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Forum Name: Surgery Topics

Question: How can I get this gall bladder out NOW?


 musikate - Mon Dec 14, 2009 6:07 pm

About 3 weeks ago I had a CCK-HIDA scan test. The results came back with 11% and 16% ef. My GI doc said I should schedule cholecystectomy, so I set up an appointment for later this month. In the meantime, my symptoms have worsened considerably. My nausea is almost constant, as is the pain. I went to the ER on Wednesday, and they admitted me. However, since the ultrasound and CT showed no inflammation and I did not have an acute abdomen, they simply kept me to keep fluids in me and manage the pain. My GI doc failed to send the HIDA scan test results to the hospital surgeon, so he did not seem to think there was any reason for my symptoms besides some fluid (possibly a cyst) in the abdomen. On Friday, the hospital released me, with some sheepish apology by the surgeon that he wished he had known my ejection fraction earlier, but it was the weekend and he had to go to a funeral.

I'm suffering a lot today. I was able to schedule an appointment with a surgeon for this coming Friday, but I'm not sure I can hold out til then! I'm taking pain meds, but they're not very helpful. Is this "biliary dyskenesia" really the cause of my pain, and if so, how can I get it out NOW? I'm unable to function as I am now.
 Dr.M.Aroon kamath - Thu Dec 24, 2009 8:07 am

User avatar Hi,
You have not mentioned several important points in the history....
- have you been having similar pain in the past?
- Have you had any abdominal pain at all in the past?
- any previous abdominal surgery?
- charecteristics of the pain? & so on.

One should NEVER treat an investigation report!

Therefore, in the abscence of details regarding your illness (and physical findings), it would be very difficult(if not impossible) to hazard an opinion.

The result of the CCK-HIDA scan does show that the 'ejection fraction' is very low & therefore could be the so-called 'biliary dyskinesia'.

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 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.
Best wishes!

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