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Avatar universal

Gallbladder seems fine but PCP recommends removal

Had a full GI work up: CT scan, Hida scab, ultrasound, endoscopy, blood and stool tests.  A few years ago I also had an endoscopy, colonoscopy, x-rays, and blood and stool tests.  Results of all the tests do not show any problems with my gallbladder, and also no gallstones.  There is some family history of gallbladder issues.

I have acid reflux for at least the past few years and, per my GI at the time, slow motility in my digestive tract.  Per my current GI I may have IBS also.  Most of my symptons were diarrhea, stomach aches/discomfort, and soft and black stools.  Prilosec has made these symptons bearable and has helped relieved them to some degree, however still have some of the above symptoms and gassiness.  In truth, I never really felt that I had classic traditional heartburn or had problems eating certain foods, such as I could eat spicy foods and not have much change in my symptoms.

However,  in the past year I have developed additional painful symptoms:
Alternating pain between my right chest muscle and right under my right rib, like a throbbing or someone grabbing me under the rib - this initially started off as pain in my right upper back, but now it's rare to have the pain in the back.  The pain definitely tends to happen after eating, but also when laying down to sleep and when waking up in the morning.  Pain killers, such as Advil and Vicodin do almost nothing to relieve the pain, however once I tried Vicoprofen and it helped a little, but this is a very potent drug and it felt very addictive as I enjoyed its effect on me, so this drug is out.  I also have nausea, a bitter bile taste in my mouth, a feeling of fullness due to the nausea, some heartburn.  Fatty/Oily foods tend to inflame the pain the worst, but eating in general tends to aggravate it.  The pain is debilitating as I can't concentrate, am ultra sensitive to any noise or stimuli, and in general am not able to function.

My PCP says I have classic gallbladder symptoms and wants to remove the gallbladder.  A GI and a surgeon that removes gallbladders will remove the gallbladder if I insist as I'm at my wit's end, but they think it could be musculo-skeletal, which my PCP says doesn't make sense as I get the pain after eating.  After discussing this with the GI and surgeon, they agree that musculo-skeletal doesn't appear to make sense either.

I will be seeing another GI for a second opinion, but at this point I'm ready/willing to have gallbladder removal surgery.  Thoughts or suggestions on this?  Thanks so much!
122 Responses
Avatar universal
School example of gallbladder or biliary tree disorder. When you eat fats, gallbladder is contracted to expell bile, which is needed to digest fats. If there are stones/sludge in the gallbladder, this causes pain on the right side under the rib cage. Ultrasound is not accurate enough to detect small stones. The most reliable test of gallbladder function is a HIDA scan which shows "ejection fraction"  of bile during gb contraction. HIDA may also show eventual problems in biliary ducts.

Black stool, unless you are taking iron pills or Pepto-Bismol, is a sign of GASTRIC (stomach) BLEEDING. Burping/upper abd bloating/heartburn is from excess gastric acid, mostly caused by H. PYLORI infection. So you should also have a breath test for H. pylori.
Avatar universal
I wouldn't jump into removing the gallbladder.  Especially if there are no signs of stones.  I would seek another opinion and another HIDA scan if you feel strongly it is your gallbladder.  Like Boron said it will show if it is functioning. Even if it's not functioning well and there are no stones you need to rethink surgery.   Removing often does not relieve the symptoms, then you are just left with an unnecessary surgery, scars and nothing gained... and in a lot of cases chronic diarrhea.
Avatar universal
Beside stones, there may be a "biliary sludge" in the gb, which is a kind of pre-stones bile - stones will eventually develop from it. Ultrasound often can't detect this sludge. CT is much better for detecting sludge, but even this is not entirely reliable. HIDA is most reliable, but it actually doesn't show stones, but only gb function.

So, it is possible that someone have lowered gb function due to stress or "unknown reason". Stress usually affects both ballbladder and main biliary duct. Now, when you remove gb, biliary duct still remains in andcontinue to cause pain. Sometimes this may be resolved by incision in sphincter of Oddi, but not always and it has considerable risk.

If gallstones won't be find by any investigation, I agree that full investigation of biliary tree (by ERCP I guess) should be done before any surgery.
Avatar universal
If you're willing to try something 'off the beaten track' before you head for surgery, consider contacting a PT or other professional who is well-trained in Barral visceral manipulation techniques. As crazy as is sounds, it can and does work. You can contact the Barral Institute and talk to them about a referral to an experienced person if you'd like to talk to a 'human being' instead of checking the website.

This is not 'schlock' treatment. The techniques were developed by a French osteopath and are used extensively in Europe. They're only becoming more 'known' here in the U.S. as 'the doc' is becoming more well-known. I believe it was a year ago (?), he was named one of Time's 'Man of the Year,' so I think that places him in very respectable company.
Avatar universal
Thanks for the insights.  My PCP said that sludge is probably the culprit.  I'll ask about checking out the biliary duct as all the tests have not shown any gallstones and the gb appears to be working fine.

The endoscopy I had was an upper endo, so not sure if the bile ducts were checked out.  I'll ask my GI to see what he thinks.
Avatar universal
ERCP is done during upper endo, but only when necessary. They fill contrast into your biliary tree (from the duodenal opening of bile duct) and then make x-ray pictures. If eventual disorder is find, sometimes can be repaired just during that procedure. Investigation can reveal stones or stenosis in biliary duct or in the area of sphincter of Oddi (exit of bile duct).

Non-invasive alternative of ERCP is MRCP. They simply make a MR pictures of your biliary tree. Maybe this MRCP can also show, is it sludge in your gallblader or not.

What you want to know first is: is it sludge or not. So, MR or CT can show this. If it is sludge you can expect ongoing problems, if you keep gb. The next thing you want to know, is if your biliary duct, especially its last part (sphincter of Oddi) are working properly. This may be checked with ERCP and sphincter manometry, which I believe it can be at the same time.

All this is a delicate matter. Above suggestion to contact someone experienced may be worthy for you.
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