Could gallstones be invisible in the Ultrasound test?

Question

My brother has been having gallstone attacks for the past 3 days. He took the sonography test 3 times now. The first showed several small stones but the second and third showed nothing. Meanwhile, he is sitll in so much pain. I don't get what's going on. How is this possible? And what explains his pain?

Answer 1

No - not really. If a gallstone is there in the gall bladder, it will be seen on the ultrasound.

There are a couple of possible explanations

One explanation is that these attacks represent "biliary colic" - the passage of a small gallstone through the common bile duct. You form the stone. You eat the fatty meal and your liver makes bile, and your gallbladder squeezes to push bile into the small intestine (to digest fat) and the stone gets pushed in there ... and the passage of this stone is excruciatingly painful. Then when the ultrasound happens the following morning, there is no stone seen because it has gone into the bowel by then.

Another explanation is that gallstones are not causing the pain. I have had a friend (an ED nurse, in fact) present several times with pain and other signs and symptoms that have made the surgeons sure that it was gallstones. The ultrasound showed no stones. She was discharged with pain relief. Attack again ... again no stones ... further investigations and nothing found.

However, the surgeons are aware of a condition called "acalculous cholecystitis" - where there are no stones (acalculous). Her gallbladder was operated on, removed, and the pain vanished!

Why? I'm not sure. Ask the surgeons.

:-)

Let me get some references for you.