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high gallbladder ejection fraction (Page 1)

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I probably should have posted this in this section originally, but I overlooked this category, sorry.

I have been having abdominal pain in my gallbladder area now for several months. The pain almost never goes away and tends to feel like a cramp in my side (like after you have run too long). Blood tests normal, ultrasound normal for gall and kidney stones (family has a big history in these two areas) and upper endoscopy came back normal with a note of exessive stomach acid, no h-pylori (spelling). Next was the HIDA scan last week. It came back with a 96% gallbladder ejection fraction! Just the opposite of what I expected. Does anyone have any insight to this and how it can be so high? What does that mean exactly? Seems like it is somewhat unusual and there's not a lot of answers. Any help would be awesome.

Thanks,

Jeff
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First Helper alicanada
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replied September 8th, 2008
Same thing here..
My HIDA scan came back at 77%, all other tests normal, but it's been hurting just like you discribed for 2 months now. I had an ER doc tell me there could still be bilary colic but it doesn't show up on tests. I really want an answer also.
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replied March 23rd, 2009
HYDA scan
Hi Jeff, I could have writen your post for you! I have had the same thing for nine months.All my test were normal to.My ejection fraction was allso 96%.My Doc said' it's normal.Than he gave me the stink-eye when I said' it still hurt.I am looking for a new Dr.. The GI Doc has even cut me loose...I Have fond a few new articles about this and how super normal is not normal,that Doc's have been ignoring or are unaware of the new research that's been published. Plaese let me know what's happend.
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replied June 10th, 2009
You have pretty much described me
I have the same issue only my ejection fraction is at 80%...everything else "normal"...No stones, no h-pylori, no ulcers....everything checks out fine BUT I have that pain....It feels like a cramp/side stitch only in my upper right side. When it starts I can't get comfortable in any position and movement about kills it. They are insistent that it's not a GB problem ( multiple doctors have said it) but yet they cannot find a cause for this. Meanwhile it's costing a small fortune in bills/co pays. I am losing hope of ever being rid of this!
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replied November 20th, 2011
SOUNDS JUST LIKE ME!!!!!!!!
All these posts are starting to sound like me! I have had a normal ultrasound, normal HIDA scan (92% EF), nothing was on the endoscopy, and my blood tests showed high liver function at first but now the blood tests have become normal again. They have put me on Bentyl for a two week trial, but it is starting to effect my urination as well as dizziness and shakes...Since this has been a little over 2 years since your post...what did they eventually find with you?
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replied June 10th, 2009
Extremely eHealthy
I had a similar problem, but it was caused by a lung infection/pleurisy (inflammation of the lining of the lungs that was really painful). I was given medication and my x-rays were coming out better, but I was still in pain. Eventually the doctor figured out that I had tightened up the muscles in my back, side, and stomach, probably bracing myself for the pain before. Then, once the other pain stopped, but muscles never relaxed and then they started to hurt. Push on certain areas and it feels like the worst bruise I've ever had. Plus, I have this dull ache and some spasms.

I'm not saying this is defiantly what it is for you guys, but maybe it started out as a gallbladder attack or a stone that passed, but now you have the muscle pain left over. I've been in physical therapy for five weeks and I'm about 50% better (I had a long way to go, so that's much better). It wasn't the lung specialist that caught it for me, it was my regular doctor. Sometimes they are better at catching things than the specialist who is only looking for things in his field.

Just a thought. I really hope you find what the problem is.
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replied November 21st, 2009
High gallbladder ejection fraction on HIDA (hepatobiliary) scan
To Savannah0410,jlipsey,Marathongirl,andjbarr aclough, It is just becoming evident that a high gallbladder ejection fraction on HIDA (hepatobiliary) scan can be evidence of gallbladder dysfunction and can be associated with significant pain. I am a physician with expertise in Nuclear Medicine. My colleagues and I are in the process of submitting cases to the literature showing that we have removed gallbladders in patients with high gallbladder ejection fractions and found that their pain was relieved and their gallbladders showed chronic inflammation on microscopic examination.
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replied April 14th, 2011
94% HIDA - need to how doc this is NOT normal
CAn you point me to any research/publications I can take to my doctor who is still insisting that 94% is normal?
Thank you.
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replied December 21st, 2009
To help4u,

Many thanks for your response. I was recently found to have an ejection fraction of 96% all other tests have been found to be normal or assymptomatic (duodenal diverticulum on ERCP, pancreas divisum with manometry).

