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Gallbladder seems fine but PCP recommends removal
Had a full GI work up: CT scan, Hida scab, ultrasound, endoscopy, blood and stool tests. A few years ago I also had an endoscopy, colonoscopy, x-rays, and blood and stool tests. Results of all the tests do not show any problems with my gallbladder, and also no gallstones. There is some family history of gallbladder issues.
I have acid reflux for at least the past few years and, per my GI at the time, slow motility in my digestive tract. Per my current GI I may have IBS also. Most of my symptons were diarrhea, stomach aches/discomfort, and soft and black stools. Prilosec has made these symptons bearable and has helped relieved them to some degree, however still have some of the above symptoms and gassiness. In truth, I never really felt that I had classic traditional heartburn or had problems eating certain foods, such as I could eat spicy foods and not have much change in my symptoms.
However, in the past year I have developed additional painful symptoms:
Alternating pain between my right chest muscle and right under my right rib, like a throbbing or someone grabbing me under the rib - this initially started off as pain in my right upper back, but now it's rare to have the pain in the back. The pain definitely tends to happen after eating, but also when laying down to sleep and when waking up in the morning. Pain killers, such as Advil and Vicodin do almost nothing to relieve the pain, however once I tried Vicoprofen and it helped a little, but this is a very potent drug and it felt very addictive as I enjoyed its effect on me, so this drug is out. I also have nausea, a bitter bile taste in my mouth, a feeling of fullness due to the nausea, some heartburn. Fatty/Oily foods tend to inflame the pain the worst, but eating in general tends to aggravate it. The pain is debilitating as I can't concentrate, am ultra sensitive to any noise or stimuli, and in general am not able to function.
My PCP says I have classic gallbladder symptoms and wants to remove the gallbladder. A GI and a surgeon that removes gallbladders will remove the gallbladder if I insist as I'm at my wit's end, but they think it could be musculo-skeletal, which my PCP says doesn't make sense as I get the pain after eating. After discussing this with the GI and surgeon, they agree that musculo-skeletal doesn't appear to make sense either.
I will be seeing another GI for a second opinion, but at this point I'm ready/willing to have gallbladder removal surgery. Thoughts or suggestions on this? Thanks so much!
I have acid reflux for at least the past few years and, per my GI at the time, slow motility in my digestive tract. Per my current GI I may have IBS also. Most of my symptons were diarrhea, stomach aches/discomfort, and soft and black stools. Prilosec has made these symptons bearable and has helped relieved them to some degree, however still have some of the above symptoms and gassiness. In truth, I never really felt that I had classic traditional heartburn or had problems eating certain foods, such as I could eat spicy foods and not have much change in my symptoms.
However, in the past year I have developed additional painful symptoms:
Alternating pain between my right chest muscle and right under my right rib, like a throbbing or someone grabbing me under the rib - this initially started off as pain in my right upper back, but now it's rare to have the pain in the back. The pain definitely tends to happen after eating, but also when laying down to sleep and when waking up in the morning. Pain killers, such as Advil and Vicodin do almost nothing to relieve the pain, however once I tried Vicoprofen and it helped a little, but this is a very potent drug and it felt very addictive as I enjoyed its effect on me, so this drug is out. I also have nausea, a bitter bile taste in my mouth, a feeling of fullness due to the nausea, some heartburn. Fatty/Oily foods tend to inflame the pain the worst, but eating in general tends to aggravate it. The pain is debilitating as I can't concentrate, am ultra sensitive to any noise or stimuli, and in general am not able to function.
My PCP says I have classic gallbladder symptoms and wants to remove the gallbladder. A GI and a surgeon that removes gallbladders will remove the gallbladder if I insist as I'm at my wit's end, but they think it could be musculo-skeletal, which my PCP says doesn't make sense as I get the pain after eating. After discussing this with the GI and surgeon, they agree that musculo-skeletal doesn't appear to make sense either.
I will be seeing another GI for a second opinion, but at this point I'm ready/willing to have gallbladder removal surgery. Thoughts or suggestions on this? Thanks so much!
