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Abdominal pain and lethargic. HIDA scan showed muscle contractions in or around liver. Cause?

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Dr. Charles S Narasi

Gastroenterologist

Practicing since :1962

Answered : 693 Questions

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Posted on Wed, 6 Mar 2013 in Abdominal Pain
Question: My daughter was just told that a HIDA scan found that she was having muscle contractions in or around her liver that have been causing her to have extreme "stomach" cramps, XXXXXXX poop, lethargy--and these symptoms seem to come and go. Her gastrointerologist is going to do some kind of endoscopy that will go as far as her liver to confirm, and plans to *snip* the muscle that is contracting if necessary. Is there a name for this condition? Do you know what can cause it? If a muscle contracting in or around her liver is the problem, are there other less invasive treatments? My daughter was told that if the muscle was snipped, there was about a 10% chance that she would get pancreatitis. My daughter is 20 and is a professional ballet dancer. Thank you!!!
doctor
Answered by Dr. Charles S Narasi 1 hour later
Hello, XXXXXXX,
HIDA scan is usually performed to diagnose gallbladder inflammation
or abnormality in contraction and emptying of the bile from the gallbladder.
The first one Acute Cholecystitis , which is an acute inflammation of the
gallbladder usually associated with one or more stones. Sometimes it
could be gravel which is cholesterol crystals. HIDA scan would be
positive in that case. But a person with this will be very sick with fever,
chills, right upper quadrant pain, nausea, vomiting and even yellow
jaundice.
The second one is called "Biliary Dyskinesia" in which the gallbladder
has problem emptying the bile and has irregular contractions giving
intense pain similar to an attack of gallstones but without the presence
of stones. This is diagnosed by a combination of HIDA and CCK scan.
(Cholecystokinin). This test can show if a person has this.
I think your daughter is probably going to have an ERCP test.
This is Endoscopic Retrograde Cholangio-Pancreatography !
Essentially, they pass the scope through the stomach into the
duodenum and put a cather in the bile duct and pancreatic duct
and inject XXXXXXX to see if there is any kind of blockage. They can
stretch the sphincter muscle of the main bile channel or the
common bile duct. This might also be helpful in finding out if
there are any problem with the pancreas.
Hope I have clesred some of your concerns.
The test ERCP is done under sedation and the procedure, depending
on the expertice of the specialist may take from 30 minutes to an hour.
They might even take samples of fluid or do a biopsy if needed.
I wish your daughter all the best and continued success in her carrer
as a ballerina.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Charles S Narasi 4 hours later
Thank you for your prompt and very informative reply; also for your show of concern form my daughter's health and career as a ballerina.

I do have a few additional questions: My daughter's doctor told her that there seemed to be a muscle in or around her LIVER that was causing the problem (and her doctor did not mention finding any problem with her gallbladder). Could her doctor have actually been talking about the same thing (i.e., "Biliary Dyskinesia") you suggested?

Also, I think the ERCP test is what her doctor is talking about performing (and some additional blood tests), but she said she might end up "snipping" the contracted muscle (could she have been talking about a biopsy?), but that there was some risk (10%) that the procedure itself could cause pancreatitis. Does that fit with what you explained in your response? And how serious is the potential complication is pancreatitis?

Finally, any idea what might have caused her condition?

Thank you again--I do not expect you to have all the answers, but I am already feeling better about my daughter's condition. I do not know if you have children, but my daughter is the light of my life, and it is very hard for me to be so far away from her at this time--and at 20 years of age, she does not always think of the questions to ask her doctor that I would be asking were I with her.
doctor
Answered by Dr. Charles S Narasi 37 minutes later
Hello, XXXXXXX,
I think the doctor is telling the same thing but did not
explain in terms that you and I would understand.
I am sure he is talking about the sphincter muscle
around the bile duct , not the liver.
Although panceratitis is a potential complication, they
can take precuations to prevent this from happening.
I think he was also talking about stretching or dilating
and the process involves snipping and biopsy as well.
I wish her well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Charles S Narasi 1 hour later
Thank you again--I appreciate your knowledge and concern more than you can possibly know. If my daughter does indeed have "Biliary Dyskinesia," is it treatable and/or curable? Do you know what causes Biliary Dyskinesia? And could an excess of calcium in her system be a causative factor? The more I learn about calcium, and specifically EXCESS calcium, the more I wonder if this could be part of her problem. She had an os-trigonum surgically removed from her foot (not an uncommon surgery for a dancer--apparently 10-15% of all people have an os-trigonum, but it seems to cause problems only for people who spend a LOT of time up on their toes, especially dancers). The weird thing was that my daughter's os-trigonum grew back not once, but TWICE (and her surgeon--Lyle Micheli, MD of Boston--who pioneered the surgery for this condition) had NEVER seen an os-trigonum grow back TWICE; he had seen only a handful of patients out of thousands who had the os-trigonum grow back once. My daughter drinks HUGE amounts of milk (she drinks milk the way other kids drink sodas), and when she was young I was always careful to get calcium-fortified milk, thinking it was best for a growing child. As soon as I became suspicious that she might be getting TOO much calcium (when she had to have her third os-trigonum surgery about 3 years ago), I made sure that she quit drinking calcium-fortified milk (and--possibly coincidentally--her os-trigonum did NOT grow back after her third surgery). But now I wonder if she is still getting too much calcium just from her normal diet and the huge amount of milk she drinks. Obviously, this issue with her os-trigonum is outside of your area of expertise, but I just can't help but wonder if there might be a calcium connection to her current GI symptoms. Any thoughts you may have on the matter would be greatly appreciated. Again, I cannot thank you enough for your help--and I will be highly recommending both you and XXXXXXX THANK YOU! XXXXXXX
doctor
Answered by Dr. Charles S Narasi 1 hour later
Hello, XXXXXXX,
I really want to thank you for your kind comments. If your
daughter's blood calcium levels are normal , I would not worry
about that. Biliary dyskinesia is also seen in patients that have
Irritablae Bowel Syndrome. The exact cause is unknown.
May be it is somewhat serotonin hormone related. We don't
have the answers yet. Most of the the time biliary dyskinesia
can be treated with anti-spasmodic medications and avoiding
trigger foods in diet. Significant number can be symptom free
after gallbladder removal. But it is not a definite cure.
Lot more needs to be researched.
Thanks again and good luck.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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