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MRCP & 2 HIDAS: Need Advice


I'm 30, and a medical student and I've been sick for the past 6 weeks (with the current episode, I've had these before).   I had a week of what the dr thought was viral gastroenteritis, with fever, nausea, vomiting, diarrhea, abdominal pain, but now thinking it was just the start of this problem.  After 5 days vomiting/diarrhea stopped but I had constant nausea and loss of appetite and abdominal pain.   I lost 10 lbs in first 2 weeks, have lost aother 5 since then.   After 3-4 weeks, I was at a bridal shower and 1-2 hours after eating (pasta with cheese, cake, etc.) got really really bad abdominal pain, gas, nausea.    Prior lab results had shown a UTI so I was given a week of Cipro starting the next day.   Later that week I started getting back pain radiating to between my shoulder blades, my dr worried it could be a kidney infection and I went to the ER but they didn't find anything.    Later I realized it may be a gallbladder issue since this and previous attacks have always started after eating fatty food.   I had an upper endoscope, only showed mild gastritis in the stomach, but still waiting to hear biopsy results.    I had a HIDA scan last week, and after 4 hours, they couldn't see the common bile duct and said could 'questionably very faintly see bowel'.  They thought I had an obstruction, but I had an ultrasound which was normal, and yesterday an MRCP which was normal.    They repeated the HIDA today, and again after almost 4 hours could not see the common bile duct and could not see the intestines at all.   I had to sign a waiver for the radiologist to ok giving me the CCK, he wanted to wait even longer to try to see the intestines.    I really thought my Ejection Fraction would be super low but instead it was very high - 94%.   I don't know if my body could not be making CCK on its own and if it's given exogenously the gallbladder works, but otherwise does not make it, or if it could be sphincter of oddi.   Originally my abdominal pain seemed more diffuse but in the last 1-2 weeks it's localized to the right upper quadrant and I feel a constant pulling/pressure there and dull pain (though I'm on strong pain medication for chronic pain, which I've been on for 15+ years - I read that can cause SOD dysfunction).  I had had some lower quadrant pain too, and have been having a lot of constipation which I've had off and on since I was 4 but had been doing well with it before this all started.  Now I usually need to take stool softeners in order to go at all and it's still usually small pieces (like rabbit pellets).   I don't know if there could be 2 issues, one with the motility/bowel issue and one GB issue.  

  I'm waiting to hear back from my GI (frustrated because they were supposed to call me tonight).    Does anyone have any ideas, why on 2 HIDAS the radioactive material would not drain into the common bile duct (GB was seen quickly, and got large with the tracer, it stayed large but just did not leave the common bile duct or show the intestines), but then the EF was really good.   The GI told his nurse that he thinks it still may need to come out, or I may need exploratory surgery.  I'm at the end of my rope, I've missed 2+ weeks of rotations for school and can't afford to keep missing if nothing gets resolved.  I will say the double PPI & H2 blockers have helped, and also started gluten free & lactose free diet around the same time, I noticed the gas & pain seemed much worse after eating gluten, so both those things have helped.    I have an immune deficiency, and also tend to have a lot of inflammation.  My father had his GB out and became septic, he also the year before had chronic appendicitis which caused adhesions and bowel obstruction.   I don't know if there's a genetic component, but we have had a lot of the same medical problems.

I don't know what next step to take, I hope I can find a surgeon to do exploratory surgery - I'm just desperate to get better and back to school.   Thank you for any help or advice you can provide.


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168348 tn?1379357075
Hi - just saw your post today .. what did your GI suggest?  Please stop back and keep us posted.  Hope you are able to figure out a gameplan.

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Avatar universal
Hello and hope you are doing well.

Understand your predicament.
For SOD there should be jaundice. Sphincter of Oddi Disease or Sphincter of Oddi dysfunction is a rare condition. It can cause an obstruction in the common bile duct and consequent symptoms of abdominal pain and jaundice. Abdominal pain is the most common symptom; less common symptoms include nausea, vomiting, fever, chills, and diarrhea. These symptoms can come and go, and can be mild one time and severe the next. So, before it progresses to more severe complications of hepatic failure, it is diagnosed, because of its presenting symptoms.

I would think more in terms of an inflammatory bowel disorders like diverticulitis and crohn’s disease can produce similar symptoms. Here the walls of the intestines are swollen. Amoebiasis is another infection, which can cause similar symptoms. Blood tests will help detect infections, besides stool examination which will reveal fat malabsorption. Colonoscopy and flexible sigmoidoscopy are procedures which are used to study the whole colon for infections and inflammations. Bacterial overgrowth is tested with a breath test. Please discuss this with your consulting doctor when you happen to meet him.

Hope this helped and do keep us posted.
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