Hida Scan High Ejection Fraction

[jrabbit1972]

I've been evaluated over the last month for gallbladder disfunction after pain in my right side and abdominal pain with or withour eating. I have terrrible fatigue, pain in my right flank and lower back, anemia, nausea and headache.  The US and CT were normal and all bloodwork normal other than the anemia.  A colonscopy and upper endo showed some erosion of the stomach and duodenum with irritation and inflammation throughout.  Biopsies were all normal.  I had a HIDA scan on Tuesday.  I was told the results were "normal" at 88% EF and to wait a month to follow-up with the GI Doc.  I had terrible pain during the CCK portion and continue to have the same symptoms with severe tiredness. To complicate things I have (thankfully) mild SLE with flares of joint pain, pleurisy and exhaustion.  I suffer from chronic UTIs and take a daily antibitotic and anti-depressant as well as plaquenil.  I read some info on Hyperkinetic Gallbladder and how the symptoms can be similar.  Are there any suggestions about where to go from here?  I can barely function some days and while I am still working it is difficult to concentrate.   Help!

[Christopher R Watters, MD]

It is very difficult to diagnose sphincter of Oddi dysfunction without first removing the gallbladder. Given the data on symptom relief after cholecystectomy when pain is reproduced with CCK, this rlieves the majority of patients. The other issues are within the expertise of your gastroenterologist and need to be reported to him/her.

[jrabbit1972]

Thank you for your reply.  My GastroEnterologist said that she feels the results were normal and that she wants to look at my Sphincter of Oddi.  She repeated the liver and enzymes test and my Lipase was 69.  She seems to think this has some significance for some reason.  In the meantime, I'm sweating a lot (anxious) and uncomfortable still although the pain has waned.   I have bouts of constipation and diarrhea but am back to eating normally and have more energy.  Two additional symptoms that are concerning is that I have been seeing blood on the tissue after a bowel movement.  This is new and has been happening for about a week.  I also have a lot of mid-to-lower back pain that comes and goes.   I feel like I'm going a little crazy over anylyzing things.  Can you offer any advice?

[Christopher R Watters, MD]

It is becoming apparent that symptom reproduction is a better predictor of good outcome following cholecystectomy than the measured ejection fraction on HIDA scan. With this said, dyskinesia would not explain all of your symptoms. It sounds highly likely that a significant portion of your misery is related to a dysfunctional gallbladder.