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Gastroenterology (Expert Forum)
Could I have been born without a gall bladder?
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Could I have been born without a gall bladder?
by gstump, Jan 18, 2007 12:00AM
I am female, age 36, 5’3” and 120 pounds. I'm in good health but with some autoimmune history (JRA and psoriasis.)
Symptoms started 11/06. I was awakened in the middle of the night a few times over a couple of weeks with pain that started in the upper right abdomen under the rib cage and then radiated across the back. On three occasions the pain was severe enough that I considered going to the ER. When I started to monitor the symptoms, I saw a definite association with the pain and eating a fatty meal, even if only a slice of cheese. At first the pain started several hours after eating. Then it was within an hour after eating. The pain can last up to six hours.
Since I have been carefully watching my diet, the “gall bladder about to explode” feeling is under control. However, I still have other discomforts like constipation, reflux, pain in the right shoulder/back/arm, and gas that feels like it is stuck in the chest under the rib cage. No vomiting.
I have seen both my pcp and gastroenterologist. I am not sure specifically what bloodwork was ordered but blood tests were normal.
I first had an ultra sound of the gall bladder. The ultra sound tech was not able to locate the gall bladder. I have never had it removed.
I then had a cat scan of the pelvis and abdomen. This test did not show a gall bladder either. The radiologist did write in the report that there were calcifications which he had interpreted to mean that my gall bladder had been removed (again, it hasn't.) Both my pcp and gastro believe these calcifications could be the gall bladder in a contracted state.
Next I had an endoscopy. The results showed LA Grade A reflux esophagitis. The biopsy results showed gastritis. The duodenum was examined to be normal. I have just finished 14 days of Prilosec and I do feel better.
Lastly, I had a HIDA scan. After an hour and a half the tech told me that the gall bladder was not showing. They then put morphine in the IV and took pictures for another half hour. My pcp said the results indicate a blockage in the duct b/c the tracer did not pass to the gall bladder. He feels is is time consult with a general surgeon. My appointment is next Tuesday.
My questions are:
• Could I have been born without a gall bladder? Would it be possible to have a stone in a duct with no gall bladder? Could anything else be blocking the duct? I had no problems at birth.
• If I do have a blockage in the duct, would my blood work have been normal? Should I request new blood work? I had mine drawn 6 six weeks ago.
• Could my gall bladder be contracted and therefore not showing? Would I have jaundice or other symptoms I am not describing?
• What next step would you recommend? Is there another test that could help to confirm if I do have a gall bladder?
• Is there a risk to my health if I live with this until the discomfort is unbearable?
• Any other toughts about my case?
Thank you!
Symptoms started 11/06. I was awakened in the middle of the night a few times over a couple of weeks with pain that started in the upper right abdomen under the rib cage and then radiated across the back. On three occasions the pain was severe enough that I considered going to the ER. When I started to monitor the symptoms, I saw a definite association with the pain and eating a fatty meal, even if only a slice of cheese. At first the pain started several hours after eating. Then it was within an hour after eating. The pain can last up to six hours.
Since I have been carefully watching my diet, the “gall bladder about to explode” feeling is under control. However, I still have other discomforts like constipation, reflux, pain in the right shoulder/back/arm, and gas that feels like it is stuck in the chest under the rib cage. No vomiting.
I have seen both my pcp and gastroenterologist. I am not sure specifically what bloodwork was ordered but blood tests were normal.
I first had an ultra sound of the gall bladder. The ultra sound tech was not able to locate the gall bladder. I have never had it removed.
I then had a cat scan of the pelvis and abdomen. This test did not show a gall bladder either. The radiologist did write in the report that there were calcifications which he had interpreted to mean that my gall bladder had been removed (again, it hasn't.) Both my pcp and gastro believe these calcifications could be the gall bladder in a contracted state.
Next I had an endoscopy. The results showed LA Grade A reflux esophagitis. The biopsy results showed gastritis. The duodenum was examined to be normal. I have just finished 14 days of Prilosec and I do feel better.
Lastly, I had a HIDA scan. After an hour and a half the tech told me that the gall bladder was not showing. They then put morphine in the IV and took pictures for another half hour. My pcp said the results indicate a blockage in the duct b/c the tracer did not pass to the gall bladder. He feels is is time consult with a general surgeon. My appointment is next Tuesday.
My questions are:
• Could I have been born without a gall bladder? Would it be possible to have a stone in a duct with no gall bladder? Could anything else be blocking the duct? I had no problems at birth.
• If I do have a blockage in the duct, would my blood work have been normal? Should I request new blood work? I had mine drawn 6 six weeks ago.
• Could my gall bladder be contracted and therefore not showing? Would I have jaundice or other symptoms I am not describing?
• What next step would you recommend? Is there another test that could help to confirm if I do have a gall bladder?
• Is there a risk to my health if I live with this until the discomfort is unbearable?
• Any other toughts about my case?
Thank you!
Doctor's Answer
by Kevin Pho, MD, Jan 18, 2007 12:00AM
, Jan 18, 2007 12:00AM
To answer your questions:
1) I do not have a good explanation why the gallbladder is not there. The next test would indeed be an MRCP. There are cases where the gallbladder position, or blockage of the biliary ducts, can lead to misleading results on the HIDA scan.
2) If there are blockages in the duct, the bilirubin level likely would rise, along with an elevation of the ALT and AST. Repeating the blood tests can be considered.
3) The gallbladder being contracted can be considered. Jaundice would occur if the bilirubin rises to a significant level.
4) I would recommended the MRCP as the next step.
5) I cannot comment on the risk without evaluation. These options can be discussed with your personal physician, or GI 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.
kevinmd_
1) I do not have a good explanation why the gallbladder is not there. The next test would indeed be an MRCP. There are cases where the gallbladder position, or blockage of the biliary ducts, can lead to misleading results on the HIDA scan.
2) If there are blockages in the duct, the bilirubin level likely would rise, along with an elevation of the ALT and AST. Repeating the blood tests can be considered.
3) The gallbladder being contracted can be considered. Jaundice would occur if the bilirubin rises to a significant level.
4) I would recommended the MRCP as the next step.
5) I cannot comment on the risk without evaluation. These options can be discussed with your personal physician, or GI 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.
kevinmd_
