Gallbladder Expert Forum
Christopher R Watters, MD
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Christopher R Watters, MD

From August of 2011 to December of 2011, I lost 20 lbs, going from 125 to 105. In December of 2011 I started noticing extreme bloating and severe fullness after eating as if my food was not digesting, which would last the entire day and get worse as I ate more food throughout the day, only feeling better with long fasting(15+ hours). This has lasted until now. The past couple months, I've had an endoscopy, a gastric emptying test, a small bowel barium x-ray, a upper right quadrant ultrasound, and a HIDA scan with CCK. All were normal except the HIDA scan. My gallbladder never appeared after 4 hours and they never injected the CCK. My GI doctor told me this may be what is causing at least some of my symptoms. I went to see a surgeon, who told me that my symptoms appear to be inconsistent with what he said were the only 2 reasons for results like mine, inflammation, and a gall stone blocking the duct(I asked about sludge and he said sludge usually shows up on an ultrasound). He said if that were the case, I would be in severe pain where my gallbladder is located. I am really looking for answers. All of my tests have come back normal except for the HIDA, and the surgeon doesn't seem to "believe" it. I am really worried and am looking for any information I can find. Although I am not a doctor, I've read that gallbladder problems can FEEL as if your food is not digesting(although clinically I KNOW mine is digesting), and bloating and an unusual feeling of fullness can occur. I have also read that rapid weight loss can contribute to gallbladder issues. I guess what I'm asking is, out of all these tests one comes back normal and the surgeon is not willing to accept it as abnormal, so MUST you feel severe pain as the doctor said for a test to come back the way mine did? And do my other symptoms(fullness, bloating) fit at all with my abnormal HIDA scan result?


Please answer, thanks.
2827584_tn?1340583296
I think you have a better handle on your problem than the surgeon. You are spot on with the weight loss triggering the issue. With the low body weight, a superior mesenteric artery syndrome would be another possibility but I agree, a gallbladder not visualizing after four hours is hard to ignore. I would remove the gallbladder first with the expectation that that would fix the problem.
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Meant to say:

I guess what I'm asking is, out of all these tests one comes back ***ABNORMAL*** and the surgeon is not willing to accept it as abnormal, so MUST you feel severe pain as the doctor said for a test to come back the way mine did?
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Have you considered going back to your GI to see what his thoughts are.  Maybe there is more imaging tests like an MRCP that could be done to look for stones or blockages in your liver, pancreas, gallbladder, etc.

