gallbladder or something else?

[betsyboop1]

I'm a fit, normal weight, 49 year old woman...i've always had low level digestive issues which i've had to accomodate dietarily. (no ice cream after meals, etc...small meals...lots of veggies) anway, last year i suddenly lost my appetite and found myself unable to eat much of anything. Every now a then I'd feel a dull pain under my right shoulder blade. a bunch of tests were done: blood, US, EUS, and HIDA. The HIDA scan revealed an EF of 24%, and GB removal was recommended, but by that time (~1 month) I'd started regaining my appetite little by little so I decided against surgery. After about 2 months, I was completely back to normal and felt bad for harassing my GI doctor :)
Fast forward to March 15th 2012: Same thing--very SUDDENLY, no appetite...but this time the upper right back pain and pain under my right rib were much more pronounced. I went on the same diet as I'd implemented last year--mostly steamed/blended veggies...and after about 10 days things started looking up. Then, about 2 weeks later, before I was fully back to normal (but had started cautiously eating "regular foods") the problem hit again but this time MUCH worse.  So from April 9th until today, Aptil 22nd, I've had consistent (though still intermittent)  RUQ pain, and whenever I try to eat something "normal," like a piece of feta cheese, I have stomach discomfort  and very bad flatulence from about 1.5 hours on. The RUQ isn't so prominent at these times, but resumes eventually. yesterday, very stupidly, i had half a cup of coffee (haven't had coffee for 3 weeks) and a 1/4 muffin, and the pain aspect of this problem was worse than ever, especially hours after drinking the coffee, lasting until noon today. (heavy, dull pain under right ribcage and under right shoulder blade.) What on earth is going on? What other tests might be indicated? (Oh--had an MRI or the liver based on symptoms and a mildly elevated AST--it revealed only benign hemangiomas.)

[Sloumeau]

joining community

[Sloumeau]

Even though this post is 3 years old, I'll respond to give those reading more info.  Betsyboop1 probably should have had an abdominal ultrasound to see if gallstones had formed in her gallbladder. This would have greatly helped her and doctors   to decide if she needed gallbladder surgery or not.  It could also show if her gallbladder walls had  thickened, indicating a probable infection.  

[Christopher R Watters, MD]

They could

[betsyboop1]

thank you!!! i really appreciate the quick response. i'll report back! (one more q: would doudenitis or gastritis cause RUQ pain (in front, side and back?)

[Christopher R Watters, MD]

I would advise removal of the gallbladder IF other possibilities have been ruled out. If there is another foregut diagnosis such as duodenitis or gastritis this should be treated first. If it resolves and the symptoms persist, you have your answer. In my experience, it is common to see gallbladder dyskinesia in combination with alkaline reflux gastritis. This is not treated with the usual acid reducers and can actually be made worse by these as the acid in the stomach neutralizes the alkaline refluxant from the duodenum. In marginal cases I will frequently give the patient a month trial of sucralfate with or without metaclopramide before recommending surgery.

[betsyboop1]

Thanks for your quick response, Dr. Walters! I guess my question is this--could these symptoms be anything else? I had an MRI, US, EUS and 2 HIDA scans. The HIDAs were borderline (27% and 33%) and the Endoscopy/EUS  revealed gastritis and duodenitis. I do have my appetite back to some degree (but I still eat very little because of the gas and pains that result from eating) but my pain is pinpointed to the RUQ, both front and back (sometimes i'll get a jab under my right armpit)
If I'm reasonably sure that it's my GB, i'll get it taken out...but if gastritis could be to blame, i obviously want to address that! (and i'm trying!)

[Christopher R Watters, MD]

The reported literature would argue that you have a 90% chance that removing the gallbladder would end your symptoms and a 10-15% chance that they will resolve spontaneously.

[betsyboop1]

thank you so much for your reply! i haven't had GB removed yet but symptoms are getting worse! i can't really seem to digest much of anything, and the RUQ pain (front and back) is worsening. The weird thing is that my stools are normal! I guess I should look into getting it removed! thanks again for your reply...i haven't checked until now!

[Paderla Anitha, DNB]

Hello and hope you are doing well.

If gallbladder ejection fraction is below 35% is considered to be gallbladder dyskinesia. Due to non-functionality of the gall bladder, there is stasis of bile, it could predispose to formation of sludge. Sludge in the gallbladder is formed from crystals and salts in excess bile. The gall bladder functions as a storage area for bile produced in the liver. This bile is then secreted into the intestines to aid digestion. When then the gall bladder malfunctions, there is stasis of bile and other crystals and salts get deposited forming sludge. This is prone for gall stone formation and sometimes infection. So, based on symptoms surgical therapy is planned.

Hope this helped and do keep us posted.