If he hasn't had a HIDA scan it would be impossible to say that his gallbladder is fine. In the old days, the standard test for gallbladder disease was an oral cholecystogram. The patient took eight pills in the evening and went in the following morning for a plain x-ray of the abdomen. The contrast was absorbed by the GI tract and the liver would filterit out of the blood and secrete it in bile. The gallbladder concentrates bile so it would visualize on the x-ray. If stones were seen floating in the gallbladder the study was abnormal. If the gallbladder didn't show up the patient was given sixteen pills that evening and x-ray repeated the following day. If it still didn't show up the study was read as abnormal. Thus, to have a negative study, the gallbladder had to be both free of stones and also functioning normally. Because 98% of the abnormal gallbladders had stones, ultrasound became the standard for diagnosing gallbladder disease. Unfortunately, patients with acalculous (non-stone) disease would have normal appearing gallbladders. In that era, we would periodically still obtain an OCG if we strongly suspected gallbladder disease. The problem with the OCG is that there were several other reasons that could cause the gallbladder to not show up. The HIDA scan was a good solution. In its original form, it was only useful to rule out acute cholecystitis. Rather than giving the patient a pill, a radioactive tracer was given intravenously that, similar to the oral contrast, is picked up by the liver and secreted into bile. Rather than having to wait overnight though, the tracer could be visualized in the gallbladder after only a few minutes and was much more reproducible. The main reason that the gallbladder wouldn't visualize was acute inflammation. When a stable analogue of cholecystokinin (CCK) became commercially available, a very useful functional test of the gallbladder was made possible. In the current HIDA with CCK test, the tracer is given and after the gallbladder visualizes, a standard dose of CCK is given. Repeat images are obtained and the amount of bile the gallbladder squeezes out in response to the CCK can be calculated. Depending on some of the specifics of how the test is done, a normal gallbladder will expel more than 35% of its contents in response to the CCK. There should also be no reproduction of typical symptoms in response to the CCK. You didn't say how old your son is but abnormal gallbladder function (gallbladder dyskinesia) has become the most common indication for gallbladder removal in the pediatric population. Hope this helps.
Dr. I had the HIDA scan and my gallbladder never showed up so they ended up giving me small amount of morphine, don't know why, and I called for a ride. My pain has been all on the left but Barium swallow test showed nothing wrong. They are thinking now that is is the gallbladder. I'm 47 and sonogram showed dissention and sludge. Surgeon wanted to be sure and now thinks it is the gallbladder. Always have discomfort on left side since it all started in Jan. but no severe attacks since end of Jan. Ever had patient have left side gallbladder pain?
This is probably beyond the expertise of the pediatrician. I would suggest that you seek the opinion of a pediatric gastroenterologist. You shouldn't need to be talking the doctor into getting standard, indicated studies. I don't know why anyone would look at normal labs and determine that a gallbladder was not the source of the problem.
We ended up switching pediatricians and got a HIDA scan ordered. Results showed 91% ejection rate. Radiologist said everything looked normal. It sounds to me like this is really high? Couldn't this be the cause of all of his symptoms? My son is in pain always and worse when he eats and drinks.
Did he experience any of his typical symptoms when the CCK was infused? This is turning out to be a better predictor of symptom resolution with cholecystectomy than the ejection fraction, especially with extremely high ejection fractions.
Right after the CCK was put in his stomach started hurting again. Later that night he was in horrible pain and it's been worse ever since. His GI at OHSU won't do anything for it. They said that nothing points to gallbladder disease and the information on this has never been validated. Is there any research that I could bring to their attention?
The Cleveland Clinic published data a couple of years ago that showed that duplication of symptoms with CCK is a better predictor of symptom resolution after cholecystectomy than ejection fraction.
My son is eleven and has had pain in the URQ on and off for over a year. It's been constant since December. All his lab work has shown nothing abnormal, which convinces his pediatrician that it's not his gallbladder. I pushed for an ultrasound which also showed nothing. How can I get the pediatrician to look further into this? My son has lost 20 pounds already because it causes so much pain to eat or drink anything. Feeling pretty desperate to find a solution.
Well my son has spent yet another visit to the hospital. He keeps getting severely dehydrated. His pain has more than increased and moved up his back now. He is vomitting green, nauseous, and dizzy now. OHSU in Oregon has sent him home refusing to say anything about it being his gallbladder. The Dr was even defensive and combative when I suggested high EF. I'm officially desperate for help. I need a surgeon that will help. Do you treat children at your clinic?
Non-visualization of the gallbladder on HIDA is grossly abnormal. The morphine is given to cause spasm of the sphincter of Oddi and induce reflux of the tracer into the gallbladder. It would be hard to argue that this was not a significant finding.
I don't aim to criticize any medical institution in this forum but you are not the first in the forum to have frustration over biliary dyskinesia while being treated at OHSU. The other lady was an adult and was seeking other institutions for treatment. She ended up at Indiana University and was quite happy without having to travel all the way across the country.
Thank you so much for explaining that so clearly! I have now scheduled surgery for next Tuesday morning. Hope to feel much better in a month or so. Thank you again!
We finally convinced the surgeon after two HIDA scans and reproduction of his symptoms that he needed the cholecystectomy. My sons physcial condition was so weak and ill that his recovery will be a huge challenge. All of the classic gallbladder symptoms have diminished. However, he is still left with a constant pain that is worsened when he eats or drinks. I'm baffled and the doctors are only offering behavioral therapy. I can't help but wonder if the inflammation that they did find in his gallbladder either contributed to or was caused by something else. Are there any other medical causes we could be looking for? The only test or scan we have not done is a cat scan.
Thanks for your help
It might be a little quick to judge the final result. Patients that continue to have RUQ pain post cholecystectomy are frequently shown to have an identifiable problem. Spincter of Oddi dysfunction is one possibility and relates to a more generalized motility disorder than just the gallbladder.