胆结石的诊断

本栏版主：听诊器 胆结石的诊断

一、胆结石有什么表现？　　临床表现与结石大小、位置、有无梗阻及感染有关。　　（1）"无症状"的胆囊结石（安静结石）：所谓无症状指没有胆绞痛，因结石未嵌顿，几乎无症状，甚至终生不被发觉。有时仅有轻微上腹闷胀、隐痛、不适、嗳气等，进食油腻后明显。易被当做"肝炎"、"胃炎"。查体右上腹轻压痛、无肌紧张，当胆囊积水时可被触及。
	（2）胆绞痛、急性胆囊炎：右上腹部剧烈绞痛，向肩、背放射，伴恶心、呕吐。为结石嵌顿所致，有时因体位改变，嵌顿解除而症状消失；否则继发感染、化脓、坏疽、穿孔而出现发热、腹膜炎、休克等表现。胆绞痛多于饱餐或进食油腻后发作，少数病人夜间发作。查体墨菲征阳性。
（3）黄疸：结石落入胆总管或嵌顿于胆囊颈部的结石压迫胆总管均可造成梗阻性黄疸。

Other tests used in diagnosis include 1.Computed tomography (CT检查) scan may show the gallstones or complications. 2.MR cholangiogram （核磁检查）may diagnose blocked bile ducts. 3.Cholescintigraphy (HIDA scan)（放射性同位素检查） is used to diagnose abnormal contraction of the gallbladder or obstruction. The patient is injected with a radioactive material that is taken up in the gallbladder, which is then stimulated to contract. 　 4.Endoscopic retrograde cholangiopancreatography (ERCP检查). The patient swallows an endoscope--a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate and remove stones in the ducts.

二、哪些人容易得胆结石？

Who is at risk for gallstones?

1.women(女性）
2.people over age 60（60岁以上者）

3.overweight men and women（肥胖）
5.people who fast or lose a lot of weight quickly（禁食者或快速丢失体重）
6.pregnant women, women on hormone therapy, and women who use birth control pills（孕妇、激素治疗的女性、服避孕药者）

　三、怎样诊断胆结石？

How are gallstones diagnosed?

Many gallstones, especially silent stones , are discovered by

accident during tests for other problems. But when gallstones are suspected to be the cause of symptoms（症状）, the doctor is likely to do an ultrasound exam(超声检查). Ultrasound uses sound waves to create images of organs. Sound waves are sent toward the gallbladder through a handheld device that a technician glides over the abdomen. The sound waves bounce off the gallbladder, liver, and other organs such as a pregnant uterus, and their echoes make electrical impulses that create a picture of the organ on a video monitor. If stones are present, the sound waves will bounce off them, too, showing their location. Ultrasound is the most sensitive and specific test for gallstones.

5.Blood tests（血液检查）. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice. 6.Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.　

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