Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
|angelfire2121 - Fri Jun 11, 2010 3:08 pm||
For the past few months I have been having nearly constant nausea, particularly after I eat, but sometimes it happens even if I haven't eaten at all. At first I was vomiting a lot, but I haven't in a while, but I still am feeling constantly nauseous and have to lay down for a while after I eat. I have had so many tests done lately, including a HIDA scan. My results said that it was functioning 70% which is okay I guess, but my doctor still thinks it is possible that it may be my gall bladder causing this problem. Is it possible that maybe I was going through a gall bladder attack, and am starting to recover so the functioning went back up before my HIDA scan? Because the hospital took a month to get me in to get the scan. Is it possible that my gall bladder was low functioning before the test, and then started to get better? I haven't been feeling near as bad as I was before..
It all started when I got a urinary tract infection, I was put on these antibiotics that made me really sick, and even though my infection is gone and I'm not taking the antibiotics, I am still really ill. I can hardly go anywhere or do anything, because I get sick a lot.
I have had so many different blood tests done, and I don't even know what half of them were for, but they all came up fine. I just got more blood taken to check for celiac.
Right now it feels like there is acid in my stomach burning my insides.
Any advice on what could possibly be wrong with me and what I should do about it? I've been to the doctor so many times and have gotten so many tests, and am about ready to just give up...
Oh, I'm only 18 years old, and am not obese, I only weigh 99 pounds, thanks to being sick for a few months straight. Also not pregnant.
|Dr.M.Aroon kamath - Fri Jul 09, 2010 2:31 am||
Your symptom is too atypical to suggest a gall bladder problem.
A normal gall bladder contracts and empties about 75% (ejection fraction-EF) of its contents in response to a meal-activated CCK secretion from the proximal small intestine. On a radio-isotope scan, this is expressed as the 'change in activity, divided by the baseline activity'.
The result of the CCK-HIDA scan does show that the 'ejection fraction' is very low & therefore could be the so-called 'biliary dyskinesia'.
Sphincter of Oddi Dysfunction(SOD): Also known as biliary dyskinesia or post-cholecystectomy syndrome, is an incompletely understood symptom complex comprising of intermittent upper abdominal pain that may be accompanied by nausea and vomiting. Believed to be caused by either scarring or spasm of the sphincter of Oddi muscle, coupled with gall bladder dysfunction. .
The exact cause of this condition is unknown but may be due to decreased Gall bladder CCK- receptor function or a decrease in the number of CCK-receptors (receptor 'down-regulation').
At what level of EF one can consider that 'biliary dyskinesia' exists is controversial. Generally an EF of less than 35% is considered abnormal.
So, how does one go about deciding which patient will be benefited by removal of gall bladder?
This may be done as follows...
- consideration of the EF, and
- to decide whether the appropriate 'symptom - complex' exists.
An EF of <35% is certainly low enough to consider cholecystectomy.But, even higher EF values may be considered for surgery if
- the symptoms are compelling and
- in those patients who have reproduction of their symptoms on administration of CCK.
Although you don't have any "typical" features of peptic ulcer disease ("typical features" are rare these days), you need to consult a gastroenterologist to exclude this possibility.Your symptoms are not compelling enough to warrant a cholecystectomy at the present time.
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