Hyperkinetic Biliary Dyskinesia a real problem?

[Kelsoxoxo]

Hello all, I recently had the HIDA with ejection fraction done. I was a 94% which is obviously on the very high end. I have been suffering with real issues for many months now, acute upper right quadrant pain, diarrhea, sensitivity to oily and fatty foods, indigestion, gas, headache, lightheaded, stomach tenderness and dull pain.  Many doctors, including gastrointestinal specialists still know nothing about a hyper gallbladder and will tell you that the higher you ejection % the better. My understanding, after countless hours and days of research is that it certainly is a real problem and as time goes on, it is starting to be slowly recognized more. Some doctors out there, who have real world experience with this condition, will promptly reccomend surgery when they have a patient who is Hyperkinetic. My understanding is this: When your gallbladder is Hyperkinetic, the biliary Ductwork actually gets stretched and distended beyond its normal function because the bile is being pushed out at a high %, too forcefully and to quickly, thus leading to biliary duct inflammation, pain ect. Also, a Hyper gallbladder is likely, and known in some cases to "misfire" and act "trigger happy" So to speak, releasing bile at inappropriate times, this releasing bile into an only partially full, or even empty duodenum and any other GI internal system it comes in contact with, thus causing inflammation, pain, nausea, distress ect. Also, clinical studies show that most Hyperkinetic gallbladders that have been removed, upon examination and lab work are typically diseased, have inflammation and scar tissue. Previous ultrasounds, MRIs, Xrays and so forth were not able to see the damage and issues. Also, clinical studies show that patients who had surgery for a hyperactive gallbladder usually had long term resolution of problems. Some doctors have now made the statement that a Hyperkinetic gallbladder can be as symptomatic and troubling to a patient as a gallbladder that has a low ejection rate and/Or partially blocked and/or stones. A Hyperkinetic gallbladder shows that it is actually not functioning properly and it causes great internal distress and problems, one of which being internal inflammation of all affected internal organs and systems working with the biliary system. Any thoughts on this or added knowledge? What do you think?

[Marinated]

I had this condition and found a wonderful surgeon in the Detroit area. Abdelkader A. Hawasli, MD Is on the research and cutting edge of gallbladders. He is an excellent surgeon

[dillyOh]

Here's the article. I had to post it in a different comment because of it's length.

Hi Folks,
I shared part of this on a specific post by a member, but thought it would be good to share here too since it affects so many. The original comment was about the relationship between women's menstrual cycle and gb attacks. Here's my take on what might be going on.

If you have noticed a connection you are not alone! And if you have found anything that works to mitigate the discomfort/pain, please share!

Note: there may be some boo boos in here, I haven't got the time at the moment to read and reread it and polish it properly. If you do read it through, let me know if I've put my foot in it anywhere. Here goes:

The liver has several jobs. The main ones are:
*bile production and excretion,
*production of cholesterol (to synthesize hormones and protect arteries, veins and nerves),
*excretion of bilirubin, cholesterol, hormones, toxins and drug metabolites (breakdown products),
*the metabolism of fats, proteins, and carbohydrates,
*enzyme activation,
*the conversion of the thyroid prohormone thyroxine (T4) to its active form triiodothyronine (T3),
*storage of glycogen (a source of energy), vitamins, and minerals,
*synthesis of plasma proteins, such as albumin, and clotting factors (blood quality).
*maintaining a reserve volume of blood for emergencies (injuries), and maintaining the right volume of blood circulating in the body,
*maintaining hormone balance for the entire endocrine system (ovaries/testes, thyroid, parathyroid, pancreas, hypothalamus, adrenals, pituitary)

All hormones are made from cholesterol.

As you can see, at least one common denominator between gallstones and menstruation is the liver/cholesterol.

One of the tasks of the liver is to maintain hormone balance.... for all of your hormones: estrogen, progesterone, testosterone, melatonin, insulin, adrenaline, cortisol, etc., etc. If the liver is already stressed because it isn't getting what it needs to do *all* of its tasks, then - something's gotta give. Because our bodies have evolved to prioritize, the liver is going to cut corners on the functions that are least vital to our survival. I suspect that is where the answer lies, though there doesn't seem to be any useful research here in the West (at least, not in mainstream medicine) on how to support the liver so it can get all of its jobs done efficiently, without having to choose between them.

So. What is stopping the liver from doing it's jobs? It could be an excess of something that interferes with its functions, or it could be a lack of the things (nutrients, raw materials) it needs to carry out its jobs.

That's why I think diet is a good place to start. Progress with this approach might be on the slow side, but at least it puts addressing both of the potential problems in our hands: reduce the digestive burden, and take in more of the things that support the liver.

