My History needs to be explained for my Question : I have had 3 1/2 years of (sever abdomnal pain with upper back pains -Pancreatitis type pain , chronic diarrhea with malabsorption -verfied by several Fecal Fat tests to be malabsorption. chronic inflamation in my blood Markers( Overexpressed> CRP, ESR , Haptoglobin etc) High than normal >(Alkaline Phosphatase Isoenzymes) with a >normal Billirubin. All common GI findings have been ruled out such as but not limited to ( Inflamatory Bowel, Celiac etc) Several empiric trials of many Various GI & immune medications including but not limited to ( Immuran, 6mp, Questran, Creon, predinsone etc.) None have helped and still without any official diagnosis. I just recently for the first time had a HIDA SCAN done with CCK stimulation which came back as stating ( non functioning Gallbladder) 0% zero ejection fraction of Gallbladder with CCK administeration. I was informed that my GB FILLED but was not emptying at all- as if it was example :a dead organ doing nothing. A GB ultrasound was normal and a MRI & MRCP was normal except of NON specific Fatty Liver ( why its fatty liver i dont know, Im not overweight , i dont drink alcohol) I am now wating to see a surgeon about removing my GB . My Question is , could my dysfunctional GB have been my main issue all this time period of 3&1/2years unoticced. Should i get my hopes up that i will feel more normal after my GB is removes.? Is the HIDA w/cck accurate for GB function ?
HIDA is the main test for gallbladder function. There is another test: ECRP - during upper endoscopy a contrast is injected from the duodenum into your bile ducts, pressures at the level of Sphincter of Oddi can be monitored...
It is quite possible that bile doesn't flow into your intestine properly so fats can't be absorbed. Beside gallbladder, bile ducts have to function normally for bile being delivered into intestine. So be sure to try to find a proper diagnosis before deciding for gallbladder removal since this won't help you if the disorder is (also) in the main bile duct.
You should also try tio find a cause of fatty liver (medications, metabolic disorder..)
Hi Boron, thank you for your comment and advice, i did not mention any more details on original email which i should have. The ERCP which you suggested has also been done
but without spraying the bile ducts due to severe pancreantitis on the table during anastesia, the persona who perfromed it claimed it was too risky to continue the ERCP and it was abruptly cancled while in the middle of it. Though it was mentioned to me on several occasions & documented that my (SOD) sfinkster of ODD is consistently swollen for no apparent reason and on an MRCP All common bile ducts seem clear without stones or sludge. I am going on the latest of HIDA w/cck claiming my Gallbladder is just nonfunctional (delayed filling and zero emtyping 0% ejection fraction)
I am hopng and praying this can be my problem all 3 yrs because other than the chronic malabsorption/type of diarrhea , My pains have been getting worse by the day. to describe the pain. it alsmost mimics a pancrantitis type pain daily. As far as the MRI with Fatty liver my doctors are also confused since i dont have common other Fatty liver issues (i dont drink and am not abese. so it must be another cause.) could it be indirectly related to my GB issue of nonfunction ? what are the metababolic disorders you are refering to that could also cause the Fatty liver findings? i was thinking it could have been the malabasorption all these years as the cause. such as example: when some patients who have crohns can also get a slight fatty liver , but i dont have crohns.another thoery .OR the bile reentering the liver on occasion durng lying down possition. any more suggestions i can discuss with my doctor is greatly appreciated before my GB removal next week. There are still too many missing links in this whole ordeal. Also an unexplained always elevated RENIN (renin activity plasma -reaching over 12 ) meanwhile my kidneys have been looked at extensiveley and fine on all scans.
Bear in mind that it is likely that "swollen sphincter of Oddi" will remain swollen after gallbladder removal. It is also possible that SOD is actual cause of most if not all of your problems. Think twice if it is appropriate to remove the gallbladder in this situation. If SOD remains, gb removal won't treat you...
Metabolic causes of fatty liver are some hereditary metabolic disorders, but also high tryglicerides, insulin resistance (diabetes type II). Malabsorption itself could cause fatty liver. The cause of fatty liver in Crohn's disease is malabsporption of certain nutrients and not Crohn's disease itself. If your stool tests revealed malabsorption than you do have malabsorption.
Malabsorption may be due to nonindaquate production of bile (liver disease but not likely in your case, I'd say), insufficient delivery of the bile into intestine (bile duct issues - what you have), pancreatitis (you may have recurring attacks of pancreatitis) or small intestinal disease.
