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HIDA scan shows my gallbladder is emptying at 2%

Hello Again!

My dr. said that my HIDA scan result shows that my gallbladder is emptying at 2%, plus I have a 1.3 cm polyp on it (which showed up in the ultrasound).  Should I have my gallbladder removed if a surgeon suggests it?  I think I should.  Just trying to get other opinions.

Thanking you in advance.  
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Avatar universal
thank you for helping me understand a lot of my questions about my HIDA showing 3% GBEF, and prefertial filling of the GB. I also have mild inflammation and some inflammatory changes in my right paracholic gutter- My appendix is fine. I just scheduled my GB removal. I feel a little better now, especially know that the manonmetry(?) test is a bit risky- I was wondering if they should order it... NO thanks! Do you know why the gall bladder would preferentially fill?
I am glad that you are all doing ok.. any updates?
Thanks
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Avatar universal
Please post your question as its own post because this one is so old.
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469934 tn?1333135282
Hi Susan:

I'm so sorry you are suffering.  My understanding is that an ejection fraction rate under 35% means that your gallbladder is NOT functioning properly.  It could be related to any number of things including disease or defect.  They have to draw the line somewhere and, from what I've read, at 35%, something is usually wrong.  Whether your GI will remove your gallbladder is really up to both of you.  I was suffering so much that I was willing to take the chance and begged to have my gallbladder removed.  I knew that it might not help and that it could make things worse but on the off-chance that it cured my symptoms, for me, it was worth the risk.  It's a tough choice.  My symptoms were better for a couple of days and then I got much worse.  Two years later, I'm still suffering but at least I now have decent pain management.  If I knew then what I know now, I would have asked for an Endoscopic Ultrasound before having my gallbladder removed.  If you have any questions or if you go ahead with the surgery and need any support, don't hesitate to send me a message or a post.

All the best to you and yours,

Sam
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1481388 tn?1287608454
I just had my Hida Scan and was able to get my ejection fraction which is 33%. I have had pain in my right side and my back/under my shoulder blade. This has been going on for months I have an Ultrasound, Ct Scan, MRI with contrast, all were normal. I was referred to a new Gastro Dr and he did this Hida Scan. So my question is what is normal????From what I have read anything above 35%. So is 33% mean thaat my gallbadder is bad??? I am really getting tired of all the pain and really tired of all the test.

Any advise from anyone!!!!

Susan
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756668 tn?1287225387
Happy to hear you are doing well!!!  
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Avatar universal
Hi Sam!

Thanks for asking.  I am 100% better - now I  can eat anything I want - which could be a bad thing as far as gaining weight is concerned.  :  )  I appreciate you keeping in touch, and hope you are doing great as well.

Karen
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469934 tn?1333135282
Hi again:

I'm just wondering how you are doing.  Are you still doing well?  Have any of your previous symptoms returned?

All the best,

Sam
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Avatar universal
You too, thanks!
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Avatar universal
No gallstones showed up at all - just a lot of inflammation, and it turned out that what they thought was a polyp was actually an inflammed lymph node.  Hopefully you're doing well too.

Take care!
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469934 tn?1333135282
I'm so glad to hear that both of you have done well post-cholecystectomy!  Take good care of yourselves.  Feel free to write if you have any questions or concerns that I might be able to help with?

All the best,

Sam
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Avatar universal
Did you also have stones or not? I had mine taken out on May 22nd. Although the first scan revealed no stones, and the second only one stone, it turns out that my GB was full of stones and very inflamed.

Glad to hear you're doing so much better. Congrats!
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Avatar universal
Hi Guys!

Sorry it took so long to respond Banned 1, just trying to recover.  My head is spinning from all of the information above!  Thank you all.  I had nausea after every meal but especially after fatty meals, heartburn, and bloating.  Also, after an endoscopy, I was diagnosed with gastritis which I have read can be caused by a bad gallbladder.  My ejection rate was 2%, and they only saw the 1.3 cm polyp - no stones - during the ultrasound.  I had my gallbladder removed on May 11th and have been fine since!  The pathology report revealed severe chronic cholestitis - so my gallbladder was definitely not happy.  :)
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469934 tn?1333135282
You certainly have an interesting take on these subjects.  I wasn't aware that the scientific community at large had decided whether SOD caused gallbladder dysmotility, low ejection fraction or even pancreatitis OR if these problems caused SOD.  