Just an idea
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Thanks for answering, but unfortunately the problem has gotten more confusing. At the recommendation of the surgeon I had a 2nd HIDA scan(4 weeks later), this time my gallbladder visualized after 45 minutes and they injected the CCK for 30 minutes and my ejection fraction was somewhere in the 50% range. This is very confusing. I am certain the first abnormal scan was accurate, as the radiology told me that on their part there was no human error and that other tests performed that day with the same machine were accurate, as for my part I was told the only reasons for it not showing up would be eating close to the test, fasting for over 48 hours before the test, or taking narcotics. I did none of these things BOTH times. I spoke to the surgeon who still does not feel it has anything to do with my gallbladder, but told me as a last resort(meaning no other test shows anything else wrong) he would be willing to consider taking out my gallbladder, giving me a 60% chance it may help my symptoms. I am very confused at this point and truly don't know what to do. I realize a gallbladder can't fill and empty if it is truly not, but I am also absolutely certain the first abnormal result was accurate. Any help or insight would be appreciated. Thanks.
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2827584_tn?1340583296
One potential explanation is that you are making tiny gallstones that pass down the duct. I have had several patients that had cholecystectomies after HIDA scans showed either nonvisualization of the gallbladder or ejection fractions of 0 where the final path demonstrated a tiny stone in the cystic duct, obstructing it. This is something that is very difficult to see on ultrasound. When a patient's history is consistent with gallbladder disease and other sources have been ruled out, I tend to look for any evidence to support my diagnosis. Were any of your symptoms reproduced after the CCK infusion?
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No, I felt normal after the CCK infusion, since I hadn't eaten for about 14 hours at that point. It really seems to be the presence of food that makes me feel the uncomfortable fullness, as if something is going wrong with the digestive process or something. I just don't understand why the doctors I see are unwilling to see the weight loss as a cause of my symptoms, since before the weight loss, I've never had any digestive problems in my life and then suddenly I lose 20 lbs in a short amount of time after being thin to begin with and I start having digestive problems. I'm not sure what other digestive organ can be affected by weight loss other than the gallbladder. I even asked my gastro which test she would trust, the abnormal or the normal and she told me the normal. I'm very confused.
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2827584_tn?1340583296
Google superior mesenteric artery syndrome. This can be seen following weight loss and reprsents compression on part of the duodenum with obstruction.
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Thanks for answering. I looked that up and I'm not sure it fits. I am able to gain weight, since I am back to my starting weight of 125 again, and I have never vomited, but I won't discount it as a possibility. I did see my GI doctor, who now is taking the first abnormal HIDA and the weight loss as a cause a little more seriously. She said she is 50/50 with her thinking, that she either thinks it's some sort of irritable bowel or it's my gallbladder. She seems to agree that a completely healthy gallbladder wouldn't not show up on a HIDA scan, even if the 2nd scan was normal. But she also seemed skeptical that removing my gallbladder would help the problem, saying my symptoms might come back after removal.
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I met with my surgeon and have scheduled surgery to have my gallbladder out. The decision was really on me, as he really had no reason to offer me the surgery other than the fact that it may be my gallbladder, but it may not be. He brought up the possibility of tiny stones, as you did, and also said that the first abnormal HIDA could have been due to a duct that was closed because of a gallbladder function problem(such as biliary dyskenisia). I just wanted to get another opinion, since obviously no one can know if the problem is my gallbladder. In your experience, would a correctly/fully functioning gallbladder present with such an abnormal finding on that first HIDA scan, despite the second one being normal(53%)?
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2827584_tn?1340583296
I think that is a good decision. The fact that it took 45 minutes for your GB to visualize is not normal. It is consistent with chronic cholecystitis.
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I Googled superior mesenteric artery syndrome and this could be what is wrong with me. I am not sure of all the % in the explanation of the syndrome could you please explain a little better.
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2827584_tn?1340583296
The superior mesenteric artery comes off the aorta and supplies blood to all the small intestine and about two thirds of the colon. It is directed at a downward angle and the duodenum crosses the aorta below the takeoff. The typical patient that gets into trouble has lost a fair amount of weight. With the loss of fat "padding", the duodenum gets pinched between the aorta and the SMA causing obstruction.
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Thanks for answering. I just wanted to clarify what you said. When you said "The fact that it took 45 minutes for your GB to visualize is not normal.", did you mean the first HIDA where my gallbladder didn't visualize after 4 hours is not normal?
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here are my symptoms I am a 46 yo female and I have severe N/V when I eat anything greasy and or spicy. after I eat I feel like I have ate the entire cow.(i look like I am almost 6 mo preg.) the pain is in the RUQ and for the most part is a dull ache pretty much all of the time however; after I eat a high fat meal I have severe pain. My doctor has run the following test ,small bowel follow through, gastric emptying, upper GI, endoscopy, colonoscopy, HIDA scan with CCK and an MRI. I have been on bentyl, restora and now xifaxan, but they do not seem to help and i have also been on Linzess d/t severe constipation. I am also on B12 inj d/t severe anemia. I have not lost that much weight (approx 12lbs in a couple of weeks) but I just figured that is because I cannot eat nor do I have an appetite. the only test that were abnormal were the gastric emptying which the doctor dx me with gastropoiesis and the HIDA scan with CCK they told me the radioactive tracer did not show up in a portion of my liver. but they sent me for an MRI that per my doctor was normal and they just think it was a fluke in the HIDA scan...I am just so tired of hurting everytime I put food in my mouth. do you think SMA could be my problem?
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2827584_tn?1340583296
There is no reason to give CCK when it has taken 4 hours for the GB to visualize as that is consistent with chronic cholecystitis. You are getting the test because there is clinical evidence of gallbladder disease. All you need is objective support. You had that on the initial study. In my humble opinion, the rest of your course has been wasted time.
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2827584_tn?1340583296
SMA syndrome would be unlikely if the small bowel study was normal. They would have seen evidence of obstruction in the fourth portion of the duodenum if there was an SMA syndrome present. Your symptoms are consistent with gastroparesis. It is common that these patients actually gain weight because they tend to gravitate towards high calorie sweet things that go through better.
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then I am at a loss. they have started me on Xifaxan and I was told that I should see a difference after three doses, unfortunately the dull ache is still there. and I am afraid to eat anything greasy or spicy to see if the n/v and pain returns because after I had the HIDA scan w/CCK done it took me three days to stop hurting, now I am back on my bland diet and the only symptoms I have right now is a dull ache in my RUQ. just not sure where to go from here or what to expect. does this sound like IBS?
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Thanks for answering, I really appreciate it. But that's where my situation becomes very complicated. There was actually never any suspicion that my gallbladder was the problem during the course of any of these tests. I actually asked for the upper right quadrant ultrasound and it was ordered reluctantly. Same thing with the first HIDA, I asked for it and again it was reluctantly ordered for me. The first HIDA scan showed an abnormality and the doctors don't really know what to do with it because in their minds they don't seem to want to believe it really could be my gallbladder and also that 2nd HIDA scan was normal. They just pretty much try to explain why it doesn't make sense or come up with reasons why it wasn't accurate. Everyone involved is just very skeptical and won't look outside of the box. I understand the vast majority of people with gallbladder problems have right side pain and stones, and it becomes hard to see it may be gallbladder related without pain or evidence of stones. Again, my symptoms are a very intense heavy, fullness/bloating in my mid abdominal area after eating, that persists and increases throughout the day, which I believe are directly related to a rapid 20 lb weight loss(eating very low fat) that occurred directly before I started noticing my symptoms. I understand most doctor's first thought wouldn't be gallbladder related based on my rather vague and common sounding symptoms. And I get that I have a lot of things working against me, on paper I appear healthy, and I am a 23 year old who is now at a healthy weight. But the way they act like it is nearly impossible confuses me.
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