From the mechanism of action used to describe the etiology of symptoms due to high ejection fraction it seems all should give pain reproduction with CCK infusion?

I had no worsening of pain during or after the HIDA scan.

It it possible for the gall bladder to be symptomatic in the absence of pain reproduction during and after
HIDA scan?
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replied January 29th, 2010
High Ejection Rate HIDA Results: Not necessarily normal.
Nearly a month ago I had a fairly sudden attack of upper right quadrant pain, bloating and fullness penetrating straight through to my back. It kept me up all night that night, not knowing what was wrong, wondering whether I should wake my husband and son to take me to the ER. The next day I went to the doctor. She felt that what I was describing were "classic gallbladder symptoms" and sent me off for a blood test to check for liver and kidney function (since they are also in that area) and also an ultrasound to look at the gallbladder. The ultrasound showed some "contraction" and slight wall thickening (9mm), which were pronounced inconclusive results. My pain / symptoms have been fairly constant for the past month. At a bare minimum it's a dime-sized pressure point area in my upper right back that feels like someone is pushing really hard on me with their thumb. Most of the time I also have the bloated "pit" feeling under my right rib cage. Only pain medications are allowing me to get sleep. Doctor says having a constant pain is atypical for gallbladder, usually it comes and goes with periods of feeling totally normal and attacks that last a few hours. Atypical symptoms combined with "normal" test results mean no diagnosis yet. I got a referral to both a surgeon and a GI specialist. The surgeon sent me for a HIDA while I was waiting to get an appt with the GI. When I called for the HIDA results I was told by the nurse that the test showed everything was "normal". However, when I had my follow up appointment with the doctor, she indicated the results showed an 88% ejection rate, which is technically considered "normal", but she was starting to see case studies about high ejection rate pain symptoms in patients, and she had another patient with the same symptoms and a 93% ejection rate for whom the removal of the gallbladder solved her symptoms. She suggested that the medical community is starting to pay attention to higher numbers. Monday I will have an Upper GI Endoscopy and assuming those results are normal - ruling out other possible causes of this pain - I will schedule a gallbladder removal. It seems wrong to hope for abnormal results on a medical test, but until we know what's wrong we don't know what to do to fix it and I'm pretty miserable. The intensity of the pain isn't severe, it's the constant discomfort and difficulty sleeping that wears you down. Good luck to everyone.
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replied January 31st, 2010
My symptoms are very similar to yours and didn't become constant until the did an endoscopy using pethidine for an anesthetic then put me on morphine for pain - big mistake.

I've found a doc who's willing to take my GB out based on the ejection fraction alone but I'm still not sure.

Historically it seems they've know hyperkinetic gall bladders can be problematic for decades but it's still controversial.

I just read a study in which thickening of the GB wall is a common finding in hyperkinetic GB and is termed Hyperplastic Cholecystoses and I think your case is clearer than mine.

It seems you should get pain from fatty foods and the CCK infusion with low EF to indicate the GB is a problem according to some docs. Yet I've found several studies that found no correlation with pain on CCK, low EF on HIDA scan and successful pain relief with GB removal - so I see no reason why high EF should be different.

Apparrently EF above 90% - especially in the high 90's is extremely problematic and indicative of a dysfunctional GB according to recent research and there's only been one study that investigated high EF and GB removal. All but one of the patients got full or good pain relief after. This is a much better correlation than similar studies with GB removal and low EF. But this is only one study with a small test population.

I'd just like to hear if pain on CCK infusion and fatty foods is essential for a dysfunctional GB in high EF before getting mine out. The problem is if it's the sphincter Oddi that's causing the problem GB removal can make it much worse. So you don't just whip it out without careful consideration - especially if you're female where SOD is more common.

At the moment I'm having a lot of success with sub lingual nitrates and baclofen which you might find helpful until you make a decision.
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replied January 31st, 2010
My symptoms are very similar to yours and didn't become constant until the did an endoscopy using pethidine for an anesthetic then put me on morphine for pain - big mistake.

