gallbladder ultrasound

  I had an abdominal ultrasound.  I was told it was all normal.  However,
  my pain I'm told by my GI doctor suggests it MIGHT be gallbladder related.
  But I had already had this normal US.  Is it ever appropriate to do other
  tests to more definitively look at the gallbladder, or is the ultrasound
  usually good enough?
  Thanks.
_______________
dear Ellen,
There are several issues that your letter addresses.  We have received numerous postings from individuals describing atypical abdominal pains (some with and some without gall stones) who had the gall bladder removed only to have persistence of the pain after the surgery.  We like to have a history of biliary colic ( right upper abdominal pain that increases in a step-wise fashion after eating)or cholecystitis before suggesting that surgery will improve symptoms.
I recognize that there are some patients with gall bladder-related pain who do not have gall stones.  These patients, however, are a minority.  
The most sensitive test to detect gall bladder dysfunction is an ultrasound with CCK administration.  CCK causes the gall bladder muscles to contract and changes the volume of the gallbladder.  Patients with an inflamed gall bladder will have less than normal contractions and a reduced change in volume.  
The other respondents to your letter were inaccurate in their advice.  A HIDA scan will detect a blockage of the cystic duct (the duct out of the gall bladder).  This test is usually positive in patients with gall stones blocking the duct.  An ERCP will provide information regarding the anatomy of the bile and pancreatic ducts but will provide little if any information regarding the cystic duct or the gall bladder.
This information is provided for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-rf
*keywords: abdominal pain, gall stones, tests
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