School example of gallbladder or biliary tree disorder. When you eat fats, gallbladder is contracted to expell bile, which is needed to digest fats. If there are stones/sludge in the gallbladder, this causes pain on the right side under the rib cage. Ultrasound is not accurate enough to detect small stones. The most reliable test of gallbladder function is a HIDA scan which shows "ejection fraction" of bile during gb contraction. HIDA may also show eventual problems in biliary ducts.
Black stool, unless you are taking iron pills or Pepto-Bismol, is a sign of GASTRIC (stomach) BLEEDING. Burping/upper abd bloating/heartburn is from excess gastric acid, mostly caused by H. PYLORI infection. So you should also have a breath test for H. pylori.
Black stool, unless you are taking iron pills or Pepto-Bismol, is a sign of GASTRIC (stomach) BLEEDING. Burping/upper abd bloating/heartburn is from excess gastric acid, mostly caused by H. PYLORI infection. So you should also have a breath test for H. pylori.
I wouldn't jump into removing the gallbladder. Especially if there are no signs of stones. I would seek another opinion and another HIDA scan if you feel strongly it is your gallbladder. Like Boron said it will show if it is functioning. Even if it's not functioning well and there are no stones you need to rethink surgery. Removing often does not relieve the symptoms, then you are just left with an unnecessary surgery, scars and nothing gained... and in a lot of cases chronic diarrhea.
Beside stones, there may be a "biliary sludge" in the gb, which is a kind of pre-stones bile - stones will eventually develop from it. Ultrasound often can't detect this sludge. CT is much better for detecting sludge, but even this is not entirely reliable. HIDA is most reliable, but it actually doesn't show stones, but only gb function.
So, it is possible that someone have lowered gb function due to stress or "unknown reason". Stress usually affects both ballbladder and main biliary duct. Now, when you remove gb, biliary duct still remains in andcontinue to cause pain. Sometimes this may be resolved by incision in sphincter of Oddi, but not always and it has considerable risk.
If gallstones won't be find by any investigation, I agree that full investigation of biliary tree (by ERCP I guess) should be done before any surgery.
So, it is possible that someone have lowered gb function due to stress or "unknown reason". Stress usually affects both ballbladder and main biliary duct. Now, when you remove gb, biliary duct still remains in andcontinue to cause pain. Sometimes this may be resolved by incision in sphincter of Oddi, but not always and it has considerable risk.
If gallstones won't be find by any investigation, I agree that full investigation of biliary tree (by ERCP I guess) should be done before any surgery.
If you're willing to try something 'off the beaten track' before you head for surgery, consider contacting a PT or other professional who is well-trained in Barral visceral manipulation techniques. As crazy as is sounds, it can and does work. You can contact the Barral Institute and talk to them about a referral to an experienced person if you'd like to talk to a 'human being' instead of checking the website.
This is not 'schlock' treatment. The techniques were developed by a French osteopath and are used extensively in Europe. They're only becoming more 'known' here in the U.S. as 'the doc' is becoming more well-known. I believe it was a year ago (?), he was named one of Time's 'Man of the Year,' so I think that places him in very respectable company.
This is not 'schlock' treatment. The techniques were developed by a French osteopath and are used extensively in Europe. They're only becoming more 'known' here in the U.S. as 'the doc' is becoming more well-known. I believe it was a year ago (?), he was named one of Time's 'Man of the Year,' so I think that places him in very respectable company.
Thanks for the insights. My PCP said that sludge is probably the culprit. I'll ask about checking out the biliary duct as all the tests have not shown any gallstones and the gb appears to be working fine.
The endoscopy I had was an upper endo, so not sure if the bile ducts were checked out. I'll ask my GI to see what he thinks.
The endoscopy I had was an upper endo, so not sure if the bile ducts were checked out. I'll ask my GI to see what he thinks.
ERCP is done during upper endo, but only when necessary. They fill contrast into your biliary tree (from the duodenal opening of bile duct) and then make x-ray pictures. If eventual disorder is find, sometimes can be repaired just during that procedure. Investigation can reveal stones or stenosis in biliary duct or in the area of sphincter of Oddi (exit of bile duct).
Non-invasive alternative of ERCP is MRCP. They simply make a MR pictures of your biliary tree. Maybe this MRCP can also show, is it sludge in your gallblader or not.
