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- Fri Nov 07, 2008 2:30 pm
About two weeks ago I experienced steady pain in the epigastic area also extending to the back of both shoulder blades. This came on abruptly and steady at about an '8' for around 2 hours, around 9:00 a.m. As I recall, I had eaten pizza the previous night. The pain subsides, I pass it off as a stomach ache. I have a repeat of this pain at around 1:00 a.m. the following day. It wakes me up and is the same in duration but about an "7" in intensity. The pain subsides, I had a bout of gas and diarrhea. Seven days later, I have pizza again, a few hours later I feel the onset, attempt to sleep it off, I am awaken 3 hours later by a "9", duration is about 30 minutes longer than the previous episodes. I have my wife run me to the ER. They performed blood work and ultrasound. The gallbladder was partially obstructed but the GI tells me that the walls look thinkened but no signs of stones/ pancreas looks good. The MD ordered an EKG due to the back pain. It showed a variant Q-wave. I had this done 6 years ago with similar results. Cardiologist/echocardiogram and so on. I was admitted and went through nuclear scan(s)/ stress test. All test show normal so they ruled out the heart.
I went in for a HIDA scan yesterday and here are the results:
"There is unremarkable uptake of radionuclide seen on the blood pool and early images within the liver. visualization of the common bile duct and gallbladder is seen by 15 minutes. Flow from the common bile duct into small bowel is noted by 30 minutes. thus, there is no evidence for any cystic duct or common bile duct obstruction. the CCk was then administered and the calculated ejection fraction of the gallbladder is only 16%. this is below the lover limits of normal of 35% and suggests some gallbladder wall dyskinesia is present.
No evidence for any cystic duct or common bile duct obstruction. gallbladder wall ejection fraction is decreased at only 16%, which could be due to some gallbladder wall dyskinesia."
I am scheduled for an EGD on Monday and am not looking forward to it (fear of sedation).
And finally my questions:
1) I had fasted for four days, ending 2 days prior to my initial episode. would this cause biliary colic/dyskinesia?
2) The MD stated that this doesn't mean I will need to have the GB removed, I could alter my diet and see. Does this mean the gallbladder ejection rate could correct itself over time, or once it goes bad it's bad.
3) If the EGD shows an ulcer or some other incident, could that be the cause for the epigastic pain and not the gallbladder?
4) Finally, are there any other contradicitons that could give me such a low ejection fraction rate?
I appreciate the time anyone took to read this and any advise help would be greatly appreciated. As you can gather from the above, I am not in favor of having my GB removed unless it's diseased or stones were blocking/present.
Thanks for your time.
| Dr. Safaa Mahmoud
- Sat Nov 29, 2008 2:11 pm
A HIDA scan is used to diagnose obstruction of the bile ducts or bile leaks. The scan is also most commonly used to diagnose gall bladder problems when ultrasonography is normal in patients whose clinical picture is very suggestive of gall bladder disease.
The gallbladder when contracts should squeeze out its bile into the intestine. Reduced contraction is seen during the scan as reduced emptying of the radioactivity from the gallbladder. Reduced contraction may result from inflammation or scarring of the wall. It gives symptoms and signs similar to gall bladder or duct stones.
Patients with considerable symptoms from the disease may need surgical removal of the gall bladder as long as no other possible causes like gastritis and gastric ulcer are found to explain their symptoms. Surgery is also considered when the ejection fraction is very low making complications more likely.
So, if the endoscopy proved the presence of gastritis or gastric ulcer, treatment of the disease is essential since it might be the cause of your symptoms.
If the endoscopy was negative for gastritis or gastric ulcer, then these symptoms are more likely to be due to the gall bladder disease.
Starting with medical treatment and diet regulation may be helpful. But if all these measures fail to improve your symptoms surgery would be beneficial since your ejection fraction is very low making complications more likely.
Inadequate fluid intake is not likely to change the results of the scan to my knowledge.
Follow up with your doctor is essential.
Hope you find this information useful.
Please keep us updated.