Well, sonogram is probably the first line of defense because it’s usually the cheapest, and it’s very sensitive. If it shows that you have stones, you have stones. Blood work is going to be very important, specifically before considering surgery for gallbladder disease, blood work is performed and we really need to look at what’s called liver function tests. Liver function tests indicate to you if there is a potential obstruction to the ducts of the liver, if there is any liver dysfunction that may interfere with the surgery. So blood tests are super important and they have to be done. Of course, these days, COVID testing is prevalent, right? We have to do COVID testing on every patient that we do. Beyond that, if the sonogram shows that there are gallstones, we’ve basically completed our diagnostic workup. If there are any concerns, a CAT scan is a wonderful test. It’s relatively easy to perform.
And although some patients may have some claustrophobia where they have fear of closed spaces, the procedure is done so quickly, and as long as a physician explains to the person what to expect, it should be okay. So it literally takes very little time and very frequently will give you very important information, specifically also about the structure of the liver. So for example, if someone has cirrhosis of the liver, the CAT scan may show that to you. And that has great importance in terms of what we’re going to do, what kind of surgery, whether surgery should be done at all. None of these decisions should be taken lightly and each test serves a particular purpose. If the liver function tests, for example, show an elevated what’s called bilirubin, which is one of the basic tests that we perform. Then there is always a possibility that a person may have passed the stones that have gone into their what’s called ducts of the liver or common bile duct.
If that is the case, then you really have to do additional tests. One of them is an MRCP. It’s a kind of an MRI and it provides really great detail of the ductal structures, the ducts of the liver, and will tell you, usually, if there are stones or not. If the stones are present in the ducts of the liver, then it’s best to address this first. And that’s usually done by the procedure called an ERCP. And that’s a test that’s performed generally by gastroenterologists, where they will do what’s called an endoscopy, just like a gastroscopy, if you had had it before, they look into the stomach and in a very specialized scope, they can make little nick inside the common bile duct, and extract and remove those stones that are lodged in the common bile duct.