Hyperactive Gallbladder

I noticed that there had been a couple of questions about hyperactive gallbladder.  I am curious in my case as well.  I have had immense pain since March of 2011 in my abdomen, mainly the upper right quadrant.  I began going to my PCP and she ordered an ultra sound which came back negative for stones.  I then went in for a hida scan and found my gallbladder ejection fraction was 98%.  I had the pain but it was intensified with the test.  I met with a surgeon and he did not want to take it out and suggested that I see a gastroenterologist.  I had a colonoscopy and upper GI and that came back negative for anything as well.  No chrons or celiac.  I was referred to a gynecologist and urogynecologist through them, I was diagnosed with endometriosis and interstial cystitis.  I have elevated bilirubin levels and the GI doctor diagnosed me with Gilbert's Syndrome.  I was told that Gilbert's Syndrome would not create any pain at all and it is a benign condition.  I still have tremendous pain when I eat especially fatty foods.  I just don't eat anything with fat in it anymore.  For the last year I have stuck to that and do not drink either with my other HCs.  I just had my annual physical with my PCP and told her that I am still dealing with the pain and chronic constipation.  I have never had constipation until that last two years that I have been dealing with this pain.  I always had very very loose stools up until then.  She now wants me to meet with the same surgeon again and tell him that I have been through all of the tests and everything is negative.  And look at the option of having it removed again.  It has been a year since I met with him and a year ago he simply looked at me and said I did not fit the criteria....I am female, but not over 40 and fat.  I am 31 and very thin.  I was just wondering your advice.  Thank you for your help.

[Christopher R Watters, MD]

Removing your gallbladder would have been premature before ruling out other upper abdominal sources. Now that that has been done cholecystectomy would be appropriate with a high chance of relieving your symptoms.

[rae_lee2011]

Thank you very much for your opinion.  I was a bit hesitant, but I will make the appointment to meet with the surgeon.  I hope you have a great week.

[rae_lee2011]

I just wanted to give you an update.  I met with the surgeon, and he told me that it would be unethical for him to remove it, because my tests were considered normal.  He also told me that based on that, my insurance would not cover it.  He referred me to a different gastroenterologist than I saw before because he feels that it is all in the colon.  He did tell me that as far as the pain that I had during the hida scan, that everyone gets that.  Even if they have a healthy gallbladder.  I spent one third of my income last year doing everything he wanted me to get checked out, and now it just seems like a vicious circle...

[rae_lee2011]

Just curious, he told me that since I suffer with constipation and not diarrhea, he feels that is important because I would not be constipated if it were the gallbladder.  I have had diarrhea my whole life up until two years ago when this all started...

[Christopher R Watters, MD]

I would argue that your findings were not normal. Data has shown that symptom reproduction or intensification with CCK is a good predictor of symptom relief after gallbladder removal. I see nothing unethical about using available data to help patients. The fact that radiologists are behind the times in their reading of these tests doesn't mean that practicing surgeons should ignore the information.