I've found a doc who's willing to take my GB out based on the ejection fraction alone but I'm still not sure.

Historically it seems they've know hyperkinetic gall bladders can be problematic for decades but it's still controversial.

I just read a study in which thickening of the GB wall is a common finding in hyperkinetic GB and is termed Hyperplastic Cholecystoses and I think your case is clearer than mine.

It seems you should get pain from fatty foods and the CCK infusion with low EF to indicate the GB is a problem according to some docs. Yet I've found several studies that found no correlation with pain on CCK, low EF on HIDA scan and successful pain relief with GB removal - so I see no reason why high EF should be different.

Apparrently EF above 90% - especially in the high 90's is extremely problematic and indicative of a dysfunctional GB according to recent research and there's only been one study that investigated high EF and GB removal. All but one of the patients got full or good pain relief after. This is a much better correlation than similar studies with GB removal and low EF. But this is only one study with a small test population.

I'd just like to hear if pain on CCK infusion and fatty foods is essential for a dysfunctional GB in high EF before getting mine out. The problem is if it's the sphincter Oddi that's causing the problem GB removal can make it much worse. So you don't just whip it out without careful consideration - especially if you're female where SOD is more common.

At the moment I'm having a lot of success with sub lingual nitrates and baclofen which you might find helpful until you make a decision.
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replied January 31st, 2010
My doctor has suggested that correlating fatty foods to GB symptoms may not be proven (?). I eat pretty healthy anyway, but I did an experiment so I could report whether or not a high fat meal caused my symptoms to increase and it did not: I was feeling pretty good for two days and ate a cheeseburger and french fries meal with no ill effects. That's only a single incident so who knows - maybe it was particularly low fat burger and fries <ha ha>.

My doc gave me the sub-lingual pill and I tried it twice with no improvement in my symptoms - not sure what that means in terms of my diagnosis, have not been able to report that to him yet.

The endoscopy I'm having tomorrow is not the type that includes the manometry necessary to diagnose SOD, it's probably too late to ask him to include that at this point but I will ask about it before the procedure, thanks for mentioning SOD to me.

Good luck to everyone.
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replied January 31st, 2010
Interesting about fats. I have friends who have had GB problems that definitely got pain with fats, but there seems to be plenty of cases where this doesn't occur. I get severe attacks with fiber and bad diarrhea - especially bran - no problem at all with fats. One doc thinks this rules out the GB but I've read elsewhere where this may not be the case at all.

Sounds like you have a good doctor. The sub lingual pill was likely a nitrate. This is a non specific smooth muscle relaxant.

It will relax the sphincters - so is used for sphincter oddi dysfunction, but also the gall bladder, coronary arteries - so it's used for angina - and even the gut. Improvement with nitrates then doesn't tell you much - failure to improve may indicate you have some sort of condition not directly related to smooth muscle.

The sphincter oddi for example can be stenosed - ie a physical obstruction. A simple blood test should show elevated enzymes if this is the case. An inflamed gall bladder likely wouldn't respond to nitrates either.
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replied January 31st, 2010
I do feel that I have a good doc, actually two good docs: the GI and the surgeon.

The sub lingual is HyoMax-SL. It is supposed to be a muscle relaxer for the digestive tract. The fact that it didn't work must be a clue; I'll let the doc know.

The doc also sent me to the lab for a CBC last Thursday so hopefully they were checking for the elevated enzymes that could be an indicator of SOD. I'll ask.

From what I've read about SOD, that is more complicated to both diagnose and treat so I'm hoping that's not the case for me.

Thanks.
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replied January 31st, 2010
Hyomax is hyoscamine, either an anticholinergic or muscanaric if I recall. It's available over the counter as a pill in some countries as Buscopan.

It's not a sublingual nitrate and doesn't work the same way. I found it totally useless as well - I took 8 on one particularly bad day and it did nothing.

Typically they prescribe this when the suspect things like IBS but it's supposed to be of some help in SOD.

If this didn't work for you I wouldn't bother with drugs like mebeverine/colofax, nifidipine/Aladat and maybe even the TCAs like Doxipen that they typically go for next.

You really need an ERCP with manometry to diagnose SOD and even that's not predictive of surgical success with type 111 (no elevated enzymes or dilated ducts) and it carry a risk of pancreatitus from the test alone.

