wildly different HIDA/CCK results

[dave338]

I am a 31 year old male who has had RUQuadrant discomfort for years.  At the request of my primary dr, I had a HIDA/CCK scan done which showed an ejection fraction of 14%, which combined with other factors led to a diagnosis of biliary diskinesia.  In considering surgery, I requested a repeat of the HIDA/CCK scan, which was done 3 weeks later and now showed an ejection fraction of 86%.  My doctor feels that this is further evidence of my need for a laparascopic cholecystectomy, while I feel uncomfortable with two wildly different results.  My symptoms are consistent with cholecystitis - bloating quickly after meals, nausea, RUQ pain radiating consistently to my right shoulder blade area, etc.  Are the two HIDA scan results a reason to doubt their accuracy, or good evidence of chronic cholecystitis?

[CalGal]

Dave, IMO - and I can only speak for myself - I'd be looking at this and wondering if what might be going on would be something like spasms of the sphincter of Oddi. That's the muscular opening to the duodenum and it can be problematic. In some people it appears that spasms of this sphincter (sphincter of Oddi dysfunction, SOD) is only 'uncovered' after the gallbladder is removed. When those people continue to have problems and docs can't find another answer, they'll typically look to the sphincter and the biliary system. If they suspect SOD, they'll do and ERCP with manometry to verify the diagnosis - which is made by finding out if the pressures in the sphincter/duct (common bile duct) are elevated.

It would appear that in some people it's not the GB at all that's the problem, it's the SO.

The reason I'm speaking up is the in people with 'symptoms' of GB issues, but with the presence of no stones/sludge, but with only a lowered EF - or a screwy EF - it seems as though you read about them more often on the boards. They're the ones that seem to report persistent problems after surgery. Not EVERYONE of those people has problems, though, you need to understand that. The people who do 'fine' aren't posting here or on other boards. It's just the persons who are having post-surgical problems.

[dave338]

I guess I'm a little fuzzy on this - is it still likely that the gall bladder is dysfunctional and should come out, or would fixing the issue with the SO also possibly fix the problem with the gall bladder?

[CalGal]

Okay, here's the problem, when CCK (a natural hormone in the body that does a lot of signaling) is released by the body in response to fats in the diet, it's supposed to cause a coordinated response that causes the gallbladder to contract and release a measured amount of bile. At the same time, the sphincter of Oddi has to open so that the bile from the bile duct and the bile in the common bile duct can flow into the duodenum. So what's being measured as an ejection fraction could be compromised if there's a 'back up' in the common bile duct due to a malfunctioning SO.

And the question really is, at times, is the GB not contracting for whatever reason - is that's what's causing the low EF, or are the pressures in the SO so high that it's effectively 'closed' and causing back pressure and lack of flow to the duodenum and a low EF.

Does that make sense?

I don't think at this point anyone can definitively say whether or not when you get screwy readings from the HIDA scan it's due to the gallbladder or ? But when you do get 2 widely different readings, if I were you I'd really like a good explanation from the doc. I'm not you Dave, and I can't tell you what to do, but do yourself a favor and talk to your doc frankly. I'd hate to see you end up with problems after what should be a fairly routine surgery.

'Fixing' the SO can be tricky and to find out if the SO is the problem takes a fairly invasive procedure - and ERCP with manometry.

I don't mean to put obstacles in your way, but I'd like you to be armed with knowledge when you talk with your doc.

[CalGal]

Dave, have you tried following a low fat diet? Does it help?

[dave338]

Thanks for the explanations - my dr is aware of my concerns and seems to think that the two different results are symptoms of a malfunctioning gallbladder, but is going to order some bloodwork to check on elevated liver/pancreatic enzymes to see if there's any indication of SOD.

As for a low-fat diet, it has never really made much difference at all.  In fact, a few days of true dieting has made things worse a couple of time.  Could be a coincidence, but that's how I remember it.

Thanks again,
Dave