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Gastroenterology (Expert Forum)
Acalculous gallbladder disease?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Acalculous gallbladder disease?
by xmnstn, Jun 21, 2004 12:00AM
I am a 45 year-old female. I am overweight, but exercise regularly, and have a pretty healthy lifestyle. For the past year, I have been having nausea (doesn't seem to matter what or when I eat), abdominal pain and bloating, and lower back pain. Initial endoscopy showed normal results, although some mild erosions. Ultrasound and MRCP both were normal. Disida scan was normal with a 37% ejection fraction. Then had an endocopy with Kinevac drainage (5 mcg in divided doses), which showed no microlithiasis, but had a very sluggish response. Anti-nausea, GERD and IBS meds don't help. That gastroenterologist has now suggested an upper GI and small bowel study, and a gastric emptying scan. He doesn't think there's enough evidence for acalculous gallbladder disease. I decided to get a second opinion, so a second gastroenterologist believes it probably is acalculous gallbladder disease and ordered a new endoscopy with kinevac drainage, done in one dose to get an objective result to evaluate gallbladder function. Assuming the test determines that I have reduced gallbladder function, do you think that there is anything else I should rule out before having gallbladder surgery?
I want to do something to alleviate my symptoms, but am nervous about the surgery. Are there any holistic approaches I could try before resorting to the surgery?
I want to do something to alleviate my symptoms, but am nervous about the surgery. Are there any holistic approaches I could try before resorting to the surgery?
Doctor's Answer
by Kevin Pho, MD, Jun 22, 2004 12:00AM
, Jun 22, 2004 12:00AM
Having a HIDA scan with CCK stimulation would give an objective result for gallbladder ejection fraction. If it is reduced, there are some studies that suggest improvement when the gallbladder is removed.
As for other considerations - the gastric emptying scan may be something you want to consider before surgery. This test can look for delayed gastric emptying. If the upper endoscopy is normal, this makes it less likely there are anatomical abnormalities present. The small bowel study would be reasonable to look for things like Crohn's disease or any small bowel mass that could lead to nausea (the endoscopy does not reach all the way to the small bowel).
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
As for other considerations - the gastric emptying scan may be something you want to consider before surgery. This test can look for delayed gastric emptying. If the upper endoscopy is normal, this makes it less likely there are anatomical abnormalities present. The small bowel study would be reasonable to look for things like Crohn's disease or any small bowel mass that could lead to nausea (the endoscopy does not reach all the way to the small bowel).
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
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To your knowledge, was it standard practice to do biopsies on removed gallbladders in the 1950s? I know that is standard practice now, but do not know if it was done then. You have answered some of my questions before and put my mind at ease about the hereditability of gallbladder cancer. My Mother has it and her mother died of "liver cancer" 1 year after her gallbladder was removed. I suspect that her gallbladder was cancerous and that it spread secondarily to her liver. I am assuming this because primary liver cancer is so rare.
Thanks!
GastroGal