MRCP (MRI) and ERCP

[Jax555]

Question about these tests, my Ultrasound and CT scan were normal...only test that showed something for me was my HIDA scan which showed a normal EF of 52% but i had severe biliary dyskinesia (so took my gallbladder over 2 hrs to drop down the ducts into intestines) my GI thought Gallbladder should come out, surgeon said no that he thinks it might be a problem with the ducts... they are now sending me for MRCP tomorrow... can there still be stones or something blocking the ducts even though nothing showed in previous tests?  I have been in alot of pain since May, (RUQ under ribs) mostly after I eat, severe nausea, vomitting and have lost 35 lbs bringing me to my lowest weight of 110lbs.  I am just thinking if its in the function of gallbladder will this MRI really show anything, My GI is sending me to another GI that speacializes in ERCP and manomentry but takes forever here in Canada so dont go until January.  Will they still do an ERCP if MRI is clear... I really just want to feel normal again..its taken away from me playing sports and really just living my normal life.  Thanks in advance.

[warrenl7372]

Did you end up having your gallbladder out?  I've had 2 HIDA scans, first took over 4+ hours and common bile duct was still not visualized, could only very faintly see the small intestine (they said questionably faintly seen after 4 hours).   They wouldn't do the ejection fraction.    I then had ultrasound and MRCP which were normal, didn't show any obstruction of the duct.   I had a repeat HIDA today, again could not see the common bile duct or intestine after 3 3/4 hours, so they finally did EF (after radiologist made me sign a waiver - it was stupid, he wanted to wait 4+ hours just to avoid being sued so for difference of 15 mins I had to sign a waiver not to sue!).   They infused the CCK, I had increased pain and nausea, but my ejection fraction was 94%.   I don't know if it's possible that my body isn't making CCK on its own but when it's administered my gallbladder works fine, or if it's a sphincter of oddi problem - I have an immune disorder and chronic pain and have been on opiate medication for 15+ years, and had read they can cause SOD dysfunction/spasm.    I have missed 2+ weeks of rotations already due to this and am getting so frustrated.  I'd found that both the double Proton Pump inhibitors (and double H2 blockers) that my dr gave me and a gluten-free lactose-free diet have helped, pain and gas were much worse before those.   I've been on very low fat diet, barely eating anything lost 15 lbs so far.

Thanks for any help or suggestions.  Sometimes I've wondered if there's also a problem in lower GI since I've had constipation issues since I was 4, and had been doing well before all this but now often need stool softeners in order to go at all and it's still little pieces when I go, I don't know if there could be a partial bowel obstruction.   When I spoke to the nurse at my GI, they said he still thinks it could be the gallbladder, and I may need to either have it out or exploratory surgery.

[hmp123456]

My doctor did mrcp today with no dye. Is dye more visible should I have insisted?  

[gmarie626]

Jax, I am having similar problems. Had a HIDA scan (within normal limits), sonogram (normal also) My GI dr. gave me a prescription for spasms also which made me feel worse.  I don't want to eat but do because I know I have to.  I do not get cravings anymore.  I get this off and on upper right abdominal pain/discomfort daily.  My surgeon feels it is a problem with a sphincter muscle in my gallbladder not working properly.  ?? He said to get my GB removed.  But my GI and PCP doctors say not to.. I am 45 yrs old and have been relatively healthy until now. I have lost 25 lbs. and cant afford to lose any more weight.  I am scheduled to have a CT scan this week. Not sure what that will show if it's a muscular problem.  What is a MRCP? I have not had that test done yet?  I also feel like I'm being bounced around with no results.  Are you feeing any better??

[Jax555]

So saw the 2nd GI today that my first one wanted me to see, and she fully believes that  should have my Gallbladder removed...she said she doesnt believe all my problems are caused my SOD that she thinks the biliary dyskinesia is the problem and i will feel much better after... anyone had same thing and how did you feel after?  I feel like a ping pong ball being bounced around.

[Jax555]

Well MRI was normal... which i kinda figured it was going to be,  if its something to do with the function of either gallbladder or ducts, they can probably take a million pics and nothing willl show, i dont know what they will do now... HIDA scan showed the severe biliary dyskinesa but all other tests normal CT, U/S and and MRI.  What would they do next, dot ehy do anything for a lazy gallbladder or could it still be the ducts function?  My appt isnt until January now with new GI :-( it seems like decades away.

[CalGal]

They would give you an anti-spasm med to try to establish whether or not the discomfort may be coming from spasms found within the biliary tree. In some cases, pain can be due to spasms of the sphincter of Oddi or in the common bile duct. That is the basis for SOD, which is one of the things  that the ERCP with manometry would be used for.

[Jax555]

Hey, they did an MRCP today without contrast will that still show if there is small stones or something blocking?  Just want them to figure out what to do as since they know now that the Gallbladder is severely delayed emptying into ducts now just to find out why lol.  Minor details.  Hopefully they can figure it out through non-invasive procedure.  Just have almost had it with the waiting game, if I am not waiting for another tests its them passing me to another doctor as they are un-sure.  It's getting tiresome to say the least. the surgeon and my GI now seem to think its something to do with the ducts so hopefully when I see this other GI she will have my answers.
  
I am on super low fat diet when I can eat...thats probably why I have lost so much weight, if i have super nausea or vomit I cannot even stand the thought of eating, they gave me anti spasm drug but its more for colon and IBS symptoms (dont even know they gave this to me to be honest) doesnt work.  I am just trying to be patient now and wait to see what new GI says... of course my luck the HIDA scan was half normal and half abnormal just when ya thought they finally figured out what was causing it all, I get sent back to square one..

[CalGal]

Jax, the HIDA scan and the ultrasound are decent tests, but the MRCP will allow the docs a closer look. Yes, there could be sludge or changes happening in the common bile duct or elsewhere that can not be seen with the ultrasound. So be glad the doc ordered an MRCP. MRCP is non-invasive.

It will depend on what all your symptoms are and what the MRCP shows as to whether or not they do finally go forward to the ERCP. But I'm glad the manometry was mentioned. Manometry should be done if they want to check the pressure at the sphincter/ducts.

Are you 'doing' low fat as far as diet? And has an anti-spasm med been tried?

[Jax555]

anyone?