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Patients with high gallbladder ejection fraction benefit from surgery

Patients with high gallbladder ejection fraction benefit from surgery

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From the frontlines: dr. delia cortés guiral

Cholecystectomy is indicated in patients with biliary dyskinesia and symptomatic gallstones (1), but there are also patients with RUQ pain, a regular ultrasound, and a normal or high GBEF. Patients may not be given cholecystectomy if their tests are “normal.”
Patients with biliary signs, regular ultrasound, and a normal or high ejection fraction have a paucity of literature. We discovered abnormal histopathology in a subset of gastric bypass patients with upper abdominal pain and normal studies who improved symptomatically after cholecystectomy, calling into question what is “normal.” After that, we looked at all of the patients who had symptoms but had regular trials.
All patients who underwent cholecystectomy in the Division of Minimally Invasive and Bariatric Surgery at the Hershey Medical Center between July 1, 2007 and December 31, 2013 were assessed by chart analysis after receiving approval from the Penn State College of Medicine Institutional Review Board. Patients with an irregular preoperative ultrasound, such as polyps, gallstones, pericholecystic fluid, or gallbladder wall thickening, were ruled out. Patients with a low GBEF, identified as less than 35%, were also excluded from the sample. A total of 33 patients were found and studied, all of whom had biliary symptoms, regular ultrasounds, and reportedly “normal” GBEF (>35 percent).

2d echo basics

Context information: What is biliary hyperkinesia and how does it affect you? What does a physician do if a patient has common biliary colic symptoms (postprandial right upper quadrant abdominal pain, nausea, and bloating) but no gallstones are visible on routine imaging? As a next stage, nuclear medicine imaging (CCK-HIDA scan) is frequently requested. What does one do if CCK administration results in a significantly elevated ejection fraction?
Final Thoughts: Biliary hyperkinesia is a term that describes a group of patients that have no gallstones but a gallbladder that functions abnormally. Cholecystectomy can be used to treat this condition.
If a patient presents with biliary symptoms and a high gallbladder ejection fraction (EF), what do you do? Not just an average or high-normal EF, but a number that is completely off the charts. The following article describes and addresses 13 patients who had a markedly elevated EF and a standard biliary appearance who underwent a laparoscopic cholecystectomy and had their symptoms fully resolved. To describe elevated ejection fractions in patients with common biliary colic symptoms, a diagnosis of biliary hyperkinesia is suggested.

Patients with high gallbladder ejection fraction benefit from surgery 2021

Biliary dyskinesia is a mysterious yet critical disorder to recognize when evaluating patients who have discomfort in their right upper quadrant. Since this is primarily an exclusionary diagnosis, a detailed history, work-up, and analysis are needed. To prevent unwanted surgical involvement, careful patient selection for cholecystectomy is important.
Biliary dyskinesia is a symptomatic gallbladder functional condition of an unclear etiology. It could be caused by metabolic disorders that affect the motility of the GI tract, including the gallbladder, or it could be caused by a primary improvement in the gallbladder’s motility. Biliary dyskinesia is characterized by symptoms that are close to those of biliary colic.
The patient should have right upper quadrant pains close to biliary colic but a regular ultrasound examination of the gallbladder (no stones, sludge, microlithiasis, gallbladder wall thickening, or CBD dilation) to diagnose biliary dyskinesia. The Rome III diagnostic criteria for functional gallbladder disorders should be considered for patients who are suspected of having biliary dyskinesia.