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Episode 927: Functional Gallbladder Syndrome

Emergency Medical Minute

Release Date: 10/22/2024

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info_outline Episode 927: Functional Gallbladder Syndrome show art Episode 927: Functional Gallbladder Syndrome

Emergency Medical Minute

Contributor: Jorge Chalit-Hernandez, OMS3 Typically presents with biliary colic Right upper quadrant abdominal pain lasting more than 30 minutes and subsiding over several hours Often associated with fatty meals but not always Must rule out other causes of pain Peptic ulcer disease - typically presents with epigastric pain Pancreatitis - pain that radiates to the back or family history of pancreatitis Laboratory workup  LFTs including ALT, AST, and alkaline phosphatase are within the reference range Lipase and amylase within the reference range Imaging workup ...

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Contributor: Jorge Chalit-Hernandez, OMS3

  • Typically presents with biliary colic

    • Right upper quadrant abdominal pain lasting more than 30 minutes and subsiding over several hours

    • Often associated with fatty meals but not always

  • Must rule out other causes of pain

    • Peptic ulcer disease - typically presents with epigastric pain

    • Pancreatitis - pain that radiates to the back or family history of pancreatitis

  • Laboratory workup 

    • LFTs including ALT, AST, and alkaline phosphatase are within the reference range

    • Lipase and amylase within the reference range

  • Imaging workup

    • RUQ ultrasound is unremarkable

    • Upper endoscopy with ultrasound can help rule out peptic ulcer disease and small stones

    • HIDA scan may show a reduced gallbladder ejection fraction below 30-35% or it may be normal 

      • Opiates may give false-positive results

  • Opiates can sometimes make biliary colic worse due to their contractile effect on the sphincter of Oddi

  • Some patients may benefit from surgical intervention i.e. cholecystectomy

    • Classic biliary-type pain (best predictor of response to cholecystectomy)

    • Pain for > 3 months duration

    • Positive HIDA scan

References

  1. Alhayo S, Eslick GD, Cox MR. Cholescintigraphy may have a role in selecting patients with biliary dyskinesia for cholecystectomy: a systematic review. ANZ J Surg. 2020;90(9):1647-1652. doi:10.1111/ans.16003

  2. Arshi J, Layfield LJ, Esebua M. Mast cell infiltration and activation in the gallbladder wall: Implications for the pathogenesis of functional gallbladder disorder in adult patients. Ann Diagn Pathol. 2021;54:151798. doi:10.1016/j.anndiagpath.2021.151798

  3. Carr JA, Walls J, Bryan LJ, Snider DL. The treatment of gallbladder dyskinesia based upon symptoms: results of a 2-year, prospective, nonrandomized, concurrent cohort study. Surg Laparosc Endosc Percutan Tech. 2009;19(3):222-226. doi:10.1097/SLE.0b013e3181a74690

  4. Joehl RJ, Koch KL, Nahrwold DL. Opioid drugs cause bile duct obstruction during hepatobiliary scans. Am J Surg. 1984;147(1):134-138. doi:10.1016/0002-9610(84)90047-3

  5. Mahid SS, Jafri NS, Brangers BC, Minor KS, Hornung CA, Galandiuk S. Meta-analysis of cholecystectomy in symptomatic patients with positive hepatobiliary iminodiacetic acid scan results without gallstones. Arch Surg. 2009;144(2):180-187. doi:10.1001/archsurg.2008.543

Summarized & Edited by Jorge Chalit, OMS3

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