I've had the test but they couldn't enter the common bile duct - so they could only test the pancreatic ducts (I had 2). So they did a HIDA scan and came up with the 96% ejection fraction. At the time the doc said this rules out SOD and GB problems as it's emptying well so it must be IBS.

Laster research found this to be false. HIDA scan can't predict SOD at all and 96% is not good.

Problem if it isn't the GB (and there was one person with high EF in the study who didn't improved with GB removal) - the SOD can get much worse - removal actually causes SOD in 10% of cases. So it's a very tough call.

I've been offered GB removal with sphincterotomy in the same session. From the research tough it seems there's a very low success rate with sphincterotomy and a high rate of complication, scarring and later re-closure so GB removal might be the best option.

I'd really love to hear from help4u on this topic.
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replied February 4th, 2010
Update: Endoscopy showed inflammation of my stomach lining and polyps which were biopsied, I was prescribed a prilosec type of medication and told to come back in two weeks to get biopsy results. I'm feeling OK past two days: still have the ever-present thumbprint-sized pressure in my upper right back (directly behind my gallbladder). Will be interesting to see how this all turns out.
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replied April 11th, 2010
Gallbladder Pain - it may not be your gallbladder
I have been suffering with this same pain since I was 19 and I''m now 45. Had Dr''s run the battery of tests and they all said nothing was wrong. I have constant pain in my upper right side like someone is pressing from the inside. When I have an attack it''s like having the stomach bug 10 fold, with sever vomiting and diarrhea along with pain. I had one doctor say I had IBS and another say since I obviously was getting my nutrients (since I''m a little overweight) he thought everything was in my head. I recently visited my friend in a rural small town who''s husband is a Dr. He asked to see my records. He immediately saw a pattern and was zoned in on the Common Bile Duct and Sphincter of Oddi. My HIDA scan shows EF of 78% which in his opinion is on the high end and my Common Bile Ducts showed significant enlargement. He sent me directly to the hospital for blood and ultrasound. The blood was ok but the ultrasound showed my Common Bile Duct was even larger and my gallbladder enlarged. He consulted with a surgeon and they want me to have a MRI to rule out obstruction of the Common Bile Duct.

Has anyone ever mentioned to you about your Sphincter of Oddi. John Hopskins Hospital specializes in this area, it occures between 30-50 year olds, pain, vomiting etc. occures but it is not the gallbladder. It''s where the valve in the Sphincter of Oddi does not open properly and all the bile from the liver and gallbladder back up causing the pain and once the pressure is great enough it forces it out of the valvue and back up into the gallbladder.

I''m hoping that we get to the bottom of this because I''ve suffered for 25 plus years with this pain. I''m tired of Dr''s not listening because test are in the so called Normal Range. What''s normal for one person may not be for another.

I was also told that if the problem is in the Common Bile Duct or the Sphincter of Oddi gallbladder removal does not work, it may even make the problem worse so be sure your Dr. rules out these two area''s before they remove your gallbladder. My tests over the last 25 plus years showed a problem in this area but the Dr''s didn''t seem to think it was a problem even though it was in the abnormal ranges. They were concentrated on the gallbladder and didn''t look further. I''m told an ERCP will help diagnose this problem once all other tests are complete.

Good luck, I''ll keep you posted.