I also thought the method of removal (open versus laparoscopic) was responsible, in part, for the drastic increase in problems post-cholecystectomy.  In some schools of thought, Post-Cholecystectomy Syndrome wasn't nearly as prevalent prior to laparoscopic method.  Surgeons could actually see what was going on inside and fixed it, versus removal of the organ alone.  

Thank you for taking the time to enlighten me.

All the best,

Sam
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Avatar universal
To answer your question, Sphincter of Oddi Dysfunction CAN be a cause of low ejection fraction (one of the numerous possibilities which can). In fact, it's suspected that many who show up with post-cholecystectomy syndrome might have actually had SOD to begin with. (Others suspect that nerve damage at the time of removal can cause the syndrome). Because there's usually no definite testing for SOD beforehand (MRCP, ERCP with manometry) this is still a question that is very much in the air. Given the occurrence of SOD (it's somewhat rare), the possible complications of exploratory procedures (ERCP can lead to pancreatitis), and the cost involved, all in relation to the value of the organ itself (or rather, any quality of life issues at stake), is it any wonder that these tests aren't administered?

Unfortunately, the fact is that the gallbladder hasn't been as thoroughly studied as it could have because it's considered a vestigial organ, much like the appendix (which actually serves as part of the immune system). "Trouble with it? Yank it. Why bother trying to fix it, you don't need it!" Unspoken with "why bother to fix it?" for a long time was "why bother to understand it?" This is why it's hard to know for sure in some cases whether a low EF is caused by the gallbladder itself failing, or whether it's something down the line. Of course, the growing knowledge of SOD makes it clear that a greater understanding is warranted, particularly because there are different types of SOD.

(Side note: a study I read recently indicated that people who had no stones and showed ejection fractions above between 17% and 35% were less likely to experience full symptom resolution after removal. This is the only study I've seen like this, however.)

Gallbladder dysmotility is exactly that: gallbladder dysmotility. Why it happens? Again, don't know. Nerve issues affecting multiple organs? Infection? Tissue damage to the gallbladder? Inherent weakness because it's a vestigial organ (i.e., it just craps out)? All of these? Usually no way to tell until surgery time, and even then...

Because of the way the HIDA/CCK scan works, it's hard to tell what exactly is causing the problem at times. The test tells you is whether bile is getting in, whether the gallbladder is extending, and how fast bile is exiting. If a gallbladder has problems emptying (as opposed to or in conjunction with filling up) then the problem might be gallbladder dysmotility, undetected stones, microstones and sludge, polyps, sphincter dysfunction... This all leaves you wondering "Is the problem in the GB, per se, or somewhere down the line? Other tests (ultrasound, cat scans, bloodwork, and if called for, MRCPs and ERCPs with manometry) should help clarify this, however, and should help point out the problem. Of course, not all of these tests are done, and for good reason: An ultrasound, bloodwork, and a HIDA/CCK is usually good enough to make a call as to whether you're dealing with regular dysfunction or something other. Usually. A good gastro will be able to tell when more testing is really warranted. A gastro in a medical learning facility will very likely want to be super exact and so they'll probably do a bunch of testing anyway. (I kid, but only somewhat.)

It's important to remember that in most cases, removal of the organ will result in symptom resolution. In some cases, it won't, since in those cases it wasn't the organ causing the problems to begin with. This is where things get tricky, and it is why recently (last 10 years or so) some began asking whether organ removal is warranted in all cases. When a cause for the dysfunction is not immediately obvious (as is the case with stones, polyps), it's usually considered safe to keep the organ in, since it may well be the case that the gallbladder is really NOT the problem, and it could be something other. (Imagine being able to solve "gallbladder" issues without removing the gallbladder? Kinda nice, eh? Pizza and chicken wings with blue cheese followed by cups full of Alfredo sauce all around!) But just because it's considered "safe" in most cases doesn't mean it is. What if there's an infection?

In the end, the answer isn't always clear-cut. But if I were a gambling man, after getting the opinions from a couple of bookies... err, doctors, I'd bet on the side of organ removal, if that's what they were telling me.
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469934 tn?1333135282
Hi Gnorb:

I found you comments to be polite, honest and informative.  I did not view them as combative at all.  I think it's wonderful that you are here, trying to help.  That's why I'm here, too.  =)  Could you please clarify?  Are you saying that Sphincter of Oddi Dysfunction CAUSES a low ejection fraction rate or CAUSES a gallbladder dysmotility?

All the best,

Sam
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756668 tn?1287225387
I had mine taken out..the gallbladder is on march 31 st..was the best thing I have ever done;.  I had hardly to none complications. All healed and back to normal.  

