Gall bladder stones are evaluated firstly by ultrasound scan of the abdomen. Along with the sound scan, we also do the basic blood tests like liver function tests and complete hemogram. What does the sound scan tell us? It tells us how many stones, the size of the stones, where exactly the stones are there and if there are any other complications associated wit the stones like infection of the gall bladder perforation of the gall bladder or of there is slipped stones or blockage of stones using back pressure changes I the liver, if there is other effects like pancreatitis. So this is what we generally see in ultrasound. Liver function tests tells us whether the liver is involved because of gall bladder diseases, the hemogram tells us whether the patient is infected or is in sepsis because of these stones. So these are the basic tests that are done. So if necessary if we are suspecting a complication or anything severely wrong with the gall bladder, because of the stone, we would do more tests. Most commonly will be the CT scan of the abdomen. Generally CT scans are done when there is a complication of the gall bladder or when we are suspecting a malignancy or a cancer within the gall bladder, associated with gall stones. If there are other complications like strip stones or pancreatitis, we would be interested in doing MRI with MR colangiograms or colangiopancreatograms and rarely we would need both CT scans with MRI for further evaluation. Along with this more blood test would be needed to see if there is a damage in the liver, if the infection is severe, then the kidneys are involved, if there are other diseases, like comorbidities or fitness for surgery of necessary. Once we have evaluated a patient and if he is a candidate for surgery or symptomatic patient, the treatment for gall bladder stones is always almost surgery. Rarely it would be a medial line of treatment when the patient is not fit for surgery or rarely other reasons. Surgery for gall bladder stones is removal of the gall bladder, that is also called as cholecystectomy, most commonly done laparoscopically, with very few incision son the abdomen and rarely in complicated cases, we will need an open cholecystectomy. Laparoscopic cholecystectomy is the standard of care today and the admission day is either a day care procedure or maximum a day or two will be needed for surgery. It will be a straightforward procedure with minimum complications. Rarely when the patient will not be fit for cholecystectomy, either laparoscopic or open, then we would do something called as a cholecystotomy where will put a drain into the gall bladder and where we remove all the infected fluid we would stabilise the patient first and if necessary do the completion procedure in the next sitting.
