pain, bloating, vomiting, and gall bladder

I am a 27 year old female who has been on oral contraceptives since I was 13 for an ovarian cyst.  Anyway, I have noticed bloating and gas for about two years.  Then, I started vomiting about 9 months ago for no reason what-so-ever.  Sometimes it would happen after I ate, sometimes when I ate nothing at all, sometimes in the AM, and sometimes in the PM.  I went to my Dr. and they did blood work and an ultrasound.  My bloodwork on one occassion came back with a high white blood cell count and I would had an occassional fever.  The ultrasound of the gall bladder was negative.  

I contiued to be nauseated and continued vomiting, but much less frequenty now (once every 3 weeks or so, versus once every other day before).  I began to become more bloated.  I then had a HIDA scan that showed that my Gall Bladder was dialated and only pushing through 10% of the bile it is supposed to.  I went to a SUrgeon and he said I need to have my GB removed.  I would agree, but I dont have the typical pain of a gall bladder problem.  If the right side of my stomach hurts, it is only occassional and very brief.  My pain is always at the left lower quadrant of my stomach, but the pain feels like bloating or gas or dairrhea pain.  Can this still be my gall bladder or should I look for another possible cause before I agree to surgery??

[Kevin Pho, MD]

Hello - thanks for asking your question.

You state bloating and gas.  An ultrasound was negative.  HIDA scan showed a 10% gallbladder ejection fraction.  Pain is worse in the left lower quadrant with occasional right sided pain.  

There are several possibilities.  The first would be acalculous (i.e. non-gallstone related) biliary pain.  Nausea and vomiting is common with this and an ultrasound would not show any gallstones.  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.

Other considerations would be dyspepsia (peptic ulcers, GERD, gastritis/esophagitis), pancreatitis, or a mass.  An upper endoscopy may be considered to evaluate for this.  Serum tests for amylase and lipise would help evaluate the pancreas.  

If you are having left lower quadrant pain, then the causes would include irritable bowel, diverticulitis, colorectal mass, or inflammatory bowel.  To evaluate this, colonoscopy and/or abdominal CT would be helpful.  

If your gall bladder ejection fraction is only 10%, you will be prone to further gall bladder attacks in the future.  Cholecystectomy has been shown to help in a majority of cases.  If you and your physician elects to keep searching for other causes, the tests I mentioned above may be considered.

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.

[beccabond]

I feel like I could have written this myself.  I am also a 27 year old female.  Five months ago I began having constant nausea and upper left quadrant pain in my abdomen - no vomiting, but feeling like I would at any minute.  Nothing in particular seemed to set it off - sometimes in the morning, sometimes in the middle of the night, sometimes before I ate, sometimes after I ate.  I've had blood tests and an abdominal ultrasound which all came out normal.  I had an endoscopy which showed mild gastritis.  I then had a HIDA scan with CCK injection which showed an ejection fraction of 37%.  My internist and my gastroenterologist both agree that my ejection fraction is not low enough at this point to talk about removing my gallbladder, though that may be a possibility in the future.  My gastro. said he likes to see the ejection fraction be about 40% and does not like to consider removing the gallbladder until it is below 20%.  Basically, if mine was 10% like your's, he would have sent me to a surgeon for gallbladder removal.  I feel frustrated as I'm sure you do, too.  I keep reading these stories on message boards where people have no relief from gallbaldder removal or are even worse than before the surgery.  Like you, I experience basically no pain where my gallbladder is located - in the upper right quadrant.  My problem is nausea.  I was wondering if you have had an upper endoscopy.  If not, you might want to ask your doctor about this.  If it was me, I would want to rule out any stomach problems such as GERD, ulcer, etc. before taking out the gallbladder.  Then if the endoscopy comes back normal, you may want to seriously consider having your gallbladder removed.  I know you mentioned that you have been on oral contraceptives for so long.  Have your doctors mentioned to you that there is a connection between gallbladder dysfunction and birth control use?  My gastro. just took me off birth control on the off chance that this could slow down the progression of gallbladder dysfunction.  I don't know if this would be recommended for you, though, because your ejection fraction is already much lower than mine.  I'm supposed to see my gastro. again in four months for a re-check and possibly another HIDA scan in case I'm not feeling better.  Good luck to you.  Please let us know how things turn out.

[tessa0825]

I think the reason you keep seeing posts where people have more pain following GB removal than what they had before is because the only ones that feel a need to post or look for more answers are the MINORITY of Pts. that do suffer complications following GB surgery.....Complications after this surgery is not normal and certainly not the majority....I am three wks post GB surgery and I had NO complications and was back to work within a wek...I was off all pain meds in two days post op.....I had MANY stones and a completly non-functioning GB so surgery was a must.....I read these horror posts and was a little scared about my surgery also...The only pain I really had following surgery was chest area pain when I first woke up in recovery and that was from the air the surgeon had put in my diaphragm during surgery...Once I knew what it was from I did fine....I was given Reglan and zantac pre-surgery for nausea and afterwards I was allowed nothing by mouth for 24 hrs. next day clear liquids for breakfast and then I was on my own to find what I could and couldnt tolerate.....I am soooo much better now than before I had surgery...I cant tell you the POSITIVE difference this surgery has made for me....So while you read these posts of post surgery complications remember that is the minority and thank GOD most of us will be in the majority........Tessa

[menzies]

Tessa,I was like you when I had my gall bladder removed in fact I was fine for 11 months and then I started having problems.Post op I felt great and was back at work within 2 weeks I could eat and drink anything.And then WHAM!I just woke up one morning and felt a bit off in the stomache this went on and I felt naseous couldnt eat.I went to doc had ultrasound gastroscopy colonoscopy, Ct scan I have gastric reflux that has been caused by the removal of my gall bladder.They also found I had H. pylori.I am just now starting to feel better that is 5 months and heaps of medication and tests.I also know other people who have had their gall bladders removed and have similar problems my sister being one of them.I hope that you are one of the few who dont have any complications but if possible I would advise anyone to keep their gall bladder if at all possible.
Good luck.

[tessa0825]

Hello......I dont have to worry about re-flux because I live with that every day anyway...I have Barrett's esophagus and have had almost every complication that goes with it....I'am getting ready to go to John Hopkins for a second opinion because there seems to be some confusion over weather I am actually low or high grade....I just had my 3 month biopsies and now  there was an area that is questionable for low or high grade and it is to important to not get a definite answer....As long as I take my nexium, along with the life style changes I have made it pretty well controls my symptoms, and I guess I can only hope that I dont have post GB complications show up down the road.....Best of luck to you........Tessa

[kay_bear52]

I am glad that I found this site. I though, have not run across anyone that has had the same symptoms as me so it is hard for me to confirm that it is my GB. Most of my pain has been in my chest area. For the longest time I felt it was anxiety or even my heart. I went for the ultrasound which came back normal, all the blood work was fine, no H. Polori (sp?). I do not have nausea, fevers or anything else. Just severe chest pain. I had my Emptying Scan done last week and the results came back with a 4.6% ejection fraction and I have been refered to a Surgeon for next week. I would like to know more about this ejection fraction.

[tessa0825]

I just realized I said John Hopkins when what I meant was Clevelanc Clinic in Ohio....Tessa

[Cara428]

A related discussion, GALL BLADDER, IBS, BLOATING, COLITIS, HELP? was started.