What you want to know first is: is it sludge or not. So, MR or CT can show this. If it is sludge you can expect ongoing problems, if you keep gb. The next thing you want to know, is if your biliary duct, especially its last part (sphincter of Oddi) are working properly. This may be checked with ERCP and sphincter manometry, which I believe it can be at the same time.
All this is a delicate matter. Above suggestion to contact someone experienced may be worthy for you.
Non-invasive alternative of ERCP is MRCP. They simply make a MR pictures of your biliary tree. Maybe this MRCP can also show, is it sludge in your gallblader or not.
What you want to know first is: is it sludge or not. So, MR or CT can show this. If it is sludge you can expect ongoing problems, if you keep gb. The next thing you want to know, is if your biliary duct, especially its last part (sphincter of Oddi) are working properly. This may be checked with ERCP and sphincter manometry, which I believe it can be at the same time.
All this is a delicate matter. Above suggestion to contact someone experienced may be worthy for you.
Talked to my GI about the above discussion:
He said that a biopsy was done during the Upper Endo for H Pylori, no H Pylori was found so that is the definitive answer and thus he does not recommend a breath test.
He recommends a MRCP before an ERCP to check the bi ducts - the ERCP was not performed during my Upper Endo. If the MRCP comes back normal then he sees no reason for an ERCP.
We talked about the Sphincter of Oddi, but he doesn't do this and is more of a specialty, and if I'm characterizing this properly, he says that there is not much documentation on this.
He also says that the ultrasound is the best initial test for detecting gallstones and sludge, and none was found from my results.
He says my gallbladder is functioning properly per all the tests and he sees no reason to remove it, and all my pain/discomfort may continue even with gb removal.
He said that a biopsy was done during the Upper Endo for H Pylori, no H Pylori was found so that is the definitive answer and thus he does not recommend a breath test.
He recommends a MRCP before an ERCP to check the bi ducts - the ERCP was not performed during my Upper Endo. If the MRCP comes back normal then he sees no reason for an ERCP.
We talked about the Sphincter of Oddi, but he doesn't do this and is more of a specialty, and if I'm characterizing this properly, he says that there is not much documentation on this.
He also says that the ultrasound is the best initial test for detecting gallstones and sludge, and none was found from my results.
He says my gallbladder is functioning properly per all the tests and he sees no reason to remove it, and all my pain/discomfort may continue even with gb removal.
Well, some comments:
1. If you are not BLOATED in upper abdomen, and if you don't burp, you don't have heartburn, then it may be assumed that H. pylori is not the cause. I mean, if no symptoms, no reason to bother.
2. MRCP before ERCP sounds reasonable.
3. Sphincter of Oddi Dysfunction (SOD) is well known disorder. It is diagnosed by manometry (measurment of pressures in the bile duct), ERCP and possibly HIDA scan. MRCP cannot show SOD, since this is a functional, not anatomic problem.
GI maybe wanted to say, that he doesn't deal with SOD, since he is not specially trained for that. Just search online for "Sphincter of Oddi Dysfunction (SOD)" and you'll see how much is writen about it.
4. Ultrasound is officialy always the first investigation in gallblader problems, but it OFTEN misses small gallstones and sludge. It was reported few times on this forum, that ultrasound showed nothing, but CT did. Ultrasound is really not good for these "borderline" issues. It can show fairly large stones, sometimes sludge, but not always.
I think, you should have MRCP, and ask GI, if this MRCP would also show eventual sludge or stones in gallbladder.
1. If you are not BLOATED in upper abdomen, and if you don't burp, you don't have heartburn, then it may be assumed that H. pylori is not the cause. I mean, if no symptoms, no reason to bother.
2. MRCP before ERCP sounds reasonable.
3. Sphincter of Oddi Dysfunction (SOD) is well known disorder. It is diagnosed by manometry (measurment of pressures in the bile duct), ERCP and possibly HIDA scan. MRCP cannot show SOD, since this is a functional, not anatomic problem.
GI maybe wanted to say, that he doesn't deal with SOD, since he is not specially trained for that. Just search online for "Sphincter of Oddi Dysfunction (SOD)" and you'll see how much is writen about it.
