EJection Fraction of G.B.? What is that about

[Marcy__0__0]

  I have recently been very ill with G.I pain mostly in the upper R quad.  It was intially thought to be a gall bladder problem.
  Blood work reveiled since the End of May until now (5-27-98 until the last blood draw on 8-19-98) a constiantly elevated WBC count.  Intially @ 16,200 then decreaded to the lowest on 8-4-98 @12,200, then increased again latest @ 16,600.  Sed rate at intial onset of pain @ 32 then increased to 68 then decreased on the last blood draw @15.  I have had a chronic low grade fever, Highest @ 101.6 average~99.7 daily.  Ive been through a series of tests: ABD Ultrasound (Neg) Upper and lower G.I. (B.E.) with a small bowel fallow through (Negative accept for a small sliding hernia) No Gyn etiology (Pelvic ultrasound neg.) HIDA Scan did show :Gallbladder dysfunction "With abnoral ejection fraction of -18%" I also experienced the same pain and very nauseated with the Cholecytokinin agent.  I have been throwing up alot daily, stools have mucus and mal odorus, can you help?
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Dear Marcy,
You have entered the medical quagmire of what to do when there is right upper quadrant pain.  As you know from reading other letters to this Forum, many people have had their gall bladders removed for atypical pains in the presence of gall stones.  Unfortunately, a large subgroup will have recurrence of pain after the surgery.
Your situation, however, is slightly different.  You have pain without stones.  The question that you are asking is: Could one have gall bladder problems in the absence of stones?  The answer is yes.  The CCK test is very useful to assess gall bladder function.  Under normal circumstances, the administration of CCK causes the gall bladder to contract by at least 35% (the normal in our lab).  Contractions of less that 35% indicate impaired gallbladder function.  The most frequent cause for this impaired function is chronic inflammation of the gall bladder wall.  The radiology literature suggests that about 90% of people with impaired CCK response will feel better after the gall bladder has been removed.  Although the odds of improvement are in your favor, there is no guarantee that you will be perfectly OK after the surgery.  
The persistence of fever and the elevated white cell count indicate ongoing inflammation.  The presumed location is the right upper quadrant based on the location of your pain.  It is necessary, however, to exclude other causes e.g. kidney problems, ulcers as the cause of your symptoms.
Finally, you mention that the CCK administartion precipittated your pain.  Unfortunately, this finding is not specific because CCK also affects the function of the intestine and can induce intestinal as well as gall bladder pain.
This information is presented for educationalpurposes only.  always consult your personalphysician for specific medical questions.
HFHSM.D.-rf
*keywords: gallbladder, gall stones. abdominal pain
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