J. 2013;5(S1):S11. doi:10.1186/2036-7902-5-S1-S11
American Cancer Society.Signs and Symptoms of Gallbladder Cancer.
Costi R, Gnocchi A, Di Mario F, Sarli L.Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy.World J Gastroenterol. 2014;20(37):13382-401. doi:10.3748/wjg.v20.i37.13382
Jones MW, Genova R, O’Rourke MC.Acute cholecystitis. In:StatPearls [Internet].
American Cancer Society.Tests for Gallbladder Cancer.
Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK.Surgical and nonsurgical management of gallstones.Am Fam Physician. 2014 May 15;89(10):795-802.
Zakko SF, Afdhal NH. (2016).Acute cholecystitis: Pathogenesis, clinical features, and diagnosis. Chopra S, (ed). UptoDate, Waltham, MA: UpToDate Inc.
Bittencourt PL, Couto CA, Ribeiro DD.Portal vein thrombosis and budd-Chiari syndrome. Clin Liver Dis. 2009;13(1):127-144. doi:10.1016/j.cld.2008.10.002
Sanders G, Kingsnorth AN.Clinical Review: Gallstones.BMJ. 2007 Aug 11;335(7614):295-99. doi:10.1136/bmj.39267.452257.AD
Sekimoto R, Iwata K.Sensitivity of Murphy’s sign on the diagnosis of acute cholecystitis: is it really so insensitive?J Hepatobiliary Pancreat Sci. 2019;26(10). doi:10.1002/jhbp.657
Jones MW, Kashyap S, Ferguson T.Gallbladder imaging. In:StatPearls [Internet].
Pinto A, Reginelli A, Cagini L, et al.Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature.Crit Ultrasound J. 2013;5(S1):S11. doi:10.1186/2036-7902-5-S1-S11
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
