It is interesting to look up the studies that have established the "normals" for the HIDA with CCK. The numbers are all over the board. One problem is that the literature supports slow infusions of CCK - 45 to 60 minutes while every radiology group that I have asked and every report that I have seen uses a 2-3 minute infusion. This has been shown to produce abnormal results in 30% of normal patients without any abdominal complaints. The high end has been anywhere from 60-100%. I have taken this to mean that the calculated ejection fraction is probably useless. The Cleveland Clinic published a series of cholecystectomies done for biliary dyskinesia and found that symptom reproduction with the CCK infusion was the most important factor in predicting improvement following gallbladder removal. I have had a specific interest in patients with extraordinarily high ejection fractions and symptom reproduction. There has been nothing in the literature about this until the past few years. I have often suspected that these folks may actually have low intrinsic levels of CCK and "up-regulate" the CCK receptors in the gallbladder which makes them more sensitive to the standard dose administered.
I would summarize with support for her to proceed with the surgery. The fact that she has had a complete and thorough evaluation that has failed to turn up anything other than the reproduction of her symptoms with the CCK would support it.
My daughter had a 94% ejection fraction and her GI dr said all was well, but her surgeon who is young, smart and specifically trained in gastro type surgeries said it was WAY TOO HIGH!!! I wrote in this forum asking Dr Chris Watters this question and would probably say the same to you- get it out! Unfortunately, the medical communities do not recognize the odd-type problems and there is not enough research yet to support this theory, but there is one study from Canada that is listed if you Google "hyperactive gallbladder". Check it out. There are alot of peolple like you and my daughter and the resolution of symptoms after removing the gallbladder is >90%!! Good luck!!
Thank you both so much for your comments. I truly appreciate it. I think I'm making the right choice too and going with the direction of the surgeon.
I informed my primary doctor of what is going on and I received a bit confusing comments from her last night. Stating the surgeon should just go and check it out and if he sees a stone to take it. The crazy thing is she refereed me to the GI doctor initially since she wasn't an expert in gallbladder and here she is questioning the surgeon the GI doctor referred me to. I think she is just looking out for me..but doesn't make me feel that confident in everyone's decision.
With all due respect to your PCP she doesn't have a clue about this. Gallbladders removed for biliary dyskinesia look pretty normal as there is usually minimal inflammation present. You could equate it more to a muscle cramp. As for the "if you see a stone take it out", the ultrasound is far more accurate than trying to peer through an opaque gallbladder wall to see if there is a stone there. As we have said, stones are not necessary to have horrible gallbladder symptoms. Your have had an appropriate workup to rule out other causes. The only finding has been reproduction of symptoms with CCK. I think you have made the best decision. My apologies to your PCP. I'm just a little bit sensitive after seeing so many patients that were blown off after positive tests and never referred.
My daughter had her gallbladder removed today,laparoscopically, without incident. The surgeon showed us pictures and said that her gallbladder was more hour-glass shaped than the normal oval looking GB. Also had some fibrous-like strands in the middle. It went off to Pathology and I specifically asked that they look at it carefully to see if they find a pathological cause for the hyperkintic action it had. We will see. She is only 6 hours post op and is at home, taking her pain med, but I can see the difference already. Her pain is purely surgical, not the stomach, rt ribs and back pain she had preop. We are VERY excited and pleased so far. Will keep you posted. Her surgeon was very appreciative of your comments Dr Watters and was glad to see there are Dr's out there like him who truly care about the pt and their problems and are willing to deal with the grey areas that medicine can have. Kris, hang in there and follow the advice- it seems like this will be the answer for you also!!
Thank you Dr. Watters for your recommendations and insight...I truly appreciate it. I agree with you, my PCP does not have expertise with the gallbladder so to go with the advice of my surgeon and yourself is the right choice for me.
Thank you too bear1113....your daughters story gives me comfort and hope that feeling better is in sight. :)
Hi Kris- my daughters first night wasnt too bad, incisional pain at the 3 little poke holes and the gas pain from the carbon dioxide gas they use to inflate the abd during surgery. Very normal pain and controlled with the pain meds. HOWEVER... that was the ONLY kind of pain she had!!! No more stomach,rib or back pain and she was even able to eat some mashed potatoes and yogurt with no problem!! We are all so happy and are sure that this was the solution!! Thanks to her surgeon and Dr Watters, she is on the way to ful recovery- and I'll bet you will be too!! Hang in there and keep us posted!
Hi bear - that is great news!! So glad she is doing well. Next week is my surgery so hopefully things will go as well as your daughter.
Take care! :)
my daughter is doing very well 1 week post op. The gall bladder pains are gone, still a few issues with diarrhea and nausea but she hasn't been eating for a few weeks so I think that her stomach and intestines have to adjust. Her incisions are healing well, the only one that bothers her alot is the belly button one, but that will be fine in time. Wondering if you had the surgery Kris and how you are doing.
The pathology FYI Dr Watters showed "chronic cholecystitis" and also a "benign lymph node in the common duct". I read that the lymph node is common, but wha does it mean? Could that have been part of her problem? Thanks!
I am glad to hear that she is feeling better. There is typically a lymph node near the junction of the cystic and common bile ducts. This is named the node of Chalot. When there has been inflammation of the gallbladder it is typically enlarged and is frequently included with the specimen. From a technical standpoint, the surgeon usually uses it as a landmark because the artery going to the gallbladder is immediately underneath the lymph node.
Glad your daughter is feeling better. I'm actually having my procedure tomorrow. A little nervous...but I know the outcome will be good..no more pain. :)
I will let you know how things are going after.
Thank you once again Dr Watters. It is amazing to me how much I have learned about the gallbladder in such a short time. Our surgeon also has enjoyed reading your replies. My daughter is still sore and her GI tract is slowly remembering how to function, but she is 300% better than she was. Good thing she didn't just chalk it up to being a nervous nelly!! Thank you for all you do for the general public Dr Watters, it is appreciated.!!
Hi Kris, hope you are home and resting after your surgery. The chest pain from the gas is awlful, just take your pain meds and walk around. Gas X helped my daughter but no really sure why as the gas isn't in the intestines itself. Hang in there and remember that VERY SOON you feel normal again!!
Hi Bear and Dr. Watters,
Just wanted to post and let you all know how I'm doing. I feel so much better!! I was on pain meds the first few days and then after that have just been taking tylenol when needed.
Like you mentioned Bear the gas pain was the worst really and just the incision pain...which is normal.
Lucily have had no diahrrea after eating...am able to eat yogurt and other foods with no problem. Just trying to introduce foods slowly cause I know it will take time for my body to readjust.
Thank you Dr. Watters for your advice...taking my gallbladder was definitely the right thing for me to do. :)
Bear...how is your daughter doing now?
Happy to hear that you are doing well.
A related discussion, Intestinal Pain