I agree if left untreated when a gallbladder is not functoning correctly...for those who waited an had it removed causes many complications in the future.  Your doctor knows best!  I only had i attack..and that was enough for me. I stayed on my low fat diet for aboutn 2 months and never had problems again...but I decided removing the gallbladder was the best decision for me..Like I said..most people are terrified or just hearing all the bad stories..but I am not one for writing a badf story..mine for now has a happy ending.  

Wishing you the best of luck.

I too like gnorb said believes in not removing an organ....but you can live without it, and once again your doctor knows what needs to be done.  remember with it functioning so poorly, the longer you wait...well you can just imagine.  When you talk to your doctor just tell him/her what your feelings are..I had many.  But I guess I made the right choice!  
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Avatar universal
Note: I, like you, fully support yanking out the organ if issues are arising, stones or no. The points you bring up are quite valid, so the following evidence as to why it may not be as dangerous as you suggest is presented with the utmost respect.

Long story short: In cases where ejection fraction is below normal and there are no stones, there is between a 90% - 98% chance of symptom resolution with gallbladder removal, depending on who you ask. The only contraindications are nausea and vomiting, which indicate the presence of another motility disorder. (80% resolution rate in this case, as per some studies I've read.) Does @quickkaren have symptoms? Probably, hence the testing. Are they caused by the gallblader dyskinesia? Maybe, though if dyskinesia is really the only issue, then it's generally considered safe to leave it there until it starts becoming problematic. (This is as per every doctor I've spoken to about this, and just about everything I've read on the subject. The rules are different when dealing with stones vs. dyskinesia.) Still, just because it's safe doesn't mean it's comfortable, and I fully support yanking out the organ if issues arise. Heck, I'll be doing the same soon.

Long story long: The problem with acalculous gallbladder disease is that due to the testing methods normally employed it's not always clear what may by causing the dyskinesia. If a HIDA/CCK's done, there's a good chance that an ultrasound was already done not showing stones. (If stones show up that's usually declared the problem and testing ceases.) I was working on that assumption, and on the assumption that no other tests (example, MRCP, EGD, etc) were done which indicated anything else.

With those assumptions in mind

* Biliary colic due to gallstones? Since there are no gallstones, then this, by definition, can't happen. Biliary colic can happen, however, though it may or may not be caused by the gallbladder itself. (Sphincter of Oddi Dysfunction will display this symptom.)

* Nausea/vomiting? Absolutely, I've felt it myself, having had the same condition. (EF 19%.) It should be noted that in the case of dyskinesia, nausea and vomiting are possibly indicative of more global motility disorder. Some contend that a slight delay in gastric emptying can be caused by a bad gallbladder, which would mimic other motility issues; these would be more likely to cause nausea/vomiting in cases when there WASN'T a gallbladder "attack" going on. It can be the other way around, however, the motility issue causing the gallbladder to fail. Again, with dyskinesia there's no way to be certain, at least not with just a HIDA/CCK being done. (Some doctors even contend that the HIDA/CCK is not a trustworthy test, despite its acceptance in the field. From what I've seen, more trust it than don't; those that don't have been in academic settings.) To follow up on EF example, I was later diagnosed with borderline dyspepsia/gastroparesis. 4 docs have offered 2 diff opinions, split 50/50.

* Fever? Unlikely, unless there's infection/inflammation. Most commonly happens in the case of blockage, however. (Something the polyp might do, depending on location.) If this is the case then the person will likely have emergency removal anyway and possibly an ERCP.

* Inflammation or infection of the gallbladder, bile ducts, or pancreas? Yes, but this one's more iffy. Again, normally associated with stones, and this would cause symptoms. If there aren't stones, then this is a whole different can of worms you've just opened (hence the iffy-ness).

*Jaundice? Always a possibility with biliary issues.

* Erosion of the gallbladder wall? It's a possibility if the gallbladder's the problem. Far more likely if there are stones.

* Abnormal fistula? Could happen, though very rare.

Note that most of these can happen during a "gallbladder attack" period. However, if the issue is not the gallbladder (but rather SOD, for example) those that can happen will regardless of whether the organ is there.

On the matter of stones, there might indeed be stones that don't show up on the scan. In fact, up to 50% of cases show stone formation in patients where none was seen before (conversely, up to 10% of cases where stones are "seen" there really aren't any). No way to tell if symptoms were caused by these unseen stones, however, though they're obviously suspect. (Some contend that dyskinesia can expedite the formation of stones.) If there ARE stones, removal of the gallbladder does not prevent the reformation of sludge or stones. (I believe there's a 6mm size threshold for the duct in order for it to allow stones, but don't hold me to that.)