In Pain and Frustrated
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replied June 18th, 2010
I just had an abdominal ultrasound and a HIDA scan done this week. My ejection fraction is 94%. At work yesterday, I was discussing this with a Nurse Practioner who told me that I have an overactive gallbladder and that it needs to come out. Today, I scheduled an appointment with a surgeon. I am suffering severe pain in the right upper quadrant that sometimes radiates down my right flank and into my right thoracic region. I have also had severe nausea, vomitting and diarrhea(sp?). I hope that the surgeon is agreeable with removing my gallbladder.
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replied June 18th, 2010
Finally I find a website with people suffering from my same pain! I have had right upper quadrant pain going on my 3rd week. I have been to the ER 3 times, CT scans, ultrasounds, blood work and a Hida scan which was a the low end of "normal". I had an appointment with a surgeon this week who was really rude and told me that since all my tests were normal he would not consider taking out my gallbladder for at least 2 more weeks.
My medicine cabinet looks like an old ladies medicine cabinet with medications that do not work. I have had 6 people in my family both on my mom and dad's side that have all had their gallbladder removed. I have told all the doctors I have seen about my strong family history and they still dont truely believe it is my gallbladder. I am vomiting or at the very least nauseated all day long. The pain comes and goes under my ribs like contractions sometimes it lasts just a few minutes sometimes the pains come and go all day. I really do not know what to do...how can a doctor tell you live with this pain another 2 weeks and then we might consider taking out your gallbladder. I work in the medical field and have only been able to work 3 days out of the last 2 weeks. I am so frusterated and sick of being in pain....living off ensure drinks and once in awhile trying to live through the agonizing pain to have a normal meal. Good luck to all of you at least I know I am not alone in my suffering.
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replied July 5th, 2010
Gallbladder results
After nearly a year of unexplained nausea in the morning, enlarged nodes in my neck(right side), low grade fever, pain right side chest radiating into neck & shoulder and would end in my right hand...gallbladder removed. Thank goodness sent to a young surgeon...said they were classic symptoms of gallbladder disease..removed it. Nodes have gone down, no fever, no nausea, no pain. Recovery from lap. surgery a little more painful than expected. Recovery a little longer than planned. Tests are not always reliable. Find a doctor that listens to the symptoms. My tests were all normal, with a high infraction rate of 88%. Gallbladder came out looking like an organ of infection.
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Users who thank flowerbloom1 for this post: amyswayze 

replied August 17th, 2010
I went to my Primary Care Dr about 6 weeks ago. Abdominal pain when I eat. Extreme diarrhea. Weight loss. Cramping, gas, bloating etc. She ordered TONS of testing... Celiac, stool samples food allergies etc. All those came back normal. She ordered PIPIDA scan 95% EF. Sent me to GI Dr. I just had an ERD and COLONOSCOPY that came back normal. Went for CT scan today, normal. My GI Dr will not refer me to surgeon based on 95% EF. I am miserable. Instead prescribed me Welchol, which is supposed to help with the bile. 2 pills twice per day. Well now issue is I still have pain but am constipated... until I take something like DULCOLAX and then I explode... Why will know one see that I still have issue and only thing all this points to is GB????
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replied June 21st, 2012
InalotofPAin
I can relate to everyone here. For the past few years i have had right upper quadrant pain. Sometimes sharp sometimes dull. It's a never ending battle. I can't eat, sleep or function. Any time i try to eat not long after, the pain is back and in full gear. I can't get a comfortable position at night when i try to sleep. My husband is frustrated with me and thinks this is all in my head. As much as i'd love to think that its not all in my head. The problems are real and are affecting my quality of life. I've been through countless testing and nothing has popped up. All i hear is maybe its this, or it might be that. I went in yesterday morning for the Hepatobiliary scan. It was the most excrusiating pain I've ever experienced. They gave me some hormone injection that was suppose to stimulate my gallbladder to contract. The process was so painful that i asked for something to grip with my hand. And the pain has stayed with me on and off ever since. I've done some research on this testing and it states that the process will not cause pain and that there are no side effects unless you have an allergic reaction. Nurse Practioner called me today and said that my test came back normal. I'm thinking, what the heck, how can this be when i was in so much pain. And i also experienced very loose stools a few hours after the procedure. I'm going into another facility to get a second opinion as i think the facility is lying to me to prolong my issues and make matters worse to make more profit. Any advice? And has anyone gone through the nuclear scan and felt the amount of pain i went through? Please send me an email Thanks!
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replied November 21st, 2012
Have you had a HIDA scan yet? I don't know if this is the same thing or not, but I just had a HIDA scan, just got the results. IT says that " there is uptake of radiotracer by the hepatocytes and excretion into the bilary system. Ejection fraction is calculated at 99%, which may represent a hyperfunctioning gallbladder." There was no pain with the scan, but I am in pain constantly otherwise, sometimes excruciating pain. At times I can't breathe it hurts so bad. Waiting for my Dr. to schedule surgery, which has been going on for two wks. Sounds like you need a new Dr, as I do, as well as surgery. I am wondering if you are as worried that something worse will happen before we have surgery. Good luck, hope you get something done soon!
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