Is Gallbladder Removal Necessary?

[Toneman]

I am a 48 Year old male that has been experiencing chronic mild chest pain as well as back and right shoulder blade pain for a little over a year. In that time I have had two complete cardiac workups including bloodwork, echo and nuclear stress test, one in Feb 05 and the latest just one month ago, all came back normal and my cardiologist says my heart and cardiovascular system are fine.

During this time the pains came and went and seemed to usually occur after eating. I went back to my family doctor who originally thought the problem was refulx and treated it with Aciphex which cleared up everything else I was experiencing except the mild chest pain as well as the pain in my back and right shoulder blade.

During my annual physical in March, he found some liver enzymes that were elevated and had an ultra sound of my abdomen done to test for fatty liver. The ultra sound also found a "signifcant amount of sludge and particluates" in my gallbladder and the report said they could not rule out the presence of gallstones so he sent me for a HIDA scan. I had to put it off for about a month so when I went in for the HIDA scan, they did the first part and injected the dye which went well, everything went as it should. They then wanted to get a new ultra sound as mine was over 30 days old.

The tech who did the ultra sound also saw the sludge but said she also saw a shadow that may indicate a stone so she manipulated my gallbladder and took some additional pictures which she had her radiologist look over. He confirmed that there were " a few small stones in the gallbladder neck and they appear to be mobile" and advised against doing the CCK injection.

After reading the report, my family doctor reccommended I see a surgeon which I did and he said my gallbladder needs to come out, especially since these stones were in the gallbladder neck and mobile.

Does it sound reasonable to remove it on these findings, especially without finishing the CCK portion of the HIDA scan? Also, they both feel these stones are the cause of my intermittent chronic pain, does that also sound reasonable?

Any input would be appreciated.

Jonboy

[BabyBlueWolf]

What is a normal % for ejection fraction with the gallbaldder?  What % would you need to be at to make removal of the gallbladder neccessary?

[morgan55]

I just came back from the dr and was told that after an ultrasound I had sludge in my gall bladder. He's recommendation was to have it removed. Now I do not have any symptoms, the reason for the tests was because there were some elevated levels in by liver.

My question, after doing some research and reading messages here, is surgery necessary.

Lee

[Salmonberry]

Just from what all the doctors have told me about gall bladder disease, and what other gall bladder patients have told me, such intense pain under the right ribs sure sounds like major gall bladder problem/disease, which is usually resolved with surgery.  I wish my symptoms (see my posting 5/13) were that clear!  Good luck!

[Toneman]

Thank you for your reply. When I did meet with the surgeon he did a physical examination and did find that I had considerable pain upon examining my under my right lower rib cage. When he felt under my lower rib the pain was so intense it almost put me through the ceiling!

I followed up with my personal doctor the next day and went over the surgeon's findings and reccommendations along with the test results and my personal history, to which he agreed with removal of the gallbladder. Should I seek out another surgeon for advice as well?

Jonboy

[Kevin Pho, MD]

I cannot give any concrete recommendations without evaluation.  

Without the CCK test, one cannot tell what the gallbladder ejection fraction is.  If the ejection fraction is normal, the gallbladder may not need to be taken out.  

If the stones are in the bile duct, an MRCP or ERCP can be done to visualize and remove the stones.  

Obtaining more imaging of the gallbladder - including a CT scan - may give more details not available on the ultrasound.

In any case, I would suggest a second surgical opinion before proceeding on a treatment course.

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.
kevinmd_