Gallstone disease differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Gallstone disease must be differentiated from other diseases that cause epigastric, and left and right hypochondriac pain (right upper quadrant) such as: Abdominal pain, esophageal chest pain,gastroesophageal reflux disorder, peptic ulcer disease, non-ulcer dyspepsia,hepatitis, functional gallbladder disorder, sphincter of Oddi dysfunction, chronic pancreatitis, irritable bowel syndrome, ischemic heart disease, pyelonephritis, ureteral calculi and complications of gallstone disease include: acute cholecystitis, choledocholithiasis, acute pancreatitis, and acute cholangitis
Differentiating Gallstone disease from other Diseases
As Gallstone disease manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. The presence of biliary colic is an important diagnostic feature to distinguish between gallstones and non-biliary disorders. It has been shown that this feature is predictive of finding stones on imaging. [1]
However, it is important to note that biliary colic concomitant in patients with other biliary disorders such as acute cholecystitis, choledocholithiasis, sphincter of Oddi dysfunction, and functional gallbladder disorder.
Laboratory studies can be helpful, along side clinical presentation in making a preliminary diagnosis:
- Liver biochemical tests (serum aminotransferases, total bilirubin, alkaline phosphatase), which may be abnormal in patients with hepatitis, biliary tract obstruction, or (less commonly) acute cholecystitis
- Serum amylase and lipase, which are elevated in acute pancreatitis
- Complete blood count, which may show an elevated white blood cell count in patients with acute cholecystitis or acute cholangitis
- Urine analysis, which may show indicate a urinary tract infection or ureteral calculi
Other tests that may be indicated depending upon the patient's symptoms and history including:
- Upper endoscopy to look for peptic ulcer disease
- Endoscopic ultrasonography to look for chronic pancreatitis
- Endoscopic retrograde cholangiopancreatography (ERCP) with sphincter of Oddi manometry to look for sphincter of Oddi dysfunction
- Cholescintigraphy with or without cholecystokinin (CCK)-stimulation to look for acute cholecystitis and functional gallbladder disorder, respectively
- Testing for ischemic heart disease
- Esophageal manometry to look for esophageal sources of chest pain, such as esophageal spasm
To review a table of differential diagnoses for disease symptoms including jaundice, abdominal pain and fever, please click here: