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Forum Name: Gastroenterology Topics

Question: Gall Bladder Hida Scan Results


 babygirl8679 - Tue Feb 14, 2006 8:49 pm

I am a 26 year old female and have been having right upper quad pain since right before Thanksgiving of 2005. I have had a battery of tests which all were normal the pain and nausea are so severe sometimes I hate to eat I have lost 22 pounds since this all began. I am very tired and very confused about it all. I had a hida scan with a cck injection fraction of 48% which my doctor said was abnormal but not enough to do anything about it. The cck injection gave me severe pains and nausea. I just do not know what to do the pain and nausea make it very hard to function and it does not seem to be getting any better. My question is why is 48% and the symptoms I have not good enough to do anything about? Will it ever get better or worse? Are there medicines I can take for the pain and nausea? I also feel full most of the time but gastric empty was normal. Please help me go in the right direction. Also my dr. wants to repeat test in about 4-6 weeks will this do any good?
 Dr. Tamer Fouad - Thu Feb 23, 2006 4:36 pm

User avatar Hello,

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.

You may not benefit from cholecystectomy and you may not turn out to have acaclulous cholecystitis. It could turn out to be a functional GIT disturbance. I think the follow up HIDA after 6 weeks is a good idea. In the mean time has your doctor put you on any medication and has there been any improvement at all?

Best regards.
 babygirl8679 - Sat Feb 25, 2006 11:08 am

Hello and thank you for getting back to me my doctor has put me on zantac and I take a phengren suppository when the nausea gets really bad but all in all I see no real improvement I just feel icky my question remains though if my gallbladder still reads at 48% when we repeat I will still just suffer through until it gets bad enough? The nausea is what really gets me down the pain is intense but I can function when is settles the other lays me up in bed. So if my gallbladder is not going to be bad enough to take out why is it bad enough to give me symptoms?
 babygirl8679 - Sat Feb 25, 2006 4:14 pm

Hello I forgot to ask for some reason I have been craving sweets for about 3 weeks now and I am not a big sweet eater at all I may have one mini candy bar once every couple of months and be fine but my doctor wanted to send me in to get a ac1 test done but I have heard people with diabetes do not crave sugar is this possible or just something to keep me running around I am sure it has nothing to do with gallbladder results which like I said are abnormal but not enough to do anything about so I just wish because they can say its not bad enough that I could say why do I have the pain and nausea then I shouldnt I just want it to go away. I want to feel normal again
 Dr. Tamer Fouad - Sat Feb 25, 2006 4:45 pm

User avatar Hello,

Like I said earlier, generally an ejection fraction of below 35% is taken to be abnormal. 48% is not abnormal.

What your test means is that you may have something else other than gallbladder disease. So your symptoms have not improved on Zantac and Phengren?

If it does not improve you should report any increase in symptoms or any new symptoms to your doctor. Essentially you are under observation during the 6 week period.

The blood sugar test would show for sure if you have diabetes or not.

Best regards.
 babygirl8679 - Sat Feb 25, 2006 6:12 pm

Ok thank you for replying so quickly but if I may ask what else could I possibly have? And are you saying that the nausea and right upper quad pain are not being caused by my gallbladder? I have had a slew of tests and everything has been normal even blood work. The zantac I don't think helps at all and the phengren I only take when I am severly nauseated and it does help then. It is just on the everyday basis that I feel this way I have lost 25 lbs because of it. Please help me out I do know that if and when they repeat the hida scan if it still isnt bad enough to do anything with the GI specialist that I am seeing said he has done all he can do for me and can do no more so where in the world will that leave me then. So again I would like to ask that since my gallbladder is still considered normal that means the nausea and pain isnt because of that? Please help me
 Dr. Tamer Fouad - Sun Feb 26, 2006 2:00 am

User avatar Hello again,

I am not saying that your symptoms are not caused by your gallbladder. Just that we have no proof of it at the moment. We are only suspecting that it could be caused by your gall bladder.

