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chronic acalculous cholecystitis, SOD, biliary dyskinesia?????
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chronic acalculous cholecystitis, SOD, biliary dyskinesia?????

I'm a 34 year old female, mother of two (born in 2010 and 2012), BMI 19.5. I've had two episodes of severe biliary pain (following a 3 mile run and then a beer, each time) in 2.5 years. Upon further reflection, I have had mild stomach pain here and there in the intermittent time period but nothing that concerned me at the time. Both ER ultrasounds showed a normal gallbladder. My AST, ALT and ALP levels were elevated in Nov 2011 (149, 95, and 110), and last Thursday, my AST and ALT levels were elevated (188 and 105). I had a liver panel (and US) done less than a month after the attack in Nov 2011, and my AST, ALT, and ALP levels were 29, 46, and 126. Based on notes from ultrasounds, my common bile duct diameter increases during an attack but only by 1.5-2mm. I had a HIDA scan in Dec 2011, and my EF was recorded as 6%. CCK injection did not cause pain. Pancreatic enzymes and bilirubin have all been normal. Do these results seem consistent with SOD? From what I've read, the abnormal liver enzymes aren't generally seen with acalculous gallbladder dysfunction. Or, is that incorrect? Can SOD cause a low EF? Do I really need to have the gallbladder out and then experience more pain to identify SO as the culprit? I don't have severe pain daily, monthly or even annually, so I'm not inclined to have surgery. I had an appendectomy (with abscess post surgery) in 2010 two months after an emergency C-section; that was enough for me! On the other hand, whatever is going on is clearly not making my liver very happy, and I'm pretty sure I need that particular organ! Anybody in a similar situation? Any medical professionals want to weigh in? I have a GI appt next week, but I think I need a certain type of expert.
Avatar_dr_f_tn
Hi, the simple combination of biliary type symptoms, common bile duct dilation, and elevations of liver function tests, when retained stones have been ruled out makes a strong argument for type I SOD. The vast majority of patients will see significant relief of symptoms following an endoscopic sphincterotomy in this category. It is interesting that in many cases of SOD the symptoms are actually worsened by removal of the gallbladder as it was acting as a bellows or reservoir and masking the dysfunction downstream. Please discuss this with your GI specialist am sure he will provide further assistance. Regards.
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