4. Ultrasound is officialy always the first investigation in gallblader problems, but it OFTEN misses small gallstones and sludge. It was reported few times on this forum, that ultrasound showed nothing, but CT did. Ultrasound is really not good for these "borderline" issues. It can show fairly large stones, sometimes sludge, but not always.
I think, you should have MRCP, and ask GI, if this MRCP would also show eventual sludge or stones in gallbladder.
You are as insightful as always, thank you. I will see my PCP to schedule the MRCP as soon as possible. In the meantime I'll see another GI, although the recommended one's next appointment is in mid-August.
I've been cleared for gb removal, but hesitant to go ahead at this point. Although, I just ran into one of my sisters who just had hers removed last week and she seems totally fine! She had a huge gallstone though, so the circumstances are different, at least as a result of the tests, and she only had an ultrasound performed.
In the meantime I'm focused on pain management - one of my doctors told me to use a hot compress and to drink warm water in the evening. I'll let you know how it all works out.
I've been cleared for gb removal, but hesitant to go ahead at this point. Although, I just ran into one of my sisters who just had hers removed last week and she seems totally fine! She had a huge gallstone though, so the circumstances are different, at least as a result of the tests, and she only had an ultrasound performed.
In the meantime I'm focused on pain management - one of my doctors told me to use a hot compress and to drink warm water in the evening. I'll let you know how it all works out.
My daughter was having bad abdominal pain and gallbladder appeared okay accorking to ultrasound. Hida Scan however showed it to ony be functioning at 10%. She then had the gallbladder surgery to remove gallbladder, but is still experiencing the same pain. She just had a MRCP mri yesterday and has been diagnosed with Median Arcuate Ligament Syndrome and is to see a vascular surgeon next.
A good idea to have all possiblities checked out before having gallbladder removed.....
We feel our daughter's was removed needlessly.
A good idea to have all possiblities checked out before having gallbladder removed.....
We feel our daughter's was removed needlessly.
After ongoing pain and discomfort and further discussion with my PCP and GI docs, I've decided to go for the gb removal surgery. The gb is noncritical and many people function fine without it. I asked about the MRCP and it would take a little while to get it approved by insurance. While not definitive, the bi ducts would've been seen to some degree with the various tests that I've had (ultrasound, CT, Hida, endo - not sure which ones). If the MRCP came back showing sludge, removal of gb would be recommended in either case.
The pain/discomfort is more constant and has built up over the past 8 months, and thus does not look like it's going away. Thus it appears that my chance of recovery is currently 0% ... with gb removal the docs are telling me it's 50% based on similar cases to me that they've seen. Surgery is for next week, I've at least asked the surgeon if MRCP can be done prior as part of the presurgery testing.
The pain/discomfort is more constant and has built up over the past 8 months, and thus does not look like it's going away. Thus it appears that my chance of recovery is currently 0% ... with gb removal the docs are telling me it's 50% based on similar cases to me that they've seen. Surgery is for next week, I've at least asked the surgeon if MRCP can be done prior as part of the presurgery testing.
I understand you are in a lot of pain and that removing your GB gives you hope that you will get better. However, I had this same hope and I remain sick after the GB removal. I urge you not to rush into it. While they say the GB is not essential it is helpful. I feel the doctors found mine wasn't working (0%) so it must be causing my left sided pain (even though the GB is on the right side). Since I am having the same problems I was having prior to surgery I do not believe my GB was the problem and now getting them to look further is almost impossible.
Did you get a HIDA scan? Just curious what they are basing the reason for removing your GB. You also posted the GI said it was not your GB... so it's confusing as to the reasoning behind the decision.
Did you get a HIDA scan? Just curious what they are basing the reason for removing your GB. You also posted the GI said it was not your GB... so it's confusing as to the reasoning behind the decision.
Hi Cheri70, can you elaborate on why the Dr's say looking further is almost impossible after GB removal? I have a HIDA ejection fraction of 7%, but no stones under ultrasound nor CT. I am also scheduled to have my gb removed... I have also heard others who have pain on the left but got their gb removed, and continued to have the same symptoms.
