BILIARY DSYKINESIA?

[mariahul]

I AM A 42 YEAR OLD FEMALE WHO HAS HAD RUQ PAIN DAILY FOR THE PAST 8 MONTHS. I HAD AN ULTRASOUND OF MY GB AND IT REVEALED A WELL DISTENDED GALLBLADDER WITH A CBD MEASUREMENT OF 5.1MM. MY PRIMARY WANTS ME TO HAVE A HIDA SCAN. I AM RELUCTANT DUE TO MY SENSITIVITY TO MEDICATION AND THIS TEST REQUIRES AN INJECTION. I ALSO HAD THE SAME SYMPTOMS FOUR YEARS AGO FOR ABOUT 5 MONTHS AND THEY DISAPPEARED. ULTRASOUND WAS NORMAL WITH A CBD OF 4.0MM. THE PAIN IS MADE WORSE BY HIGH FAT MEALS AND CAFFEINE. I ALSO HAVE A SIGNIFICANT AMOUNT OF GAS WITH BELCHING. PLEASE ADVISE MY NEXT STEP SHOULD IT BE TO A GI SPECIALIST, OR SURGEON? I HAVE READ A GREAT DEAL ON BILIARY DYSKINESIA AND IT DOES NOT ALWAYS APPEAR TO HELPED BY SURGERY. I WANT TO AVOID SURGERY IF AT ALL POSSIBLE.
I SHOULD MENTION THAT MY MOTHER HAS HAD THE SAME SYMPTOMS AND LIVED WITH THEM FOR 15 YEARS. THANKS.

[Kevin Pho, MD]

I certainly agree with what was said in the comments below.  The HIDA scan with CCK stimulation would evaluate for biliary dyskinesia - if the ejection fraction was low, then removing the gallbladder may be of benefit.

However, before settling on this avenue, you may want to be evaluated by a gastroenterologist first to rule out other causes.  This can include the various causes of dyspepsia (i.e. an ulcer, inflammation of the upper GI tract or GERD).  If negative, then a surgery referral would be appropriate.

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]

In the absense of stones, even if you have biliary dyskinesia, the risk of living with the symptoms is pretty low: meaning that the most dangerous complications of gallbladder disease tend to be stone-related. So even if the diagnosis were firm, since you say you want to avoid surgery, there's nothing forcing you. As to the diagnosis: HIDA scan is the main way to diagnose dyskinesia. If the ejection fraction is very low AND if the injection reproduces the exact symptoms, the chance of relief by surgery is quite high. Nothing is 100%. As a surgeon, I never operated for biliary dyskinesia if the patient hadn't been evaluated first by a gastroenterologist to rule out other things as well as possible. So that's where I'd start.

[ozziemike]

I was diagnosed with biliary dyskinesia in 1994 after removal of gall bladder in 1991. I have had two sphincterotomies done on the duct. It has been an on-going problem usually leading to hospitalisation several times each year. Pain management is usually by morphine therapy. Attacks can be acute. Early pain relief is vital in minimizing the severity. I was told by my gastroenterologist that biliary dyskinesia cannot be clearly diagnosed until after gall bladder removal. He also said that he thought I had smooth muscle disease affecting, in particular, my biliary tract and oesophagus. But he said diagnosis could only be verified post mortem. I'll wait. The encouraging thing he said though was that most cases diminish in 60s. I'm in my 40s now ...

[pettiam]

I am a 30 year old male in good shape.  I have had left upper quad pain for about 7 years that radiated to my back.  the pain is worse in my back.  Over the past year the pain has started to lesson, but it is still there.  Seems that this pain, even though it is constant, is worse after meals.  I have noticed that foods containing gluten make the pain worse (celiad disease is in the family). I get bad gas and lose stools quit often. In the absence of gluten foods my stools appear to firm up.  I have had several CT's, MRI's, fecal tests, tons of blood work, upper endoscopy, but everthing came back normal.  My PCP doctor and gastro , part of the Brown Univ Medical Board, have been very detailed in all evaluations.  A very close look at pancreas and pancreatic function has proved no problems.  I recently had a HIDA scan due to some discomfort on the right side of my back.  Proved to show an ejection of less than 20%.  Gastro wants to have gallbladder removed, but my question is...  why is most of my pain on the left side and not the right?  Any advise as to what I should request next?

[Hill1986]

A related discussion, What is the next step? was started.