Pancreatitis/Gallbladder

I posted  couple of weeks ago . I went to the Er on 3-11 & was admitted for 4 days for pancreatits with mildly elevated Lipase (28) &  a  -sudden- severe pain in upper right quadrant(close to breastbone) that went straight thru to the back that was excruciating after eating that night. I also have ongoing pain in my  back and a 'shooting & spasiming pain  ' thats tolerable for now directly in my left ribs. While I was there they did a CT scan-negative except for fatty liver, Abdominal Ultrasound -negative ,MRCP negative,EGD negative.
I also had a Hida scan that was abnormal -Impression: prompt uptake in the gallbladder with a 18% ejection fraction: suggestive of Sphincter of Oddi Dysfunction or Gallbladder disease.I also itch sometimes where the pain areas are on my back & ribs.
   My doctor said that the Gold standard for gallbladder removal is an abnormal Ultra sound & that he doesnt like to take out Gallbladders with a positive Hida Scan.He said that removing the Gallbladder would only have a  very slim chance (he said 1 out of a 100) of improving my symptoms.He also said he would talk to a surgeon if I wanted him to.

  Is this really the odds of improvement of Gallbladder removal with respect to my symptoms & should I ask to go ahead with the surgery.

  For now, he has taken me off from work for 3 weeks & gave me pain medication & told me to eat a low fat high
calorie diet.

   Would a current negative MRCP rule out Pancreas problems & or sphincter of oddi Dysfunction.?

   He did an ERCP that was normal in 2006.

   What would be the -BEST -possible course of action to take at this point.
  
  
  
      

  

[Kevin Pho, MD]

I cannot give specific recommendations without reviewing your chart.

There are some small studies that suggest removing the gallbladder may help with the symptoms associated with a low gallbladder ejection fraction.  However, your doctor is right in that there are no guarantees.  

I agree with talking to a surgeon.

The MRCP would evaluate the biliary tree.  To exclude Sphincter of Oddi dysfunction, you need a Sphincter of Oddi manometry, which can be done in association with an ERCP.

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com