Most of us don't want to hear about changing our diet, but it really can improve our health. Other medical traditions (Ayurvedic in India, Traditional Chinese Medicine) say that all disease begins in the gut. If there's something wrong with the liver or the gallbladder and both are part of the digestive system, it's the logical place to start.

*Reduce the digestive burden
For example, limiting things containing hydrogenated vegetable oils and sugar reduces the digestive burden on the liver because it really isn't equipped to process either them even in moderate quantities, and ends up turning them to fat - hence, fatty liver (i.e. a liver congested with mystery fats and that cannot do its job) and weight gain.

*Get a fair bit of fiber
We also know that getting enough fiber is important. It supports the intestines, feeds our gut biome and also makes sure that the bile that has complexed with toxins in the liver for their elimination actually leaves the body. This also means that the liver must produce new (i.e. clean) bile so it's important that our diet have the nutrients required to produce new, good quality bile.

*Support the liver with what it needs to do its jobs
In the liver, bile acids combine with taurine or glycine to form bile salts. Bile salts help break down and absorb fats. When we are deficient in biel salts, the cholesterol (and other things) that are dissolved in the bile come out of solution instead of leaving the body with the bile via the stools. That's how they form sand, sludge and stones. So it is important to get enough foods that are rich in taurine and glycine in our diets (time to do some googling!).

Peppermint and ginger support the liver and some supplements help the liver too... such as the herb St. Mary's Milk Thistle. There are even liver support blends on the market that have combinations of plant extracts and nutrients known to help the liver carry out its tasks.

The liver/hepatobiliary attack-menstrual cycle connection would seem to lie in the changing levels of our progesterone and estrogens (yes, plural). I've noted that these attacks often occur one week before women's periods and right at the beginning of them. These are the times in our cycle when progesterone is lowest and estrogen is highest. This has led me to two possible explanations:

(1) Since cholesterol is required to make hormones, the cyclic changes in female hormone levels may affect the concentration or solubility of cholesterol in the bile. If the bile is weak (i.e. unable to keep excess cholesterol in solution for its disposal) then more cholesterol will come out of solution, producing sand, sludge or stones and lead to "gb attacks".

(2) Progesterone is known to relax things in our system and promote an overall sense of well-being (hence the glow of many pregnant women). A deficiency in progesterone or an excess of estrogen (known as estrogen dominance by doctors of functional medicine, naturopaths, etc.) could be the cause of spasms in both the gallbladder and the Sphincter of Oddi. This might also explain why some gbs are hyperkinetic.
It might also explain why some women get relief by limiting their intake of dairy products - dairy cows are routinely given estrogen injections and the amount of extra estrogen we consume this way could lead to an imbalance (e.g. "Hormones in dairy foods could be considered as a remarkable concern for consumers, producers and public health authorities." ncbi.nlm.nih.gov/pmc/articles/PMC4524299/).

I should add something else that seems to fit in here. Many find they cannot tolerate beef. I've been wondering if that is because steers are also given hormones to bulk them up and increase water retention (more $ per lb).

Incidentally, all of this leads me to think that this same female hormone-liver connection also plays a role in morning sickness.

Note: This does not mean you should eat less good fat (butter, lard, olive oil, coconut oil), it means you should select your food with the aim of attaining balance in the female hormones, gettign a good amoutn of fiber and getting the nutrients in your diet required to keep cholesterol in solution.

That's all for now. I hope you find something useful in there. If you have anything to add or share, bring it on! We need all hands on deck to figure these things out.

This tidbit was written by a woman named Bianca Delfosse and all credit should go to her.

[dillyOh]

I'm not a doctor but have also been dealing with hyperkinetic symptoms since about 2012 (started at about 22 years old, am now 28). My EF was 98.4 or 98.6%, all labs normal, ultrasound unremarkable, and CT with and without oral and IV contrast showed only mild degeneration of the spine. I did sit down and visit with a surgeon who told me that it wasn't a cause for concern and that he's never heard of hyperkinetic biliary dyskinesia so he wouldn't take it out "just because". He sent a referral off to a gastroenterologist and I never followed up. I did, however, change my diet significantly and lost 65lbs. The diet change seemed to help a little bit and now as I'm maintaining this weight I eat a bit differently and have noticed that the symptoms are aggravated a lot by large meals. I also don't have flare-ups as often. One other things that you might check out is this copy-pasta tidbit on the link between hormones and the ol' GB. I assume from your name that you're also a woman so I'd be curious to know if you notice the symptoms before the start or your monthly?