Gallbladder Dyskinesia and Fatty Liver

Hi
right/middle abdominal pain and gas,
Endoscopy:Normal,Hpylori -ve, Blood test albumin on lower side

Abdominal U/S

Liver normal size,homogenous but increased echogenicity.consistent with Fatty Liver.gallbladder,biliary system, spleen,pancreas,kidneys,aorta and IVC are normal.No free fluid seen

(HIDA Scan)
Following IV administration of 5.2 mCi of Tc-99m Choletec,serial dynamic images of abdomen acquired in anterior projection at 2 min/frame for a total of 51 min. 1.1 microgm of CCK was infused IV and on imaging Gallbladder ejection fraction was estimated and from region of interest analysis

Normal hepatic tracer uptake seen excretion of tracer into the biliary system with visualization of the gallbladder Subsequently, tracer is identified within the deodenum and small bowel.gallbladder ejection fraction 13% is low

1.Normal hepatobiliary scintigram without evidence of cholecystitis
2.Gallbladder ejection fraction of 13% may be indicative of gallbladder dyskinesia

Was diagnosed PCOS, but currently no medication, insulin is 5.6, fasting sugar around 85-95, weight 127 lb lost 10 lbs in 6months

Dr can you please advice,
1. What is your conclusion based on the above results
2.Is the above results 100% conclusive of Gall bladder dyskinesia? based on the flow rate can we associate how severe it is?
3.Can the above results rule out other problems like SOD or Biliary duct or Biliary diskinesia? if yes how
4.Is the only treatment for this removal of Gall bladder?
5.I have seen lot of posts on PCS(post cholecystectomy syndrome) and it makes me wonder if it this is the best option?
6.What other alternate do i have?
7.Can it be that the Fatty liver is crushing on the Gallbladder and causing the trouble and can improving Liver health help with my situation?
8.If i postpone doing the surgery, what are my risks? since i have this condition am i more prone for infections of gall bladder and can it be fatal?
Request a quick response
Thanks
Smi

[Kevin Pho, MD]

To address your questions:

1) The gallbladder ejection fraction is low, and may be a cause of the symptoms you describe.

2) An ejection fraction of 13 percent is suggestive of dyskinesia.

3) No, an MRCP or ERCP is better to evaluate the biliary ducts.  To exclude SOD, an ERCP with Sphincter of Oddi manometry would be considered.

4) Studies show that removing the gallbladder can help in low gallbladder ejection fractions.

5) I would discuss with your medical team whether removing the gallbladder can help.  Otherwise, evaluating for Sphincter of Oddi dysfunction, or looking at a biliary duct stone can be considered.

6) If the above options have been exhausted, another GI opinion, preferably at a major academic medical center can be sought.

7) Fatty liver may lead to some of the symptoms you describe.  The two major causes would be alcohol use and obesity.  Addressing either possible cause can be discussed with your doctor.

8) It would depend on what the cause is.  Postponing surgery may cause the symptoms to continue.  But, keep in mind that surgery is not 100 percent effective either.  I do not believe that a low gallbladder ejection fraction increases the risk of infection or death.

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.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[smi74]

Hi Doctor Kevin
Thanks so much for your quick and precise response, can I please request further clarifications
1. What are the complications of considering MRCP or ERCPwith Sphincter of Oddi manometry that i need to be aware of

2. Do you know of literature on alternative treamtments? and successful outcomes, for example i saw the below article on Accupuncture, can i please have your opinion on this subject
http://www.medicalacupuncture.org/aama_marf/journal/vol16_3/article7.html. Do you know of more simialr articles and studies on the effectiveness of Accupuncture for Gallbladder dyskinesia.

3. Have you heard of anyone with following symptoms: "Sometimes when I gulp water, I get a sprain somewhere in the esophagus, also I have felt sprains towards my right lower abdomen (around the ascending colon) sometimes. When I take oily food, I feel tired and the feeling of heaviness or sagging increased and sometimes felt like an extra or quick heartbeat."
can this be indicative of SOD or a general motility problem of digestive tracts ?

4. Do you know about the effectiveness of probiotics for these kind of symptoms, if yes, can i please have you view on what should i consider when getting probiotics
Thanks for all help
Smi

[smi74]

Hi Doctor
Can you please address the query posted(June 26), also along with that can you please clarify if Gall bladder dyskinesia is same as Biliary Diskinesia
Thanks
Smitha