Continued pain, nausea, digestive problems 3 months post gallbladder removal

I am a 16 year old girl who for the most part was healthy prior to the start of my digestive problems.   I am 5"3 and have never weighed over 99 lbs but my weight has now dropped to below 94 lbs due to inability to eat without pain and nausea.  Around August 2011, I started having moderate-severe nausea and abdominal pain following most/all meals, which over time progressed to be nearly constant pain and nausea that made eating nearly unbearable.  Starting in early March, I had multiple blood tests, an ultrasound, a HIDA scan, and an upper endoscopy.  The only explanation offered to my mother (a doctor) and myself was that my gallbladder was hyperactive and excreted bile way too quickly, with an ejection fraction of 89%.  Normal ejection fractions are considered to be roughly between 30-75%, but high ejection fractions are a gray area in the medical world at the moment, as most bad gallbladders have a low ejection fraction.  All the children's surgeons refused to take out my gallbladder for this reason, but with it being our only hope we searched for a surgeon willing to take the chance.  We were luckily able to find a surgeon with some knowledge of hyperactive gallbladders who removed my gallbladder in early May.  My surgery went well and there were no complications immediately following.  I did not have constant diarrhea following my procedure and my pain and nausea were alleviated until approximately early-mid June.   I began having moderate nausea and pain again following nearly all foods and some drinks such as slushies or shakes.  It increasingly worsened but has not yet reached the constant pain/nausea i was experiencing pre-surgery.  I also had approximately 3-5 bouts that lasted about 10-20 minutes of extreme nearly unbearable pain, usually in my left abdomen just below the ribs approximately 20-30 minutes after I had eaten.  Each time brought me to the floor and to tears.  I visited the GI doctor again July 5 and was told their best explanation was Functional Dyspepsia and that I should begin taking 30g Amitriptyline each night.  I was told results should appear approximately 3 weeks after I start regular dosage, which I did on July 5.  I have seen some improvement in my pain and nausea as they do not necessarily occur after every single time I eat anymore, but they are still way too frequent and persistent for me to feel normal, much less function normally.  Over the past week or so, my stools have been a bright green color and my urine has been clear for the most part. There seems to be no connection between my symptoms and my hormones as they do not worsen or alleviate with my menstrual cycle.   I am sick and tired of being so sick and tired as my symptoms have majorly impacted my life and prevented me from participating in many things as they caused me to miss over 40 days of school just since January 2012.  Please please please offer any ideas or thoughts you might have, i truly am desperate.

current symptoms
green stool
clear urine
moderate/severe nausea and pain after eating
occasional extreme pain during digestion
easily tired

gallbladder removed may 2012 currently taking 30g Amitriptyline daily

[Christopher R Watters, MD]

I am sorry to hear of your continued problems. Were your symptoms reproduced with the CCK infusion during the HIDA scan? Gallbladder dyskinesia is the most common indication for cholecystectomy in patients under 18 years old. I have had an interest in hyperkinetic gallbladder dyskinesia for twenty years. Nothing appeared in the literature about these patients until the last five years though. Although I have removed over 3500 gallbladders only 35 have been in this group of patients. I will only recommend surgery in these patients if their symptoms were reproduced because the results of the test are so variable.nfor example, there is strong support for infusing the CCK over an hour but most places only a three minute "blast" is given. This has been shown to give abnormal results in 30% of normal controls thus making the test extremely unreliable. The patients that I have operated on have generally had ejection fractions over 90%. in this group, approximately 90% have had their symptoms resolve. I have noticed that alkaline reflux gastritis is a common co-problem in this group and any residual symptoms are usually ablated with Carafate with or without Reglan. I'm sure that a gastric emptying study would have been done during your initial evaluation to rule out gastroparesis. Any surgeon courageous to take on these patients should have the knowledge to manage those who do not respond. Return of symptoms several months postop is also typical of sphincter of Oddi dysfunction. I would recommend going to the web site www.RomeCriteria.org . This is a web site about functional gastrointestinal problems maintained by the most knowledgeable experts in the world. You can learn more about functional dyspepsia and spincter of Oddi dysfunction. The main reason most surgeons wouldn't tackle your case is that the associated diagnoses and potential additional evaluation generally require a tertiary care center for the required expertise. Anybody can snip a gallbladder out of a skinny 16 year old - that's about the easiest case. The decision as to whether thats the right thing to do is the hard part.