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Narcotic pain killers and HIDA scan- false negative?
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Narcotic pain killers and HIDA scan- false negative?

I've been suffering from gallbladder like symptoms for about three weeks now – severe URQ pain that comes and goes (comes on after I eat, and randomly; most often at night and wakes me up) that radiates to my back and right shoulder, along with severe nausea that's almost constant and gets worse after eating, and intermittent diarrhea. I've been living on Gatorade, jello and chicken broth to dampen the symptoms, and have lost about 15 pounds. Obviously I can't live on those forever. Naturally this has lead me to attempting to learn more about what's happening to me, which leads to my question.

When I was in the hospital last week, I had a HIDA scan done. I've read that you're not supposed to take narcotic pain killers before having the scan done, and that not eating for 24 hours before the test can also lead to false results.

I had been receiving 2mg of dilaudid every two hours, phenergan every 6 hours, and had been NPO since admission (about 48 hours by that time). I had received a dose of dilaudid and phenergan right before they started the scan.

During the scan, the injection of the CCK brought on what sure as heck felt like a major gallbladder attack. On the monitor, it looked as though my gallbladder had hardly emptied at all by the end of the test. Enough so that the tech seemed sure that they had found my problem- until he looked at the counts. The ejection rate came back at 77%.

I'd like to think that the doctors knew what they were doing, but two of the three doctors on my case were downright abusive, completely disregarding my concerns and even accusing me of faking my symptoms when the scans came back normal.

Is it possible that my HIDA scan came back as a false negative?
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Avatar_m_tn
Yes, it is possible. Besides, % of gallbladder function does not necessary correlates with extent of bladder inflammation. Next - I answered in your other post - the stone may be in the bile duct or in the hepatobiliary duct - this would allow the gallbladder empty more or less normally, since the problem is lower - in the bile duct system.

Your symptoms, if they are real, are school example of gallbladder/bile duct disease.  

If you'll undergo operation, be sure that they will also check bile ducts for stones or stenosis.
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427550_tn?1203912164
Thank you very much for your replies!

The GI doctor I saw today seemed to believe that this was gallbladder related, given my symptoms and the fact that all the other tests had come back negative. He ordered another HIDA scan, but also said that given the nature of some functional problems (they come and go), that it may be entirely possible for there to be an issue that they might never catch on a scan.
He also gave me referral to a surgeon, saying that it might be worth removing my gallbladder based on my symptoms alone, but also based on my medical history and family history of gallbladder issues as well.

I'll be sure to mention the possibility of bile duct stones. Either way, I am just so relieved to have a doctor who's taking me seriously. I'm finally seeing some light at the end of the tunnel!
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228936_tn?1249097848
I had a HIDA scan on morphine and it worked fine. It showed I had a diseased GB and the morphine didn't make it worse during the scan . all the best
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Avatar_m_tn
As you probably know, there are two ways to investigte bile ducts: from "above" - with HIDA scan, or from "below - via upper endoscopy and ERCP. I don't want to specualte what is more appropriate in your case, this is just something you can discuss with the doctor.

If it will all come out negative, and you'll be said that it is a functional problem, take your time and investigate what it can be done in this case - maybe you can save your gallbladder. Functional problems sometimes go away - like IBS or so.
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427550_tn?1203912164
I've had an endoscopy (mostly normal results), but not an ERCP. I'll ask about it, depending on how the HIDA scan goes.

As far as surgery is concerned, I'm torn about it. I normally lead a very active lifestyle, and I dance. I know laparoscopic surgery doesn't cut into the abdominal muscles, but I'm still concerned about recovery time and potential effects on overall core strength.

On the other hand, these symptoms have NOT subsided. I have at least one attack a day, if not more. If I veer away from anything extremely low fat or bland, I can guarantee an attack. I've woken up every night from attacks, and haven't been able to get more than a few hours of sleep a night because of it. I can't go on like this. I don't want to rush into surgery, but I'll do anything at this point to be able to return to my normal active lifestyle.
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Avatar_m_tn
Gallbladder removal is considered as a minor operation.

The worth of ERCP is that the doctor can remove a small stone from the bile duct, if he accidentally finds it.

The problem after gallbladder removal is, that bile constantly leaks into intestine (from the liver) in an extent which can cause diarrhea.
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Avatar_m_tn
i have the same problems you have right now ive had these problems for a long time but its got really bad in the last three weeks, they gave me an ultrasound and i didnt have gall stones,the did an endoscopy on mt stomach and they didnt fined anything except my spleen was enlarged and my liver was elevated...i should be geting my results of the hyda scan today sometime, But my doctorrr doesnt think mine is gallblatter he thinks theres something wrong with my stomach....On Monday im going to get a Gastric Emptying test done on my stomach, and he thinks that is the problem i dont know if thats something you want to look into or not....Hope You Feel Better!
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