CRP and other inflammatory markers speak for inflammation - either in the biliary system, liver or anywhere..so it is not likely that you have only some "functional disorder" of gallbladder.
Causes of high renin:
Addison's disease - insuficciency of adrenal gland
Renin-producing renal tumors
Urine test would show if you have kidney inflammation (one cause of elevated renin)
What is your blood pressure?
You should have complete blood work done ("chem 20" test - all main minerals, also vitamins)
Hormones: aldosterone, insulin
TNF - often elevated in autoimmune disorders
If your EF during HIDA was 0% and you did not fell any pain during CCK stimulation (?) than your gb did not contract at all - so it is possible that pain comes from bile ducts not gallbladder.
I hope you won't do something wrong in a rush.
Write down all of your current symptoms (any diarrhea?, paleness?, fainting?, numbness, tingling?, headache?...)
Then write down all positive results of all tests you've had so far. This will help you and your doctors to find original cause of your problems.
thank you so much Boron for your input. For a better (full clinical picture) to answer a few of your questions. Yes i do have Malabsorption proven on several Fecal Fat tests including but not limited to 72hr stool fat. Most chems have been normal except my always elevated (Alkaline Phosphatase). Yes during the CCK stimulation i felt extremely naussious, dizzy.extreme heat and pressure type pain in upper back and upper abdomin. my inflamatory markers most of been elevated consistently (CRP,Haptoglobin,Firb
my lowest vit&min have been extremely low (VIT-D) and also low Iron and zinc. All other more common problems have been ruled out , ie:Crohns, UC, Celiac etc.) During the Same time (day apart) i also had an MRCP which showed all Billiary Duct work Clear without any visible stones or sludge. I was informed by the Radiologist as well as my current GI that my Gallbladder was as if it was a dead organ doing nothing. Delayed filling and also Never emptying when supposed to. My GI and GP both now agree to have it removed. but im hoping that will alleviate some of my main problems or atleast regulate me some. meaning: i have chronic unpredictable diarrhea attacks with extreme pain. I am hoping it is all because of the nonfunctional GB. If removed ,yes i may fall inot the catagry of diarrhea after GB removal but atleast it would be a little more constant and regulated perhaps with daily use of something like a Bile resin ie:Questran,Colestid, Welchol etc) It is now beleived by my GI that my rare case is : my GB is not emptying when needed to digest and then when lying down all the Bile comes out from gravity which too little or too much can both cause diarrhea . Anymore input before i meet my new surgeon ?
My aldosterone has occasionally been low which was originally beleived to be the cause of the High Renin (by my Endocinolgist) but even when replacing with use of Florinef . Renin is still slightly high. Now with the latest GB findings the Endo now beleives i am having a Domino affect (very rare case) of the Kidneys attempting to compensate for so much liquid. I could not find anything on this thoery on the net. Since i am also a former thyroid cancer patient it was originally thought i had a hidden carcinoid ( all testing was negative for carcinoid and or another Neuroendocrine tumor) ( CgA =normal) all other endocrine markers normal and also ( Octreotide scan normal) etc. so now a simple thing like the Gallbladder seems to be getting the full blame from everyone causing a Domino affect on my entire system.
Low aldosterone, low cortisol (it would be worth to test) and high renin occur in Addison's disease (it's an autoimmune disease). This would go with low blood pressure, dehydration, hyponatremia anf hyperkalemia. Symptoms: frequent urination, tiredness, salt craving, dizziness.
Tests: blood: aldosterone, cortisol, renin, Na, K; urine: Na, K.
Adrenals may not function properly in hypothyroidism. You should check your TSH, *free T4 and *free T3 levels. Also thyroid antibodies TPO-ab and Tg-ab.
Hypothyroidism slows down many funcions in the body: peristalsis of the bowel, so it could also slow down peristalsis of the biliary system.
Also: what is your diet (food and fluids?)
I think you should write down the whole history this way:
1. Current symptoms - completely and exactly: where exactly is pain, triggers, relievers, is it constant, appears at night...spreads somewhere...? Constipation, diarrhea, bloating, stool changes..etc?
2. Current diet and meds you're taking
3. Complete medical history from birth, including positive results of all tests, all surgeries, injuries...and meds you've had.
4. Family history - important diseases in your close family members.
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