New User Question- Low Ejection Fraction

Hi There- I've been reading the posts as I am new to this forum. I have had upper right abdominal/pain under the rib cage for 2 mos now.Its pretty constant and gets somewhat worse after a couple of hrs after meals or fluids. Over the past year+ I do get extreme pain in the back and shoulder blade after eating meals such as Salmon, steak or burgers.
I am a 44 yr old male in pretty good health; I try to eat healthy.   Ultrasound was clear of gallstones.  Had the Hida scan last week.  I felt alot of pain and nausea when they injected the stuff that contracts the gallbladder.  Went to my GI doc last Friday- My gallbladder is operating at 6% ejection fraction. My GI doc is conservative- he said a surgeon would put me right on the table. He drew blood to check the biliary and liver enzymes as well as some pancreatic enzymes.
My questions are these:
1) He gave me the following drugs/supplements and wants to monitor me for a few weeks:
a) Ultrase (pancreatic/digestive enzymes)
b) a concentrated gel tab of peppermint oil
c) an Rx for a anti-spasmodic (waiting for Rx) couldnt read the name)

2) I have a high tolerance to pain but do not see this getting better- what are your experiences? Should I go for the surgery?

3) Do I need to be concerned about other issues such as Pancreatitis or Pancreatic Cancer- Breast cancer runs in both sides of the family- I understand that there can be some genetic links between the genes that cause breast cancer and those of pancreatic cancer.

4) What add'l questions should I ask my GP or my GI docs?

5) What add'l tests should I or do I need to ask for?

6) I have dealt with a disease called Still's disease (JRA) in a systemic/febrile form since my teenage years- that went away for about 18 yrs but recently re-appeared about 4 yrs ago (+RA factors; high sedrate)- could inflammations such as those contribute to this?  I took prednisone for about 6 mos approx 4 yrs ago but have been under control otherwise since then.

Your input appreciated.
-2207Lg


This discussion is related to Hida-scan ejection 21% - No Stones - Surgery?.

[CalGal]

With an ejection fraction that low, a surgeon would put you on the table. But the overall problem is in someone with just a low ejection fraction and no stones or sludge present, there can be issues after the GB is gone. However, at that level of EF, it may be ultimately unsafe for your overall health not to have the surgery. Pooling of bile in the GB can lead to stagnation of the bile and bacterial issues in some cases, in others, sludge and stones can form and lead to other unpleasant issues.

Fat in any form is going to be difficult for you to digest. I'd suggest if you're going to follow your doc's suggestions that you also stay on a very low fat diet.

You do need to be concerned about the possibility of pancreatitis. If your common bile duct is irritated in any manner (sludge ejected?) and begins to spasm it can lead to backup of bile and pancreatic fluids which can impact both the liver and the pancreas. Once that starts it can be difficult to reverse.

Ask your doc if he believes his conservative measures will change anything. Your GB isn't suddenly going to start working again, so why wait? I'm not a big proponent of surgery, but you don't have a lot of other choices. But you also need to realize that having your GB out may change your ability to process fats after the surgery. You may have to stay on a low fat diet to make sure you don't end up with bile-induced diarrhea. At the very least it might be a good idea to go low fat for many months after the surgery to try to allow your body to adjust to the change in bile output.

If you haven't had your liver and pancreatic enzyme levels checked, be sure to do so.