Could I have gallbladder disease?

[N.]

I am a 31 y/o caucasian female.  I am an active duty military member, and have been stationed in Adana, Turkey, since June 2002.  I have been experiencing chronic diarrhea, and intermittant nausea and abdominal pain for approximately 15 weeks now.  The first changes I noticed in my health was that my stools became loose ("cow patty consistency") and light tan-orange in color.  Stool frequency also increased to about 7-9 stools a day.  Next I began having these "attacks" where I would experience diarrhea (consistency anywhere from loose to watery, and up to 20 stools in one day), moderate to severe nausea (although I have not vomited yet), and a dull, cramping pain in the center of my abdomen (not upper right quadrant).  Between these attacks, which may be spaced out as closely as a day to as long as a week, my stools became loose and look poorly digested.  I now have to eat Pepto-Bismol tablets like candy--if I don't take one tablet at least three times a day, I will get diarrhea and become nauseous.  Also, I experience indigestion and/or heartburn virtually every night.  My attacks seem to come on mostly at night.  I am usually woken up and have several bouts of diarrhea before I can return to sleep.  I can't say for certainty whether or not fatty meals seem to preceed an attack; there doesn't seem to be a rhyme or reason to what I eat and when an attack will follow.  I did put myself on a dairy free diet for one month, but did not see any change in my symptoms.
     I have received a pretty extensive medical work-up thus far.  I first received three separate stool cultures and ova and parasite tests, which were all negative.  Repeat CBC and chemistry profiles (including amylase, lipase, and liver enzymes) have all been normal. Colonoscopy with random biopsies was completely normal.  I have had two separate abdominal ultrasounds, which were normal (no gallstones seen).  I had a barium upper GI series, and initially the radiologist thought I had duodenitis, but endoscopy with random biopsies a week later revealed no pathology.  Bloodwork for H. pylori antibodies was negative as well.      
     My past medical history is as follows.  I was diagnosed with overactive bladder 4 years ago, and have been on Detrol-LA 4 mg SID ever since.  I did take birth control pills for 1 year, but am not currently taking them.  I do have elevated total cholesterol (224), but am not currently taking any medication for it.  Otherwise, I am generally a very healthy individual.  I have never been pregnant.
     My doctor wants to rule out biliary dyskinesia, and plans to send me for a nuclear scan (otherwise he is stumped).  My question is, would you consider gall bladder disease (in the absence of stones upon ultrasound) as a possibility?  Are there any other rule-outs that you would consider?  My symptoms persist, and I am getting extremely frustrated, and just want whatever my condition is to be diagnosed and treated, so I can get on with my life.    

[Kevin Pho, MD]

Surgeon has kindly addressed your question in his comments below and I agree with his assessment.

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.

Thanks,
Kevin, M.D.

[Kellysbabies]

Not that I'm a doctor, but have you looked into irritable bowel syndrome?

[nadia]

I never had stones either.  I had similar symptoms to yours, however, everyone does have somewhat varying symptoms with gallbladder disease. I never had chronic diarhea (diarrhea), but I'm sure that it is very likely. The difinitive test is a Hida scan with CCK.  I had chronic gallbladder disease and had mine removed last June. I hope you can schedule one soon so that you can get some relief!  Good luck.

[surgeon]

it's possible to have GB disease without stones. However, your symptoms really don't suggest it. The HIDA scan with CCK is not really "definitive." There is a broad grey zone of what's normal or not. In particular, biliary dyskinesia usually refers to people with symptoms that strongly suggest gallbladder, but whose gallbladder is normal on ultrasound. In that case, if the HIDA scan shows abnormal function of the gallbladder AND if the CCK injection reproduces the symtoms then there's a good (not 100%) chance removing the GB will help. Your symptoms are not at all typical of GB. I'd be reluctant to take out your gallbladder. Another issue is that many people get intestinal cramping with CCK injection. So I'd guess it will be hard to be certain in evaluating the results of your test. There are other conditions still on the table, such as irritable bowel, or Crohn's disease,etc. I'd consider a CT scan with enteroclysis, a way of imaging the small bowel.

[GastroGal]

I know of a 38 year-old who had no history of gallstones, but was recently diagnosed with Stage IV gallbladder cancer that has spread to the head of the pancreas, liver, and bile ducts.  Patient's tumors are shrinking with Gemzar and 5FU.  How could that cancer have started without stones?  The patient had no history of gallbladder problems.  Is the a rarity?  Could it have been caused by polyps?  Just curious as to what you think.
Thanks.

[surgeon]

gallbladder cancer is rare, even in people who have gallstones. In humans, nothing is 100%: gallbladder cancer almost always occurs in people with gallstones, particularly people who've had them for many years -- and then only in a very small percentage. But it's been known to occur in younger people, and those without stones. Yes, it's very rare.

[GastroGal]

Thank you surgeon!

[Gastro_interest]

I would ask for a GES (Gastric Emptying Study), because the loose stool and indigestion could indicate a motility disorder.

[sister2222]

A related discussion, gallstones was started.