All investigations you've had, were to check only gallbladder. If even your HIDA scan was OK (what % was it?), then there's really a question, if it is gallbladder. Your symptoms may all arise from biliary duct - in this case removing of the gallbladder wouldn't help.
I would recommend you have MRCP before surgery. After gallbladder removal, constant diarrhea may be a problem, since bile is flowing into intestine all the time, and because it can't be all re-absorbed in the small intestine, it reaches the colon where it triggers diarrhea.
I would recommend you have MRCP before surgery. After gallbladder removal, constant diarrhea may be a problem, since bile is flowing into intestine all the time, and because it can't be all re-absorbed in the small intestine, it reaches the colon where it triggers diarrhea.
The surgeon and pcp don't feel that MRCP is warranted before surgery, so I guess I'm kind of stuck in the meantime. I don't know what % my HIDA scan was, but I can inquire as supposedly it was OK. The surgeon and pcp told me that 50% of cases similar to mine resolve issues. As I have trouble functioning during day, sleeping, staying asleep, I'm willing to go ahead and try their recommendation.
The drs didn't say it was impossible, I'm saying it's almost impossible to get them to see why I am still in pain. First it was "it takes time to heal" and now it's "we aren't seeing anything - maybe you are constipated" (??), however they hadn't really tested for anything either. I just had an MRCP on Saturday and I await the results.
If 50% get better, then 50% get worse. Post surgery I had a good 5 months of pain so bad I could not function and at that time doctors telling me to deal with it. It was way worse than prior to surgery. Now I am finally back to the way I was prior to surgery, so "back to where I started", although now I also have upper left/center pressure pain.
I wouldn't remove my gallbladder without at least knowing my HIDA scan results. Anything over 35% means it's working fine. I also question removing a gallbladder that does not have stones. I wish I had listened to boards like this before surgery, I'd be less doctor bills, less scars and less pain.
If 50% get better, then 50% get worse. Post surgery I had a good 5 months of pain so bad I could not function and at that time doctors telling me to deal with it. It was way worse than prior to surgery. Now I am finally back to the way I was prior to surgery, so "back to where I started", although now I also have upper left/center pressure pain.
I wouldn't remove my gallbladder without at least knowing my HIDA scan results. Anything over 35% means it's working fine. I also question removing a gallbladder that does not have stones. I wish I had listened to boards like this before surgery, I'd be less doctor bills, less scars and less pain.
I've been eating pretty healthy for awhile now, I'm guessing a low-fat diet as I've been avoiding fatty and oily foods, sauces, etc. In addition, with my GERD, I try to eat bland food. I admit that on occasion I eat a little something sweet, but it's very little and very rare, and symptons do get somewhat worse, but life without a little sweet now and then is not much of a life IMHO. However, regardless of the foods that I eat, the pain and discomfort is pretty regular and constant: right abdomen below ribs and right chest muscle - the muscle tends to get worse when I turn and when I lie down.
I'm not sure about rushing into gb removal on the basis of 50/50 promise of improvement (statistical) without knowing what's behind. Would you mind to get results of your HIDA scan?
I was not trying to force you into a "healthy diet". You've mentioned that fatty foods cause you pain. Fats are in: meat, oil, butter, margarine, egg yolk, dairy, nuts, chocolate. It's not about dropping all fat, just to limit it. Fats directly trigger gallbladder contraction and pain. I was not saying anything about sweets in general, only about fat.
Just saw another GI for a 2nd opinion. He thinks it could be microscopic or nonspecific colitus and recommends a colonoscopy. He was very baffled why gb surgery was recommended and OK'd when all tests came back negative/normal, as they're able to see gb and duct with all the tests that I had. I will discuss this with my other docs and most likely cancel the surgery and go for the colonoscopy.
