The gallbladder — a sac located near the liver that serves as a storage space for bile — can be stricken with various problems, such as gallbladder cancer or inflammation (called cholecystitis).

Gallstones are also a common gallbladder problem, and infection can occur if the gallbladder remains blocked by a gallstone or continues to be inflamed.

Gallbladder disease is the term used to describe many of these maladies that can plague the gallbladder. But in many forms of gallbladder disease, a person may have no symptoms — up to 90 percent of people with gallstones, for example, don’t have any symptoms at all. So how can gallbladder disease be diagnosed?

Gallbladder Disease: When Diagnostic Tests Are Needed

Your doctor isn’t going to test you for something that you’re not complaining about, so generally, the only time diagnostic tests for gallbladder problems are done is when a person experiences symptoms. Warning signs of gallbladder problems include:

Bouts of severe pain in the right upper abdomen and sometimes the right chest or back
Pain after eating, particularly high-fat foods, or at night
Fever, with shaking and chills, especially if occurring with, or after, abdominal pain
Nausea and vomiting
Heartburn and indigestion
A feeling of fullness in the abdomen, or excess gas
If you don’t have symptoms, that doesn’t mean your gallbladder is perfectly normal. Often, doctors will spot signs of gallbladder problems during diagnostic testing for some other symptom or health condition.

Gallbladder Disease: Eliminating Other Causes
If you have some combination of these symptoms, your doctor probably will start by asking detailed questions about them. He may ask for more details about the pain — what it feels like, when it happens, and where in your belly it hurts. Your doctor will also ask questions to look for other possible causes of abdominal pain, like:

Irritable bowel syndrome (IBS)
Crohn’s disease or ulcerative colitis
Cancer or inflammation of the pancreas
Kidney stones or urinary tract infections
Pneumonia (when it involves the lower part of the right lung, it can be confused with gallbladder discomfort)
Viral hepatitis
Appendicitis
Gastroesophageal reflux or ulcers in the stomach
Diverticulitis or diverticulosis — conditions affecting the lining of the colon
Gallbladder Disease: Diagnostic Imaging Tests

After asking questions about your symptoms, doing a physical exam, and eliminating some causes from the list of possibilities, your doctor probably will perform some imaging tests to look at your gallbladder.

Imaging tests used to diagnose gallbladder problems include:

An ultrasound. This is the most commonly used of the diagnostic tests for gallbladder problems. While very effective in diagnosing even very small gallstones, it can’t always clearly diagnose cholecystitis (inflammation of the gallbladder).
X-rays. An abdominal X-ray can spot gas and some types of gallstones containing calcium. Some X-ray types require that a patient swallow a dye or have dye injected into the body so the X-ray can capture a clearer picture of the gallbladder.
Computed tomography (CT) scan. This imaging test uses a computer and X-rays to spot gallbladder problems, but isn’t the most effective method of diagnosing gallstones. CT scans can help spot ruptures (tears in the gallbladder wall) and infections inside the gallbladder or its bile ducts.
Magnetic resonance imaging (MRI) . Regular MRI, or another type called magnetic resonance cholangiography (MRC), can help diagnose stones in the bile ducts. MRC uses regular MRI imaging technology plus a dye
Magnetic resonance imaging (MRI) . Regular MRI, or another type called magnetic resonance cholangiography (MRC), can help diagnose stones in the bile ducts. MRC uses regular MRI imaging technology plus a dye administered into the bile duct. This test is very useful for diagnosing biliary tract (gallbladder and surrounding ducts) cancer, but may not be able to spot tiny stones or persistent infections.
Endoscopic retrograde cholangiopancreatography (ERCP) . This test uses an endoscope (a tube fitted with a tiny camera and light) that is inserted into the throat, down through the stomach, and into the small intestine. This test can help spot gallstones or problems in the bile ducts of the gallbladder — it’s considered the “gold standard” when it comes to diagnosing stones blocking bile ducts, and allows for removal (using a small basket-like device) during the test. But there is a risk of complications, so the test is typically only given to people who are thought to be very likely to have stones blocking the bile ducts.
Cholescintigraphy (also called DISIDA, HIDA scan, or gallbladder radionuclide scan). A small amount of radioactive dye is administered, and then a scanning device is used to track the dye as it moves into the gallbladder. This screening method can spot a blocked duct and acute inflammation, but not chronic gallbladder inflammation or gallstones.
Gallbladder Disease: Blood and Urine Tests

