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.
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