Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
|max2 - Thu Feb 09, 2006 9:28 pm||
I am a 55 year old male with upper right (just below rib cage) pain for past several years. I have been in-patient four times for this pain,treated with npo and anti-biotics. Have had more tests than I can recall,with only one showing results. This leads up to my questions. I had a HIDA scan w/CCK that came back negative / normal ? My primary Dr still feels that my gall-bladder my be the problem,in spite of the results. I am also wondering because when the CCK was injected I had intense pain exactly where my pain has been for years,AND I felt 100% better after the test. I had the same results five years ago when the HIDA was done ie: 100% relief after the test for 3 to 6 months. Could I still have a bad gall-bladder ? Also,anti-biotics are becoming almost inaffective.
|Dr. Tamer Fouad - Sat Feb 11, 2006 2:12 pm||
Hepatobiliary (hydroxy iminodiacetic acid [HIDA]) scans is useful in determining which patients with right upper quadrant pain and suspected acalcular cholecystitis may benefit from cholecystectomy.
After the gallbladder fills with the radioisotope, a cholecystokinin (CCK) analog is administered. CCK stimulates emptying of the gallbladder, allowing an ejection fraction to be calculated. A gallbladder ejection fraction of less than 35% is considered abnormal and suggests that a patient with the appropriate symptom complex may benefit from laparoscopic cholecystectomy. Administration of the analog also may recreate the pain experienced by the patient.
Patients with low gallbladder ejection fractions (less than 40%) determined by cholecystokinin cholescintigraphy have a high positive predictive value for the diagnosis of chronic acalculous cholecystitis.
The sensitivity of this test is 95% in the diagnosis of cholecystitis. However, false negatives have been known to occur in cases with acalculous cholecystitis.
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