A blood test may also be performed to help diagnose gallbladder disease. A complete blood count, or CBC, can help confirm an infection if there is a high white blood cell count. Other specific blood tests can also reveal high bilirubin levels (the cause of jaundice, a complication of gallbladder problems) or elevated enzymes suggesting an obstruction in the gallbladder.

Urine tests may also be performed to help diagnose problems with the gallbladder by looking for abnormal levels of chemicals like amylase, which is an enzyme that aids in the digestion of carbohydrates, and lipase, another enzyme that helps break down fats.

Even if signs and symptoms are not directly suggesting gallbladder disease, your doctor has many ways to visualize the gallbladder. With these tests, your gallbladder disease can usually be promptly diagnosed — and just as importantly, properly treated.

 

From Everyday Health

There are few things in life that are more excruciating than a gallbladder attack, so it’s no surprise that patients who have experienced one firsthand are willing to undergo gallbladder surgery to avoid another painful episode. Nearly 25 million Americans have gallstones—crystalline formations made up of cholesterol and other components of bile made by the liver to digest fat. One million new cases of gallbladder stones are diagnosed each year. Experts expect that number to grow, thanks to our increasingly sedentary lifestyles and overindulgence in refined sugars and fatty foods.

Amazingly, 70 to 80 percent of the people with gallstones never know they have them. But for the remaining 20 to 30 percent who have felt the effects of gallbladder stones on the move or had a stone block one of the ducts that let bile flow from the liver to the small intestine, life can be pretty miserable. Acute pain in the right side of the chest that often radiates to the upper back and shoulder blades, nausea, vomiting, and frequent burping, belching and flatulence are a few of the unpleasant symptoms. While some individuals try to cope with gallbladder disease with changes to their diet and exercise routines, nearly one million people still undergo gallbladder surgery—also known as a cholecystectomy—every year.

Not too long ago, gallbladder surgery was a major “open” procedure that required the surgeon to make a five- to seven-inch incision across the abdomen. Patients usually stayed in the hospital for up to four days, and at-home recovery was slow and painful—often taking up to six weeks before patients could return to their normal routines. While open procedures are still used for complicated cases, laparoscopic gallbladder surgery is a less invasive alternative that is more commonly used today. During a laparoscopic procedure, the surgeon makes two to three small incisions in different areas of the abdomen. Patients remain in the hospital two to three days, and at-home recover generally takes two to three weeks. But now, even laparoscopic gallbladder surgery is quickly becoming old hat.

Using the robotic-assisted da Vinci Robotic Surgical System, surgeons at DSA have propelled minimally invasive to the next level, with single incision made in the patient’s belly button.

With the single-incision, robotic-assisted gallbladder surgery, a patient can have his or her gallbladder removed in about the same amount of time as a lunch break and be home in time for dinner—with minimal discomfort and a nearly invisible scar tucked in the belly button. If you suffer from painful gallstones or gallbladder disease, Matthew Johnson, MD, general and GI surgeon, can help determine if gallbladder surgery is the right treatment for you.

Hospitals address diabetes, anemia, mental health before surgery to prevent complications, save money
Are you healthy enough to have surgery?

By LAURA LANDRO
Sept. 26, 2016

More hospitals are asking that question before patients undergo elective procedures such as hip and knee replacements. They are identifying those at higher risk of infections and other complications due to diabetes, heart disease and anemia—or simply being sedentary and out of shape. And they are steering them to “pre-habilitation” programs that include medical treatments, diets and exercise regimens to improve their chances of a successful surgery.

