Acalculous gallbladder disease?

[xmnstn]

I am a 45 year-old female. I am overweight, but exercise regularly, and have a pretty healthy lifestyle. For the past year, I have been having nausea (doesn't seem to matter what or when I eat), abdominal pain and bloating, and lower back pain. Initial endoscopy showed normal results, although some mild erosions. Ultrasound and MRCP both were normal. Disida scan was normal with a 37% ejection fraction. Then had an endocopy with Kinevac drainage (5 mcg in divided doses), which showed no microlithiasis, but had a very sluggish response. Anti-nausea, GERD and IBS meds don't help. That gastroenterologist has now suggested an upper GI and small bowel study, and a gastric emptying scan. He doesn't think there's enough evidence for acalculous gallbladder disease. I decided to get a second opinion, so a second gastroenterologist believes it probably is acalculous gallbladder disease and ordered a new endoscopy with kinevac drainage, done in one dose to get an objective result to evaluate gallbladder function. Assuming the test determines that I have reduced gallbladder function, do you think that there is anything else I should rule out before having gallbladder surgery?
I want to do something to alleviate my symptoms, but am nervous about the surgery. Are there any holistic approaches I could try before resorting to the surgery?

[Kevin Pho, MD]

Having a HIDA scan with CCK stimulation would give an objective result for gallbladder ejection fraction.  If it is reduced, there are some studies that suggest improvement when the gallbladder is removed.  

As for other considerations - the gastric emptying scan may be something you want to consider before surgery.  This test can look for delayed gastric emptying.  If the upper endoscopy is normal, this makes it less likely there are anatomical abnormalities present.  The small bowel study would be reasonable to look for things like Crohn's disease or any small bowel mass that could lead to nausea (the endoscopy does not reach all the way to the small bowel).  

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.
Medical Weblog:
kevinmd_b

[surgeon]

As a surgeon who's done many gallbladder operations, including many for presumed acalculous disease, I'd urge caution. Acalculous disease, or bilary dyskinesia, is hard to diagnose. The results of surgery are unpredictable. The best test, in my experience, is when the HIDA (or disida) scan is strongly positive; meaning, the ejection fraction is very abnormal AND the injection of the drug to cause the gallbladder to contract reproduces the symptoms. Moreover, I like to see that the symptoms the patient has are otherwise quite typical of gallbladder disease. In your case, virtually none of the criteria by which I personally would recommend having surgery are met. I think that, whereas it's not impossible you have gallbladder disease and will be improved by surgery, the chances you'll get satisfactory outcome are significantly less than 50 - 50.

[xmnstn]

Well, during the disida scan, I did get VERY nauseous when injected with the CCK, and although the results were in the normal range, the tech said I was very slow to visualize in the small intestine, very close to the hour limit they used. My mother also had her gallbladder removed due to stones when she was about the same age as I am now. I'm really getting tired of feeling like **** all the time. If you don't think it's my gallbladder, do you have any suggestions as to what is causing my symptoms? Thanks for your response.

[surgeon]

Many people feel nausea when CCK is injected; some also get cramps. It's hard to diagnose things online; I'm simply giving an answer to whether I think removing the gallbladder will help. I can't say it won't, and am not in a postion to recommend anything. I am say, however, that on the basis of the info provided, I'd be reluctant to recommend surgery. I'd say you should continue to follow through with your original gastroenterologist.  You will still be getting an official answer here from Dr. Pho.

[GastroGal]

Sir,
To your knowledge, was it standard practice to do biopsies on removed gallbladders in the 1950s?  I know that is standard practice now, but do not know if it was done then.  You have answered some of my questions before and put my mind at ease about the hereditability of gallbladder cancer.  My Mother has it and her mother died of "liver cancer" 1 year after her gallbladder was removed.  I suspect that her gallbladder was cancerous and that it spread secondarily to her liver.  I am assuming this because primary liver cancer is so rare.
Thanks!
GastroGal

[achieve]

My Hida Scan showed "no detectable effect of CCK on gallbladder contraction".  Would you remove the gallbladder with these results?  I am to the point where all foods bother me. Right now I have what feels like a tight band under my right breast.

[2305]

A related discussion, Severe Abdominal Pain with Vomiting was started.