Constant pain and nausea

[Zydo]

For about 12 years now I've had constant pain and nausea in the gall bladder area.  I've had endoscopies, upper gi's with barium, lower gi's, ultrasounds, catscans, but all have turned up nothing but mild reflux, which I took Losec for 6 months but didn't do anything for the pain or nausea.  Blood tests show liver functions normal.  The pain and nausea doesn't vary when I eat, but will vary over a period of several days or weeks and then a little better, but never going away.  Feels like a stomach flu or an infection.  The pain isn't a stabbing pain like gall stones, but a constant uncomfortable prickly, burning, pressure pain. I have had mild indigestion, constipation, bloating and gas, but have modified my diet to eliminate these things, and have eliminated every food from my diet to be sure that it isn't an intolerance problem.  Doctors are stumped.  I am at a loss as of what to do next.

[tobycat]

I have had nausea, abdominal pain on right side and diarrhea for about 2 months.  I have had a gallbladder HIDA scan, abdominal ultrasound, upper GI, colonoscopy, endoscopy and blood work.  
My gallbladder HIDA scan with CCK revealed an ejection factor of 21%, my liver enzymes are slightly elevated, I have fatty liver, moderate hiatal hernia, and acid reflux.  My GI doctor recommends having gallbladder surgery to remove the gallbladder.  I have had abdominal ultrasound but do not have gallstones.  I also have irritable bowel disease with constant diarrhea, nausea and pain in the lower abdominal on the right side.  

I saw another GI doctor today for second opinion and he stated that he would not recommend gallbladder surgery even if HIDA scan came back with low ejection factor - he said he would only have the gallbladder removed if I had gallstones.  His main concern is that removing gallbladder will increase diarrhea from irritable bowel - he says having g/b surgery will not improve nausea or abdominal pain (which is not what my first GI doctor told me).  If the gallbladder has a low ejection factor (delayed empyting), will this ever improve with diet or weight loss?  My understanding is that once the gallbladder is impaired (low ejection factor), it is diseased and needs to be removed.   The advice from my 2nd GI doctor is confusing since I thought the HIDA scan was a conclusive test for an impaired or diseased gallbladder disease.

I am having a repeat HIDA scan done next week and wanted to see if there are any other tests I should have done to confirm whether or not to have gallbladder removed.  

One other note: I am scheduled for bariatric surgery (gastric bypass) for weight loss in 2 months and my surgeon states that in about 50% of patients, they will develop gallstones from quick weight loss so he usually recommend having gallbladder removed (even if it were healthy now).  I just don't want to take out gallbladder if I don't need to - should I wait until after bariatric surgery, see if my gallbladder gets worse, and then have it removed in a subsequent surgery?  Is having a low ejection factor enough reason to go ahead and have it removed?  

[4gpact]

If the gall bladder studies are normal, you should request a gastric emptying test. You may have a disorder called gastroparesis; delayed stomach emptying. Your symptoms are certainly consistent. It is a very easy test, and will give you the answer to that question at least.

[erinye37]

...I have had a gallbladder ultrasound, came back normal........monday I get a hiata scan done..........3 weeks of misery; sharp upper stomach pain with nausea, sharp left side pain, pain in lower back radiating down legs (sometimes legs feel so weak i want to collaspe), when lieing down everything is worse.........can't even work (especially in some areas at work it is 110 degrees plus....makes me real sick then).......at times I feel so sick I just wish I was dead (pitiful, sorry)......I need help bad....I am so tired of all this......no work with no more sick leave, how am I suppose to pay my Rent, and all other bills, which makes my stress level worse, and usually when my stress level is worse I get sick anyways........Somebody Help Me!!!!!!!!!!!

[glengariff]

My husband has been suffering from lower abdominal pain for about two weeks.  We spent about 5 hours in the emergency room yesterday because he had finally had enough.  The blood tests, x-ray and sonogram all came back normal.  He is not in constant pain, but the shortness of breath is real problem for him.  The doctors from ER suggested that the shortness of breath was from his diaphram?  He also had a slight bit of fluid in his lungs, but they said this shouldn't cause the shortness of breath.  In reference to the ABP, would shortness of breath also be a factor?

[Kevin Pho, MD]

Hello - thanks for asking your question.

One consideration for unexplained gall bladder pain would be acalculous biliary pain (ABP).  One test to evaluate for this would be a HIDA scan with CCK stimulation.  

In people with normal gallbladders, the ejection fraction ranges between 35-75 percent. Patients who suffer from bouts of biliary pain and have lower ejection fraction readings are assumed to have ABP. Studies have shown that surgical removal of the gallbladder (cholecystectomy) helps ABP patients more than 90 percent of the time.

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.

Thanks,
Kevin, M.D.

[surgeon]

If it's been 12 years, the good news is it can't be something dire. If you haven't had a HIDA scan with CCK injection, you could consider it: it's a test of the function of the gallbladder. Some people have dysfunction even though the gallbladder itself appears normal on ultrasound.

[paty91356]

I had something very similar to what you describe about 25 years ago.  I was so sick, I complained, fussed and whined long enough that I got a surgeon to remove my gallbladder...it was pathologically "normal", no stones, but I haven't had a minutes trouble since it was removed.