Sometimes the fixes are simple, such as IV iron infusions before surgery for anemic patients to reduce the need for a blood transfusion. A regimen of protein shakes can help malnourishment in older patients who don’t get enough protein in their diet. Studies suggest that patients with vitamin D deficiency can benefit from supplements to help improve recovery after knee replacement.

Weight reduction and blood sugar control in diabetes patients can take longer, but are worth the effort, Duke experts say. “Even if we have only a few days or weeks to get on the right track, they are going to do better in the hospital and go home better as well,” says Dr. Tracy Setji, medical director of inpatient endocrinology consultation services at Duke.

Willie Walters, 68, had knee replacement surgery in 2013, but the hardware began to come apart, leaving him hobbling and in pain. His primary care doctor referred him to Duke, where surgeon Thorsten Seyler saw him last February. Mr. Walters, who has diabetes and weighed 331, also had a stress fracture in his tibia.

Dr. Seyler, assistant professor in the department of adult reconstruction, removed the failed knee in April. He stressed the importance of overall good health and warned Mr. Walters about the increased risk for an infection after surgery due to his weight and poor blood sugar control. “No one had ever mentioned to me that this might be a problem,” says Mr. Walters. “They told me a lot about diabetes that I didn’t know.”

Dr. Thorsten Seyler, a Duke Health surgeon, says it’s important to counsel patients about special risks they may face in surgery and explain the benefits of ‘pre-surgical optimization’ programs. ENLARGE
Dr. Thorsten Seyler, a Duke Health surgeon, says it’s important to counsel patients about special risks they may face in surgery and explain the benefits of ‘pre-surgical optimization’ programs. PHOTO: SHAWN ROCCO/DUKE HEALTH
In June, Dr. Seyler referred Mr. Walter to the endocrinology clinic and Duke’s diet and fitness center for a physician-supervised diet. By August, he was down to 302 lbs., which improved his blood sugar levels and enabled him to stop his oral diabetes medications. Mr. Walters recently told Dr. Seyler he was happy he joined the program. He is working toward his goal of getting down to 280 to 290 lbs., and “is doing great,” Dr. Seyler says. Surgery is scheduled for November.

About 80% of patients who are referred to a pre-surgical improvement program follow up and attend the appointments, says Dr. Seyler. Some patients are resistant to the idea, which can involve expenses not covered by insurance. “The key is to take the time to counsel patients and explain the benefits,” Dr. Seyler says.

Duke is now developing additional preoperative programs for conditions including mental health disorders. Dr. Seyler co-wrote a study of Medicare patients with bipolar disorder, depression and schizophrenia who had knee replacements from 2005 to 2011. The study, published in the October 2016 journal The Knee, found significantly increased medical and surgical complication rates compared with patients without psychiatric diagnoses, and higher odds of developing infections and fractures.

One possible explanation is that depression can lead to stress and exacerbate existing medical conditions. Preoperative mental health screening might identify patients at risk for increased complications, but more research is needed to determine if psychiatric disease can be modified to help prevent such complications, the study found.

At the University of Michigan Health System, a program known as MSHOP, for Michigan Surgical and Health Optimization Program, assesses patients’ risk for surgical complications based on their CT-scans, personal characteristics and a surgical outcomes database. It then assigns a regimen they can complete at home for a week to a month before surgery, to improve fitness, nutrition, and breathing capacity, with inexpensive aids like DVDs and text message reminders.

Data from 500 patients in the program from 2011 to 2013, published last December in Annals of Surgery, showed hospital costs were reduced by $2,308, and the average length of stay was reduced to four days from six.

“The reason many patients don’t do well is because they are already deconditioned as couch potatoes, and then they get a big operation which makes them even more frail,” says Michael Englesbe, a University of Michigan transplant surgeon and associate professor who led the study and directs the MSHOP program. Dr. Englesbe says that the program “empowers patients to have control over their outcome,” and recommends all patients train for elective surgery, much as they would before athletic competition.