Here's the deal: As far as dyskinesia is concerned, there are other issues to consider, such as global motility issues and Sphincter of Oddi dysfunction. If SOD is present then removing the gallbladder won't resolve the issues. There are potentially other signs of SOD, however, such as elevated pancreatic and liver enzymes, particularly during a gallbladder "attack", but these are not always the case. If a global motility issue is discovered, then you're playing by a different set of rules and assumptions as to what's safe and what isn't.

All of that said, a polyp is another matter entirely. Polyp there? That puppy's gotta go, period. Too close to the possibility of cancer for comfort. These are, in my humble opinion, never safe.

I sincerely hope none of this came across as disrespectful or combative in any way.
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469934 tn?1333135282
I'm sorry but I disagree with your comment.  As I said earlier, I'm not a doctor and I know next-to-nothing about medicine but even I know that it can be dangerous to hold onto a non-functioning gallbladder.  

Some risks of abstaining from gallbladder surgery could include:

*Unpredictable gallstone pain (biliary colic);
*Nausea;
*Vomiting;
*Fever;
*Inflammation or infection of the gallbladder, bile ducts or pancreas;
*Jaundice;
*Erosion or perforation of the gallbladder wall;
*Add symptoms caused by blockage of the common bile duct and ampula of vater; and
*An abnormal connection (fistula) between the gallbladder and the bowel in rare cases.

When inflammation and/or infection occur, there is a trickle down effect to the liver and pancreas; damage can occur throughout the entire digestive system.  Unlike your liver, your pancreas is an unforgiving organ and once it is damaged, pancreatitis is likely.

It's true that some people who have their gallbladders removed continue to suffer OR are worse off than before; I am one of them.  For the most-part, though, this is not the case when the gallbladder isn't functioning properly.

All the best,

Sam
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Avatar universal
As far as gallbladder function is concerned, if it's not bothering you, leave it alone. That said, functioning or not, the polyp is enough of a concern to justify a request for getting it out, since it becomes a cancer risk.
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469934 tn?1333135282
Hi Karen:

I'm not a doctor and know next to nothing about medicine but I would think that if your gallbladder isn't functioning, it will cause serious problems unless you remove it.  Please bear in mind that gallbladder removal (cholecystectomy) is still a serious surgery and removal of it can cause other problems.  It's not an easy decision but a surgeon is not going to tell you to remove it if it doesn't need it.  A 2% ejection fraction rate is horrible.  Feel free to email me if you need support relating to this surgery.  I had mine removed in May 2008.

Here are some references relating to gallbladder:
Digestion and GI Health – Your Gallbladder – http://www.womentowomen.com/digestionandgihealth/gallbladderhealth.aspx
Cholecystitis – http://gastroresource.com/GITextbook/en/chapter13/13-2-pr.htm
Gallstone Removal – http://www.surgeryencyclopedia.com/Fi-La/Gallstone-Removal.html
Management of Common Bile Duct Calculi – http://www.surgeons.org/Content/NavigationMenu/WhoWeAre/Regions/QLD/080506_CWon.pdf
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) – http://www.sages.org/sagespublication.php?doc=PI11
Functional Gallbladder and Sphincter of Oddi Disorders – http://www.romecriteria.org/pdfs/p1498FuncGallbladderandSOD.pdf
MERCK – Gallstones – http://www.merck.com/mmhe/sec10/ch140/ch140b.html
Gallstones and Gallbladder Disease – http://adam.about.com/reports/Gallstones-and-gallbladder-disease.htm#adamHeading_4
GALLSTONES (Cholelithiasis) – http://www.rxmed.com/b.main/b1.illness/b1.1.illnesses/GALLSTONES%20(CHOLELITHIASIS).htm
Cedars-Sinai – Gallstones – http://www.csmc.edu/5344.html
National Digestive Diseases Information Clearinghouse (NDDIC) – Gallstones – http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/index.htm
Gallbladder Attack – http://www.gallbladderattack.com/gallbladdersurgery.shtml
Pathology Outlines – Gallbladder – http://www.pathologyoutlines.com/gallbladderpf.html
Diseases of the Gallbladder and Bile Ducts – http://rezidentiat.3x.ro/eng/litbiliaraeng.htm

God bless, Godspeed and good luck, Karen!

All the best,

Sam
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