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Possible Gallbladder Disease

cisco_teen

cisco_teen

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OK Guys, heres whats going on:

Monday morning, Janurary first, first thing i do is pay my respects to the porcelain gods. Not Fun. But i digress...

As the day continues, i gradually develop a fever, pain in between my shoulder blades, abdominal cramping. The next morning, at about 1, i went into the ER because i knew i was starting to get really dehydrated. For those medical geeks out there, my BP was 98/64, running tachy at 142, and temp was 101.7. Fortunately, i was like the only patient there, so i immediately got an IV and some Zofran and Toradol. They collected blood for a CBC, BMP, and LFTs.

So here is whats up:

My bilirubin level was 2.25, which i understand is way up there. I think that is the direct bilirubin, but i did not have a chance to look at the labs myself.

Im getting a gallbladder ultrasound in oh, say...3 and a half hours from now. Then i follow up with my doc on friday.

Anyone out there gone through this? I know about a lot of the treatment options for gallstones, and it sounds like i have a blockage in my bile duct. I know its easily correctible, but i didnt think too many people got them at my age (19).

I suppose this serves as a very much needed wake up call to start getting into shape and eating right. If anyone can offer some insight, that would be great, im a little bit nervous about whats going on, but i think it makes it easier being in the healthcare field myself.
 
Had the ultrasound, and it was negative for gallstones or other abnormalities. I guess more tests are on the way!
 
if no gallstones, it could hardly be a gallbladder attack. i had surgery to remove mine in 2000, took 25 minutes, now done by laser - 4 verysmall incisions to put in tubes and a mini camera. surgeon looks at a tv screen. went home same day. but, with no stones, that operation doesn't make sense, and i never had pain in shoulder blades. it was all in the uper abdominal area, really INTENSO and for hours.it would begin all of a sudden and end all of a sudden. stone blocks tract, stone moves on through tract. good luck and let us know more, OK?
ding
 
First off... it isn't a laser surgery. But they can do it with a camera, small instruments and just a few holes. Second, you can have gallbladder disease without stones, although it would be rare in your case. And they probably would have picked it up on the U/S. I assume the rest of your labs were fairly normal?

How are you feeling?

One possibility is that you had a stone (a single stone). It caused all of this pain and such. You passed the stone normally (hence it isn't there anymore) and your symptoms will get better slowly. Not saying this is what happened, but it is possible.
 
I study radiography, and ive always been interested in medicine, so i do know some of whats going on. All of my labs were normal, the bili was just 2.25, and 2.50 is jaundice. Not cool.

Ive been pretty queesy, and ive not had a lot to eat untill today, and even still i took it slow. Im actually having some more symptoms right now, I can feel the tenderness in my RUQ where my gallbladder is and there is tenderness inbetween my shoulder blades.

the ultrasound tech mentioned that i might be getting some different tests to try and figure out whats going on.
 
UPDATE

Went to the doctor today, and about as soon as he had me laying down on the table and felt my abdomen, he sat me back up and said "Im gonna refer you to a general surgeon'.

The bilirubin level of 2.25 was the indirect count, which is much better. the direct bilirubin was normal. However, some of the bilirubin also spilled over into my urine, which is bad.

I anticipate that i will be getting a HIDA scan and possibly surgery.
 
Yep, I agree. I see a HIDA coming your way. And I agree, it still sounds like gallbladder.. although an elevated indirect bili with normal direct would point to possibly another/second problem. Did they do a CBC? How about an LDH? And your other LFTs were normal? And I should ask where you're from... the US or elsewhere b/c that could change thoughts somewhat.

Now I'm kind of intrigued and want to know the answer.
 
Haha, allright jockboy

I am a 19 y/o male from eastern north carolina, USA. When i went to the ER on Tuesday, Janurary 2nd, they ran a CBC, BMP, and LFT, all were normal except the indirect bilirubin was 2.25. Also, they did a urinalysis, and that was positive for containing bilirubin.

Doc sent me home with some Meclizine, and some maalox stuff...so far so good, ive been eating right...lol, i lost 6 pounds in the last 6 days from not eating hardly anything at all, ive started to eat more though. Today i had a salad, some cereal with skim milk, and some soup. plenty of water, of course. Im just afraid of vomiting again, that is SO debilitating and i have school starting on monday, and clinicals twice a week.

If you could explain the difference between indirect and direct bilirubin, that would be outstanding. Thank you all for all your support!
 
sure...

indirect bilirubin (also known as unconjugated bili) is (in a nut shell) the bilirubin that has not been processed by the liver.

direct bili (or conjugated bili) has been processed by the liver.

