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Hello, Current Oncology Fellow Here. I Would Like To Get
Question: Hello,
Current oncology fellow here. I would like to get your opinion regarding if I should pursue a cholestectomy. I’ve been having vague abdominal discomfort and nausea which seems to be associated with food. I’ve been seeing a GI doc who did an endoscopy which was normal however the gastric biopsy was positive for hpylori. Thinking that was the cause I completed the 14 day treatment and a month out I continued to have that same discomfort (which makes the hpylori concerning for an incidental finding). A few weeks post treatment I also developed a Cdiff infection which was not fun... So my GI doc ordered me a HIDA scan for concerns of biliary dyskinesia and it showed an EF of 8%. However, the tech administered the CCK within 5 minutes where as the literature stipulates it should be infused over an hour or else it can lead to false positive results. My GI doc had no further recommendations for me and advised me to talk to a surgeon to see if I should take out my gallbladder. Now I’m a pretty healthy 31 year old guy with no PMH. I’m not really experiencing biliary colic type pain either. It’s more of a vague RUQ and Epigastric discomfort that’s intermittent and associated with nausea. My RUQ ultrasound was normal as well. I’m not convinced this is related to my gallbladder. Curious to know what you think.
Current oncology fellow here. I would like to get your opinion regarding if I should pursue a cholestectomy. I’ve been having vague abdominal discomfort and nausea which seems to be associated with food. I’ve been seeing a GI doc who did an endoscopy which was normal however the gastric biopsy was positive for hpylori. Thinking that was the cause I completed the 14 day treatment and a month out I continued to have that same discomfort (which makes the hpylori concerning for an incidental finding). A few weeks post treatment I also developed a Cdiff infection which was not fun... So my GI doc ordered me a HIDA scan for concerns of biliary dyskinesia and it showed an EF of 8%. However, the tech administered the CCK within 5 minutes where as the literature stipulates it should be infused over an hour or else it can lead to false positive results. My GI doc had no further recommendations for me and advised me to talk to a surgeon to see if I should take out my gallbladder. Now I’m a pretty healthy 31 year old guy with no PMH. I’m not really experiencing biliary colic type pain either. It’s more of a vague RUQ and Epigastric discomfort that’s intermittent and associated with nausea. My RUQ ultrasound was normal as well. I’m not convinced this is related to my gallbladder. Curious to know what you think.
Brief Answer:
MRCP should be done.
Detailed Answer:
Hello and thank you for choosing "Ask a Doctor" service for your query,
Have seen your details and I appreciate your concerns,
Going through the details I would say that HIDA scan is an less sensitive and specific test and if you are not convinced that it has been done properly by your technician then I would suggest you to go for MRCP test.
MRCP is a highly sensitive and gold standard test to diagnose problems related to hepato-billiary system.
High intensity of magnetic field is targeted specifically on the hepato-billiary tract.
This a highly sensitive and specific test and would clear all doubts whether cholecystectomy has to be done or not.
RUQ pain has commonly two differencials-
1)Gastritis and ulcers etc- Treated but not relieved.
2) Gallbladder problem - Needs to be ruled out.
I would suggest you to go for MRCP scan to rule out hepato-billiary system involvement.
Once done do revert back.
Discuss why your doctor is not concidering MRCP.
Hope I was helpful.
Thank you!
MRCP should be done.
Detailed Answer:
Hello and thank you for choosing "Ask a Doctor" service for your query,
Have seen your details and I appreciate your concerns,
Going through the details I would say that HIDA scan is an less sensitive and specific test and if you are not convinced that it has been done properly by your technician then I would suggest you to go for MRCP test.
MRCP is a highly sensitive and gold standard test to diagnose problems related to hepato-billiary system.
High intensity of magnetic field is targeted specifically on the hepato-billiary tract.
This a highly sensitive and specific test and would clear all doubts whether cholecystectomy has to be done or not.
RUQ pain has commonly two differencials-
1)Gastritis and ulcers etc- Treated but not relieved.
2) Gallbladder problem - Needs to be ruled out.
I would suggest you to go for MRCP scan to rule out hepato-billiary system involvement.
Once done do revert back.
Discuss why your doctor is not concidering MRCP.
Hope I was helpful.
Thank you!
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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