HIDA 17%, should I have gall bladder removed?

I am a 60 year old male, not overweight, and am about to have my gall bladder removed, perhaps this week.  No fever, no weight loss or gain.  I started having stomach aches (queazy, nausea) last October 2006.  I would be sick for days, then better for days.  The nausea occurred both during day and/or night.  Sometimes eating helped, sometimes not.  No vomiting, no yellowing in eyes, no RUQ pain.  Saw GP and he ordered blood work and ultrasound.  Blood work was normal, ultrasound normal except that common bile duct measured 5.9mm which is the upper limits for someone my age.  No stones were seen.  Saw GI doc.  He ordered HIDA scan with CCK and endoscopy.  HIDA scan came back with ejection fraction of 17.6%.  HIDA scan report suggested possible chronic cholecystitis.  Endoscopy showed that I had a mild hiatal hernia and moderate, nonspecific, chronic gastritis.  Biopsy for H Pylori was negative.  In past month since these tests were performed, I have had less nausea but more pain in the pit of my stomach, sometimes intense and drilling through to my back under the LEFT shoulder blade.  Typically this happens at night but does occur in the daytime but less often.  I have had minor on and off again pains in the RUQ in the past month as well.  My GI doc thinks the gall bladder should be removed.  He said that symptoms aren't always classical (significant RUQ pain, etc.) and that my HIDA scan indicates my gall bladder is barely working.  I should also note that for years now I have frequent morning bowel movements, between 2 and 4.  No blood in stools.  Oh, I have been taking Protonix, 40mg, on and off.  I don't think it really helps but I am back on it again.  Should I go ahead and have the gall bladder removed?

[Kevin Pho, MD]

There are some small studies that suggest that removing the gallbladder in cases of low GB ejection fraction can help the symptoms.  An ejection fraction of 17% would certainly qualify for that.

However, there are no guarantees, especially if the symptoms are not coming from the gallbladder.

A referral to a surgeon can be considered to further evaluate this option.  

Another test to consider would be an MRCP to evaluate the biliary ducts for any stones.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

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, M.D.
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