So a blockage of bile (such as with gallstones) would increase you're direct bili as the liver would still process it, but it wouldn't be able to be excreted. An elevated indirect would imply that unprocessed bili was high... which can have a number of causes. Of course, yours isn't really that high ultimately. You can check out http://www.emedicine.com/med/topic1066.htm for a more comprehensive explanation of causes of unconjugated hyperbilirubin. And you can see that the numbers can go MUCH higher. Hope this helps.
 
cisco_teen said:
If you could explain the difference between indirect and direct bilirubin, that would be outstanding. Thank you all for all your support!
Click to expand...
From what I glean from this website:

http://www.nlm.nih.gov/medlineplus/ency/article/003479.htm

'
[B]Why the test is performed Return to top
This test is useful in determining if a patient has liver disease or a blocked bile duct.
Bilirubin metabolism begins with the breakdown of red blood cells. Red blood cells contain hemoglobin, which is broken down to heme and globin. Heme is converted to bilirubin, which is then carried by albumin in the blood to the liver.
In the liver, most of the bilirubin is chemically attached to a glucuronide before it is excreted in the bile. This "conjugated" bilirubin is called direct bilirubin; unconjugated bilirubin is called indirect bilirubin. Total serum bilirubin equals direct bilirubin plus indirect bilirubin.
Conjugated bilirubin is excreted into the bile by the liver and stored in the gall bladder or transferred directly to the small intestines. Bilirubin is further broken down by bacteria in the intestines to urobilins, which contribute to the color of the feces. A small percentage of these compounds are reabsorbed and eventually appear in the urine, where they are referred to as urobilinogen.'[/B]
This was actually quite facinating. Good thing I decided to go into Medical Laboratory technology.

Hope everything works out alright for you.
 
UPDATE

My stomach seems to have calmed down somewhat for now, occasionally it will flare up on me...i should say my gallbladder, not my stomach. oh well. But, with a proper diet and a handy supply of Tums, im sure ill be fine untill feburary when i see the surgeon.

Ill be sure to post again and let you all know how im doing. Thanks for all your support! It really does mean a lot to me :)
 
Until FEBRUARY? You're joking! This is just to get to the consultation?
 
yeah 3nipples, welcome to Navy Medicine. Its ok though, thats pretty fast considering that my symptoms are manageable
 
UPDATE

Allright, i had my surgery consult today. Well, seeing that it is after 12:00 EST, i had it yesterday.

I met with the doctor, we went over my history, X-Rays, and Ultrasound, and a brief examination. It was determined that i will be undergoing a HIDA scan this Friday.

Honestly, im a bit nervous at the possibility of surgery. Being in the medical profession doesnt make it easier, because i know what happens in the OR and what can happen. Plus the thought of missing school is discouraging, lol.

Thank you all who have been reading this, I will definately let you know the results of the HIDA scan and whats going to happen.

~Love,

Eric
 
Oh. My. Gods.

Let me tell you, that HIDA scan was HELL!

Allow me to rephrase...the first hour was just fine, because they were taking preliminary images of my gallbladder (which was then radioactive, by the way). Once most of the tracer has moved into the gallbladder, then the nurse comes in and injects you with CCK (cholecystokinin), the enzyme that makes your gallbladder contract.

As soon as she started pushing that CCK into my vein i instantly became symptomatic. I felt AWFUL, exactly the same as i did back in january when this whole thing started. My entire abdomen instantly became distended with gas, and it seemed like all of my blood drained from my limbs and went to my midsection. I was clammy, very nauseous, and my RUQ was burning some...not fun at all. talk about an apatite killer.

My ejection fraction (how well the gallbladder contracts) was 63 percent, which is excellent. However, because the CCK reproduced my same initial symptoms, that means there is some sort of disease process and it will probably mean i have a cholecystectomy (gallbladder removal) in the future.

Now that the test from hell is over (CCK should be outlawed) i go back to the surgeon on monday and we discuss whats going to happen. Ick.
 
Not exactly the best news, but at least you're finally moving towards a resolution. Hang in there and all the best (*8*)
 
I had similar pain in my right side, just behind the lower part of my ribcage. No warning, had nothing to do when I ate, but when I got it, I GOT IT.

We thru all kinda of tests, nuclear scan, etc. No gall stones visible on x-rays, but my nuclear scan showed gallbladder function of 15, which was like at the lower end of the marginal normal scale.

Had a laproscopic (spelling?) removal of the gall bladder and walked out of the hospital feeling better than I had on any give day for 6 months prior to that.

Pathology report showed that while I had no developed stones, I had cholesterol polyps that were accomplishing the same thing, coupled with a bile duct that was 1/2 of the "normal" diameter.

The surgeon that was skeptical about even doing the procedure conceded that I must have been pretty miserable.
 
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