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Having abdominal pain and heartburn. Ultrasound showed polyp in gallbladder. Any advice?

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Internal Medicine Specialist
Practicing since : 2004
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I am unsure what questions I need to be asking or what my test results mean. I have been having constant right side abdominal pain for 1 year now. It's a dull ache behind my bottom rib that turns to sharp & crampy pain through out my entire abdomen right & left on an almost daily basis. I am on acid reducing medication for the last year as well as I was having really bad heartburn, burning down my throat, acid or sour tasting burping, regurgitation of food. The heartburn & burning now is only moderate a night or two a week (only at night and more when I lay down) but the burping & regurgitation has stayed. An ultrasound showed sludge/depris/possible polyp in my gallbladder, gallbladder hard to see otherwise normal. A HIDA Scan showed enjection fraction of 38%, gallbladder hard to visualize, tracer found in stomach causing possible gastritis. A endioscope appeared normal with the only biopsy result that was not normal was for mild inflammation. Blood work I have been told is basically normal, some results slightly too high or too low but not significantly or leading in a specific direction. Now I have just received the results of my contrast CT Scan and the results state in the right lobe of liver there multiple sub centimetre hypodensities that appear fairly well circumscribed. Not well characterized on this single phase study but possibly small polyp. no gallstones or calcifications. rest of the CT was normal. What does this all mean? I am starting to feel like I am losing my mind trying to get answers.
Posted Mon, 18 Mar 2013 in Abdominal Pain
Answered by Dr. Enrique Molina 47 minutes later
I am sorry that you have had abdominal pain for such a long time. Sometimes it is very difficult to pinpoint a reason for your pain. The CT scan findings that you describe are most likely benign liver cysts, of no significance, and should not be the cause of your pain.
Your HIDA scan showed an ejection fraction of your gallbladder which is borderline low: an abnormal level is below 35%. You indeed have sludge on your gallbladder, probably from poor contractility within your gallbladder (therefore poor ejection fraction). This may very well be the cause of your pain; however the pain is typically crampy, worse after meals, particularly a fatty meal, which is not exactly what your are describing.
The burping, regurgitation and acid reflux, are all a separate problem, which i do not believe is related to your abdominal pain. You can undergo further work up and testing with a gastroenterologist for this problem. Seems like a gastric emptying study, and ph study of the esophagus may be needed.
I think the next steps are to repeat a HIDA scan but with an injection of CCK which stimulates the gallbladder to contract (and if this is abnormal, then you may need to have your gallbladder laparsocopically removed, after consulting with a surgeon). Also a dopper ultrasound of the abdomen can be done to visualize to abdominal vessels and make sure they are ok. If you haven't tried yet, you should ask your doctor for a trial of a bowel anti-spasmodic (such as Bentyl, Levsin).
Based on all you have mentioned it seems that whatever you have is not something malignant, which is good news.
Hope that helped! Let me know if you have further questions
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