Causes of right upper quadrant pain include liver diseases, gall bladder disease, lesions of the hepatic flexure of the colon (carcinoma, diverticulosis, ischaemic colitis, Chron's disease, atypical appendicitis or even constipation), renal diseases (pyelonephritis, nephro-lithiasis, hydronephrosis, renal carcinoma or other disease of the kidney or ureter, including obstruction of the urinary tract) or a dissecting aneurysm. Other causes include referred pain from the heart or a respiratory disease of the lower lobe of the lungs (lobar pneumonia or infarction from pulmonary embolism).

Many metabolic diseases can give the same picture including, diabetic ketoacidosis, Addisionian crisis, adrenal tuberculosis and metastatic carcinoma. Infections such as herpes zoster or a subphrenic abscess can also lead to pain in the right upper quadrant.

I mentioned earlier the possibility of functional bowel disease such as irritable bowel syndrome, dyspepsia. It can lead to pain, nausea that are usually associated with alterations in bowel motions in the case of IBS.

As you can see the list is endless, did you get a CT scan done? If that didn't show anything and you are unable to tolerate the pain then maybe you should seek another opinion.

Some cases do turn out to have cholecystitis even with normal HIDA scans and improve dramatically from surgery.

Best regards.
 babygirl8679 - Sun Feb 26, 2006 10:48 am

Yes I have had a cat scan of abdomin and pelvis had a small cyst on left ovarie but everything else was normal. I have had a liquid gastric empty study, a upper gi with small bowel follow through, xrays, blood work stool cultures, endoscopy colonoscopy, which he said my bowel wasnt as clean as he had hoped but still nothing from any of the tests but alot of aggravation and what seems like a waste of the doctors time. Currently I have had this dull pain in my back but on my left side for 2 days now but I know it is nothing just like the rest and I really do appreciate all your time and if I sound ungrateful I apologize. So out of all the tests they have done on me would it still be possible to have anything from what you mentioned earlier? I would have thought it would have shown up on some sort of test. Also you said the gall bladder is what is now under investigation but is it really likely that if on the date of the next hida scan things will be different? It all just seems so hopeless I lead a pretty stress free life up until now I am a little stressed about the whole mess what is going on with my body?
 Dr. Tamer Fouad - Sun Feb 26, 2006 1:06 pm

User avatar Hello babygirl8679,

I really understand how terrible it must be to be in constant pain and remain in the dark about what is causing it. I just really wish I could do more to help you.

My opinion is the next HIDA scan would probably be no different than the first one. What your doctor was doing was putting you under observation. Doctors do this when they are unable to reach a diagnosis. They wait and see, hoping that some other tell tail sign would appear and resolve the issue.

It seems you cannot afford such luxury given the constant pain you are in. The only advice I can give you is to seek a second opinion from another gastroenterologist.

Please keep me updated.
 babygirl8679 - Tue Feb 28, 2006 10:57 am

I have racked my brain trying to remember everything I have felt or have been feeling so I could maybe help resolve this issue and other than pain and nausea I can not think of anything I bought a home blood glucose monitor and have been checking my sugar the other day it was 138 with out eating but since then its been in the 80's except for one other time it was 127 2 hours after a meal so it cant be sugar from what i have read on the internet. I know I stay cold and skin is extrmely dry no matter what I do to it. I also know when I feel the most nauseated I have to pee alot. I also know sometimes when I get up to fast or bend over I get like black spots in front of my eyes and feel dizzy. And one other thing is I feel heat not like a fever but like my body is heating from inside out makes me uncomfortable sometimes. I have no idea whats going on with me and no one else does either I think I have had every test know to man so I would think something would have shown up by now with the other diseases or illness that you previously mentioned. Thanks for all your time. If you can thnk of anything else I would be happy to hear about it.
 babygirl8679 - Sun Mar 05, 2006 12:25 pm

Well I guess this is it I still have alot of unresolved feelings about everything but I know there are more people out there suffering than just me thanks for your time I will check back periodically to see if there are responses but I doubt it Thanks for everything

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