biliary dyskinesia or colitis

[mine4wine]

I have all the symptoms of issues with my gallbladder, but no tests are confirming gallbladder problems. I also have mucus in my stools, which I have not seen as a symptom of gallbladder issues. I see a GI doctor in about a week and I'm sure he will be looking for something other than gallbladder issues because of the stools. Should I continue to push for a HIDA Scan? Or is upper right abnominal pain and shoulder blade pain normal with intestine issues?

[cmdm2010]

I have all the symptoms of gall bladder disease without the vomiting and I had high liver enzymes but a normal abdominal ultrasound anyone have any ideas the pain had mostly receded by the time I got the ultrasound though... That was a week ago I don't have any pain now?

[mine4wine]

I never saw my results. I was just told they were normal and then asked what my numbers were. However, the technician that gave me the HIDA scan did explain that some facilities give the CCK over 3 minutes but that they did it over an hour so not to cause so much pain. My pain during the test was similar to that which I've experienced at home.
Thank you for this insight. The surgeon I am seeing said that he would still take my gallbladder out if we (he and I) were sure that there wasn't another reason for my pain. He did say that he too has had patients that tests have not shown anything to be wrong with the gallbladder but that after its removal they have felt better. I see him again in a month and for now I am trying to figure out what foods cause the pain. Which is tough because I seem to be in pain regardless of what I eat.

[Christopher R Watters, MD]

I am interested in your test result. The HIDA w/ CCK was set up to detect gallbladders that weren't contracting normally. Although the medical literature has come to viw anything over 35% as normal it is unclar where this number comes from. Minor variations in how the CCK is administered have a huge impact on the results. Most radiology departments are infusing it over 3 minutes. This has been shown in studies to give abnormally low ejection fractions in 30% of normal volunteers. Recent work at the Cleveland Clinic has shown tat symptom reproduction is a better predictor of symptom relief following gallbladder rmoval than the measured ejection fraction. Having had a interest in biliary surgery over the past 25 years, I have had particular interest in a small group of patients that have biliary type pain as defined by Rome criteria (www.RomeCriteria.org) but have had ejection fractions that are extremely high, especially if their symptoms reproduced with the CCK infusion. As you probably know, when you get a numerical result from a biological test, they tend to give a roughly bell shaped curve. Typically, "normal" is defined as the mean plus or minus 2 standard deviations. Because the HIDA w/ CCK is only meant to detect abnormally low ejection fractions, the folks with ejection fractions above 90% are called normal even though they are well above the normal range. When we have proceeded with gallbladder removal in these patients, 90% have seen resolution of their symptoms. Out of more than 3500 gallbladders that I have removed, only about three dozen have been for these criteria. I recently saw a patient that had been on chronic narcotics for 8 years for his unrelenting pain and was considering some European clinic that promised magic pain relief when I saw that he had had a HIDA w/ CCK 8 years previously that showed a 98% ejection fraction and gave him severe pain similar to his worst days. Since his ejection fraction was over 35% the report sent to his PCP said "normal." Once his gallbladder was finally removed the remaining issue was how best to wean his narcotics. Because it has become all too common for these patients to suffer because misinterpretation of the tests and the fact that primary providers are unfamiliar with the probem, we are in the process of establishing a clinic specifically for patients with functional biliary pain. We are pulling together biliary gastroenterology, surgery, radiology, and pain management services to provide a multidisciplinary approach to these frustrated patients.

[mine4wine]

I had HIDA scan done my GB in functioning at 97%. I am now keeping a food diary and trying to stay away from lactose. I really hope it is lactose intolerance because that is easy to fix. But I haven't had much dairy lately and none today and I am still in pain. So I guess I have to have patience. Thank you for your response!

[Reruho]

Have the HIDA Scan done to see if it is a low functioning GB, it is the only test that will tell you how your GB is functioning. You can can have normal results on all the other types of GB testing. because it happened to me for 20+ years. I also suffered with chronic Cholecystitis (inflammation of the gallbladder), which may not show up on bloodwork, mine never did. The only abnormal blood work I had was a slightly elevated alkaline phospatase, which my doctor said was insignificant.. I recent read that  the biliary dyskinsesia is also associated with GERD and gastritis. I was diagnosed with gastritis twice.
Reta

[mine4wine]

I had a CT scan still no sign of gallstones. But intestines had a considerable amount of stool. I do not have an appointment with a GI specialist next week (like I thought), instead it is with a general surgeon. I called my doctor to see if this was a mistake and she will not be in her office for a few days. In the meantime, I'm in a lot of pain. If I run a fever I'm suppose to go to the ER, what else should I watch for if this is intestinal, rather than gallbladder?

[Arti Sharma, M.D.]

Hi, pain in the right upper quadrant and right shoulder blade could be due to gallbladder problems, liver problems, acid peptic disease, IBS or any cause related to the upper right colon. Sometimes pancreatitis too can cause pain in the middle of abdomen and left shoulder blade. Mucus in stools is seen in bacterial and parasitic infections, Crohn’s disease and ulcerative colitis. As you said gall bladder pathology has been ruled out by all the tests. You may need gastric endoscopy to rule out acid peptic disease, ultrasound of the abdomen, colonscopy to rule out colon pathology, liver blood tests and amylase/lipase for acute pancreatitis. You need to discuss all these possibilities with your gastroenterologist. Do keep us posted.
Take care and good luck.