What is the most accurate test for finding gallstones STAT!

April 4, 2011 7:14 AM

What is more accurate for detecting gallstones--HIDA, MCRP, CT, ultrasound?

YNMD but...

The entire months of Feb and March have been increasing symptoms with two trips to the ER within 6 days. However, none of the docs wanted to scan me for gallstones. They said all symptoms were 100% ulcers/GERD. Well I just took my upper endoscope and it was 100% normal--no ulcers, no inflammation, nothing.

My symptoms have been on and off for a few years but the last 2 months, increasing, persistant, and unbearable.

Constant nausea
Middle/upper stomach pain (not right side classic gallstones though)
Lower back pain
Indigestion
Stomach churning like crazy whether I eat or not
Can't eat due to nausea, pain, and/or random vomiting/wretching (no blood)
Lost a lot of weight (15lbs) in a short time (because not eating)
Pain waking me up at 2amish
Pain every time I ate--as soon as it hit my stomach
Feeling like something was "stuck" in my esophogus
Feeling like I was 3rd trimester pregnant again because of the pressure--like my stomach was pushed up high so it was hard to breathe
The 2nd ER trip was because of this pressure then out of the blue immediate stabbing/ripping pain near my kidneys--both sides equally, I couldn't breathe in because every time I did it was excrutiating stabbing pain
The stabbing pain incident left me dizzy, disoriented, felt like blood was rushing down both of my arms to my fingertips.
Chills at times
Felt so wrong like I was going to pass out or something bad was going to happen (no it wasn't a heart attack-impending doom but close)

And both times at the ER? Three residents and two ER docs said "oh you have ulcers", gave me a blood test (LFT, pancreas, CBC) showed normal levels. Second time to the ER in 6 days with the stabbing back pain? No tests what so ever. They pulled my blood tests for SIX DAYS prior and said "oh now that your pain is gone, you're not an ER case."

Both times--no scans. I even went to my doctor first on emergency via cab and told of my symptoms. He said 'you need to walk across the street (yes I did by myself and disoriented) and get scans. Well the @#$# ER refused any scans saying "this is clearly ulcers--you can get an ultrasound outpatient."

I think the whole thing was total b.s. even if it were ulcers or something else, I think the ER should have scanned me. My primary didn't believe me it was gallstones so he sent me for the endoscope and I had to compromise with him to get the ultrasound--if I go for endo you give me an ultrasound.

The GI doc who performed the endoscope was outraged that no one scanned me. I told her yea the stabbing back pain was very odd and didn't seem like ulcers. She said "nope it didn't. That sounded like a stomach perforation going on. They should have immediately scanned you."

And no I'm not a doctor either but any research I've seen clearly said it was more gallstones, possible pancreatitis going on (no jaundice), stone stuck--SOMETHING gallstone related and blood levels could be normal through all of that. Ultrasound three years ago (when I had severe, doubled over stomach pains and back pains) were completely normal.

I think the ultrasound is a huge waste of time but going tomorrow since I told the scheduler about my 2 ER visits ("Why the heck didn't anyone scan you in the ER?"). The fastest I can get in with a GI doc is the end of April. I have a boatload of work to do in May and we're looking at vacations and possibly 2nd baby planning in Aug. So I want to get this all done.

So if I want to really push it with a doctor after this ultrasound (I bet it will show normal), what is more accurate? MRCP (MRI), HIDA, or CT?

The pain has subsided but after eating a bean/rice burrito, that pressure, can't eat feeling came back in 3 hours after eating. This weekend, without eating, putting my son to bed, out of the blue wretching. So something is going on even though I'm not in severe symptoms like I was for two months but it obviously can still be 'triggered'.

posted by stormpooper to Health & Fitness (9 answers total)

I had an ultrasound to diagnose a gallbladder attack and they found a bunch of stones in the ultrasound, and found some stuck in the common bile duct as well, so I don't think it will be a huge waste of time, but my symptoms were pretty different than yours.
posted by kpht at 7:22 AM on April 4, 2011

Ultrasound is they way they check for gallstones. So the scan won't be a waste of time if you think that's your problem.
posted by saradarlin at 7:25 AM on April 4, 2011

Ultasound will show presence or absence of gallstones along will any associated gallbladder wall thickening or inflammation which would be indicative of an acute inflaamatory process.

HIDA scan shows gallbladder function, namely whether your gallbladder is squirting out enough bile when it is supposed to. They can use some medication to try to reproduce the pain if your problem is a poorly functioning gallbladder.

Start with the ultrasound, if normal, then HIDA scan. Many reasons for that progression that I won't get into here, but feel free to Mefimail me if you have questions.

Your PCP should be able to order both of these for you if needed, because as you know IANYD.
posted by defenestrated at 9:09 AM on April 4, 2011

Holy crap, grammar all jacked up. Sorry for the incoherent post. That's what I get for posting on the go.
posted by defenestrated at 9:10 AM on April 4, 2011

For 6 years I was in and out of ERs and doctor's offices with issues related to my gallbladder. They never did a scan. Finally, I told my doctor I couldn't handle the pain anymore, and she ran every test under the sun, including the ultrasound where they discovered the gallstones. Definitely do the ultrasound, that's a great way to start.
posted by Zophi at 9:13 AM on April 4, 2011

IANA/YD. Ultasonography is the standard for initial testing for gallstones in most circumstances afaik. I think the literature states that it is a better yest than other imaging modalities for finding gall stones. MRCP might be show stones in the duct as well, but they would like order ultrasound initially anyway, and if you still had symptoms even after a negative ultrasound, then consider the MRCP, which is better at looking for things like gallstone pancreatitis. HIDA scans, similarly, are good for helping to rule in or out other processes when you have symptoms but a negative ultrasound, perhaps if they were considering a diagnosis of chronic gallbladder issues.
posted by honeybee413 at 1:20 PM on April 4, 2011

Count me in as one more "ultrasound easily diagnosed my gallstones" statistic. Very quick and painless too (unlike the gallstones.)
posted by crabintheocean at 1:42 PM on April 4, 2011

Not a waste of time at all. When I had gallstones, I presented with absolutely classic symptoms. I had right upper quadrant localized pain and a positive Murphy's sign. I walked in certain it was gallstones and I was correct. The diagnostic test used to confirm gallstones was an ultrasound. That's the first line test and almost always catches them. Things like HIDA, MRCP, and CT are almost certainly overkill when a simple ultrasound is often definitive - especially when you consider that something like a CT is going to expose you to unnecessary radiation.
posted by MasterShake at 2:47 AM on April 5, 2011

Response by poster: Thanks. Went today. Waiting anxiously for results (today/tomorrow). I really hope it shows something, not for drama-sake but for an answer and treatment because this is just ridiculous.

Thanks everyone.
posted by stormpooper at 8:54 AM on April 5, 2011