I agree with all the suggetions made by Boron so far. Surgery for GB removal can always
be re-scheduled later. Right now, I`m suffering thru the 4th day of a mild GB attack. This is now the 4th since 2006. In my case the attacks last about 5 days then re-occur 6 to 9 months later - after a large meal. Pain begins just below rib cage on right side. With all
the tests you have had so far it may be your GB is inflamed. I can offer what works for me when an attack starts. No solid food for 3 days only quality apple and cranberry juices. 4th day, soups, apple sauce, steamed vegetables. 5th day, add small amounts
of lean chicken. I would suggest avoiding coffee, sweets, chocolate, peanuts, eggs, soft
drinks. Drink lemon water and fruit juices. THe black stools are troublesome.Tell me more about the frequency of this condition. Some years ago , I was prescribed Prilosec
for Acid Reflux which i did not tolerate well. I felt nauseated and weak. After a BM, noticed some food that passed thru my intestines undigested. I now use DGL, Deglycyrrhiziated Licorice tablets. DGL has the ability to protect the digestive tract from corrosive stomach acids. A good friend of mine is a pharmacist who said the Proton Pump Inhibitors were never meant for long term use. Maybe 6 to 8 weeks max. Decresing stomach acid can bring on poor nutrient absorption from food causing gas and general body weakness in some people. Have you been using Prilosec for a long time ?
be re-scheduled later. Right now, I`m suffering thru the 4th day of a mild GB attack. This is now the 4th since 2006. In my case the attacks last about 5 days then re-occur 6 to 9 months later - after a large meal. Pain begins just below rib cage on right side. With all
the tests you have had so far it may be your GB is inflamed. I can offer what works for me when an attack starts. No solid food for 3 days only quality apple and cranberry juices. 4th day, soups, apple sauce, steamed vegetables. 5th day, add small amounts
of lean chicken. I would suggest avoiding coffee, sweets, chocolate, peanuts, eggs, soft
drinks. Drink lemon water and fruit juices. THe black stools are troublesome.Tell me more about the frequency of this condition. Some years ago , I was prescribed Prilosec
for Acid Reflux which i did not tolerate well. I felt nauseated and weak. After a BM, noticed some food that passed thru my intestines undigested. I now use DGL, Deglycyrrhiziated Licorice tablets. DGL has the ability to protect the digestive tract from corrosive stomach acids. A good friend of mine is a pharmacist who said the Proton Pump Inhibitors were never meant for long term use. Maybe 6 to 8 weeks max. Decresing stomach acid can bring on poor nutrient absorption from food causing gas and general body weakness in some people. Have you been using Prilosec for a long time ?
Prilosec doesn't seem to have real problems taken long-term from what I hear, as I've been on it for years, maybe 5 years or so. Also a Net search on this topic seems to confirm this. While it wasn't supposed to be taken long-term, people have done so and it's one of those things that I generally never hear problems about, at least it's not one of those news stories that shows up where there are lawsuits left and right. For gas I take Gas Defense that has the probiotics or whatever the good bacteria stuff is called and this helps tremendously.
Without Prilosec I have stomach aches, diarhea, constant needs to relieve myself, bloating, gas, black tarry stools ... thus for me Prilosec is well worth it as it makes all these symptoms more manageable, although it does not solve my problem.
Thanks for the tips on eating/drinking, I'll give it a whirl and see what happens. I generally try to eat fairly bland and not heavy as it's not worth having the pain on the right under the ribs. My colonoscopy isn't for a couple of weeks, but will report back how it goes.
Without Prilosec I have stomach aches, diarhea, constant needs to relieve myself, bloating, gas, black tarry stools ... thus for me Prilosec is well worth it as it makes all these symptoms more manageable, although it does not solve my problem.
Thanks for the tips on eating/drinking, I'll give it a whirl and see what happens. I generally try to eat fairly bland and not heavy as it's not worth having the pain on the right under the ribs. My colonoscopy isn't for a couple of weeks, but will report back how it goes.
My GI where I got the second opinion suggested isometric exercises to help with the pain in the right chest muscle. I've been practicing these and some additional isometric abdominal exercises for a couple of days now. These do seem to be helping so far at least a little bit, which is the only relief I've been able to have. The other doctors I've seen gave me 3 options: live with the pain and sometimes it goes away (I've had this pain everyday for 8 months), take narcotic painkillers, have surgery. At the minimum it's nice to have some other healthy options that I can perform myself. This in addition to a low far diet and some exercise help to manage the symptoms, although the disease is still present.
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