Surgeons have been advising patients for years to get into shape or quit smoking before surgery. But now researchers are focusing on a wider array of risks that should be addressed before going under the knife, including nutritional deficiencies, mental health problems and sleep disorders.

“In health care, we often bring patients into surgery without fully addressing their chronic medical conditions,” says Dr. Solomon Aronson, executive vice chair in the anesthesiology department at Duke University School of Medicine in Durham, N.C. By improving their health before surgery, he says, “we can significantly diminish the risk of complications.”

Dr. Tracy Setji, medical director for Duke’s inpatient endocrinology consultation services, helps diabetes patients get blood sugar in good control before surgery. ENLARGE
Dr. Tracy Setji, medical director for Duke’s inpatient endocrinology consultation services, helps diabetes patients get blood sugar in good control before surgery. PHOTO: SHAWN ROCCO/DUKE HEALTH
That can mean postponing surgical procedures for days, weeks or even months. But hospitals have found the benefits include fewer complications, reduced days in the hospital and fewer readmissions after discharge. That saves costs and avoids financial penalties from insurers. Medicare has started to pay a set fee for knee and hip replacements so hospitals are on the hook for any additional costs, including complications. Infections and other adverse events after surgery can also lead to costly malpractice claims.

If a diabetic patient’s blood sugar is too high, it can impair the body’s ability to heal and increase the chance of infection. Studies have shown that obese patients have more wound-healing complications and deep infections after joint replacement surgery. A 2015 study in the Journal of Arthroplasty found that patients with anemia had more infections, longer postoperative hospital stays and were more likely than non-anemic patients to require blood transfusions, which are linked to complications. Patients who take narcotics for chronic pain are at increased risk for problems with anesthesia.

Duke Health, which includes three hospitals, a network of clinics and medical practices and the medical school, recently began an initiative to refer high-risk surgery candidates to Duke clinics for treatment. The program, called Poet, for Peri-Operative Enhancement Team, is currently targeting patients with diabetes, anemia, malnourishment, complex pain syndromes and poor exercise tolerance.

Dr. Matthew Johnson is a very compassionate surgeon that always takes extra time when communicating with his patients as well as their families regarding their care. He is driven, kind, and extremely innovative in the field of surgery. He is also one of the few surgical endoscopists in the country. In 2011, as a chief resident, he received the Professionalism Award at the University of Nevada School of Medicine and continues to emphasize this professionalism throughout his surgical practice. He is very well respected by his colleagues in the field and always strives for perfection.
Dr. Johnson did his undergraduate training at the University of Texas at Austin and is a faithful Texas Longhorn to this day. He subsequently attained his Medical Doctorate at the American University of the Caribbean, in St. Maarten, N.A. where he also attained a Masters in Medical Science (M.M.S.). Dr. Johnson’s residency training was completed at the University of Nevada School of Medicine, Las Vegas, NV in General Surgery (2005-11). He then went on to become one of the early fellows in the country to complete an Acute Care Surgery fellowship at the University of Nevada School of Medicine, Las Vegas, NV (2011-13). During his residency and fellowship, Dr. Johnson also trained in Surgical Endoscopy with a specific emphasis on both diagnostic & therapeutic ERCP. In fact, along with other colleagues, he developed a new method for treating obstructing complicated biliary disease using combined cholecystectomy and ERCP in a one stage procedure, so-called the “One-Step/ELBS”. Throughout residency and fellowship, Dr. Johnson presented at many national conferences regarding ERCP use by surgeons for trauma and general surgery in addition to authoring several publications.
Following post-graduate training, Dr. Johnson joined Desert Surgical Associates and hit the ground running. He cares for patients in the field of general surgery, minimally invasive surgery, trauma, and critical care. Dr. Johnson’s specific interests involve minimally invasive robotic surgery, advancement of minimally invasive surgery in trauma patients, foregut surgery, hepatobiliary surgery and the use of ERCP for both diagnostic and therapeutic measures.