disease: Fun trivia

Gallbladder disease is a common condition typically affecting young and otherwise healthy individuals. Risk factors include obesity, diabetes, female gender, pregnancy, family history, rapid weight loss, liquid protein diets, and race or ethnic background. When typical symptoms of right sided upper abdominal pain, nausea, vomiting, and bloating occur within 15-90 minutes of eating, especially a fatty meal, gallstones are usually suspected. Ultrasound of the gallbladder is the first test ordered and will confirm the presence or absence of gallstones. If gallstones are confirmed then surgical removal of the gallbladder is recommended.

The basis of this test is the fact that a radiolabeled chemical is administered intravenously that is concentrated in the liver where bile is made before being stored in the gallbladder between meals. If the gallbladder is diseased it may fail to be seen on the scan due to blockage or fail to empty as expected when a hormone called cholecystokinin (CCK) is given intravenously. Typically, the gallbladder will empty a third or more of its volume when CCK is given during a HIDA scan but usually not more than 70-80%. The fraction of volume the gallbladder empties is referred to as the ejection fraction. A low ejection fraction is typical of a diseased gallbladder.

An unusual phenomenon has been observed in some celiac patients. Gallbladder type abdominal pain without gallstones and a “supranormal” gallbladder ejection fraction. Radiology studies have been reported in the literature that shed light on this phenomenon though it’s significance has been largely missed by the medical community.

Various ultrasound findings have been reported in celiac disease, primarily in the European literature. Colli et. al in Italy noted increased fasting volumes of the gallbladder by ultrasound in untreated Celiac patients and Mariciani et. al. in the U.K. found increased gallbladder volumes and elevated gallbladder ejection fractions using MRI. Low CCK levels have been reported in Celiac patients (Deprez et.al. 2002, Rehfeld 2004). This physician has had several Celiac disease patients who have had high gallbladder ejection fractions (typically >90%) associated with classic gallbladder symptoms that resolved after gallbladder surgery.

Bilirubin is a yellow pigment released from dead red blood cells into your bloodstream. Recent research shows that having high blood levels of bilirubin may help to prevent heart attacks.

Gallbladder disease should be considered in Celiac disease patients despite normal ultrasound and HIDA tests, especially if a “supranormal” ejection fraction is noted and pain reproduced with CCK. Patients with abnormal high gallbladder ejection fractions should be considered as possible undiagnosed celiacs and should undergo blood tests for Celiac disease and consideration of upper endoscopy with small bowel biopsy.

1. Arch Intern Med.

I should also suggest you read info to do with What Is Pelvic Inflammatory Disease as well as Pelvic Inflammatory Disease Symptoms.

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