# What is the difference between and IBS and a bad gallbladder?



## Guest (Apr 12, 1999)

Can anyone tell me the difference between IBS and a bad gallbladder?If you have IBS the main symptoms would be.............If you have a bad gallbladder the main symptoms would be............Thank you in advance


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## LindaB (Feb 13, 1999)

Do the following sound familiar as far as symptoms go? This is from www.healthanswers.com. I have edited it to eliminate some phrases that would not convert to the bulletin board, so check the web site for complete text and pictures. Symptoms: abdominal pain in the right upper quadrant or in the middle of the upper abdomen may be recurrent sharp or cramping or dull may radiate to the back or below the right shoulder blade made worse by fatty or greasy foods occurs within minutes following meals jaundice fever Note: Often there are no symptoms. Additional symptoms that may be associated with this disease: stools, clay colored nausea & vomiting heartburn gas/flatus, excessive abdominal indigestion abdominal fullness, gaseous Gallstones develop in many people without causing symptoms. The chance of symptoms or complications resulting from cholelithiasis is about 20%. The following is from www.laparoscopy.com/pleatman/gallblad.htm. It has also been edited to keep this post from being 20 pages long, so check the web site for yourself. What is the function of the Gallbladder?The liver manufactures bile, which is used to help in the digestion of fatty foods. The bile is secreted from the liver cells into small bile ducts, which join together to form the common hepatic duct. The bile then goes into the gallbladder where it is stored and concentrated for later use. When you eat a fatty meal, a hormone called cholecystokinin (CCK) is secreted. It causes the gallbladder to contract and also causes relaxation of a small valve (the sphincter of Oddi) at the end of the common bile duct. This allows bile to flow into the duodenum and mix with food for digestion. After the CCK effect wears off, the valve closes, the gallbladder relaxes, and the cycle is repeated. What happens if the gallbladder is removed? If the gallbladder is removed, it would seem that there is no place for the bile to be stored. It turns out that the bile duct system is very compliant or "stretchy," and the bile can be stored within the biliary tree itself. In other words, even though the gallbladder does have a function, the body can "make do" without it, storing the bile within the liver for later use. In any event, if the gallbladder is full of stones or the cystic duct, which connects the gallbladder to the common bile duct, is blocked, the gallbladder is not doing its job anyway. What Causes Gallstones? Most gallstones are made of cholesterol, a normal component of bile which is manufactured by the liver as a building block for many important hormones and other compounds. Cholesterol is not soluble in water, so there are other compounds in the bile bile such as bile acids and lecithin which act as detergents to keep the cholesterol in solution. If there is an imbalance such as too much cholesterol or not enough bile acids, the cholesterol can become supersaturated, leading to formation of small crystals and eventually stones. Estrogen is an important risk factor for gallstone formation; estrogen increases the concentration of cholesterol in the bile. This may explain the increased incidence of gallstones in women as compared to men, as well as in pregnancy, women using birth control pills, and obesity (circulating estrogen levels are increased in women with obesity). What tests are available to check for gallstones? The best test currently available is the ultrasound examination. This test uses high-frequency sound waves which are sent out of a special probe into the tissue being examined. The sound waves bounce back to the probe where they are detected, allowing an image to be calculated based on the time taken for the sound waves to go out and come back. This is very similar to sonar depth gauges and fish finders. Gallstones are easy to diagnose because they are so dense that they send a strong echo back to the ultrasound probe. In addition, because they are so dense, sound waves cannot pass through them, causing a a "shadow" to appear on the image behind the gallstones. The ultrasound test also allows examination of the bile duct for evidence of stones or dilation, as well as thickening of the gallbladder or fluid around the gallbladder itself. Another test is the oral cholecystogram. This test involves taking a medication the day before the examination. The medication is absorbed by the body, excreted into the bile by the liver, and then stored in the gallbladder. The medication is visible on x-rays, so it can be used to outline any stones that may be present in the gallbladder. Plain x-ray films of the abdomen can sometimes show gallstones, but this test is not very sensitive, since only 20% of gallstones are visible on x-ray. An additional test is the radionuclide scan, commonly called a HIDA scan. This test is usually done to look for evidence of acute cholecystitis. In this case, the cystic duct is blocked by a stone or inflammation. This prevents flow of bile in or out of the gallbladder. The test involves intravenous injection of a very small amount of a radioactive substance or radionuclide. The substance is then excreted by the liver into the bile. In normal circumstances the gallbladder will fill with the radionuclide. A gamma camera is used to visualize the gallbladder and bile ducts. If the gallbladder is visualized, the test is considered to be normal. If the gallbladder is not seen, a diagnosis of acute cholecystitis may be made. A variant of this test is also used in certain patients who have symptoms suggestive of gallbladder disease, but no evidence of gallstones. In this test, called a CCK-HIDA scan, the HIDA scan is done as described above. After the gallbladder is visualized, the hormone cholecystokinin (CCK) is given to cause the gallbladder to contract. By using a computer attached to the gamma camera, the amount of radionuclide ejected from the gallbladder after stimulation with CCK can be calculated and reported. If the "ejection fraction" is very small, one may predict that removal of the gallbladder will relieve the patient's symptoms. When should the gallbladder be removed? The presence of gallstones alone does not necessarily mean that the gallbladder should be removed. Some people are found to have gallstones during routine testing for other problems, but have no symptoms related to the gallbladder. These patients can be safely watched until symptoms develop. Many of them will never have a problem and not need to have surgery. On the other hand, once symptoms develop, the gallbladder should be removed. Typical symptoms include upper abdominal or right upper quadrant pain radiating to the back or shoulder. This pain often comes within one to two hours of eating a fatty meal. The pain may be severe, and accompanied by nausea and vomiting. The pain usually subsides within one to four hours. The pain is not relieved by antacids or acid blockers such as Tagametï¿½ or Pepcidï¿½. There are also other serious complications of gallstones such as acute cholecystitis, obstructive jaundice, and acute pancreatitis. In acute cholecystitis a stone blocks the outlet of the gallbladder, leading to complete blockage of flow in or out of the gallbladder. This may lead to inflammation of the gallbladder itself. Blockage of the blood flow to the gallbladder may also occur, leading to gangrene and rupture of the gallbladder. Obstructive jaundice and pancreatitis are related to passage of a stone out of the gallbladder into the common bile duct. If a stone gets stuck at the end of the bile duct it can block the flow of bile, causing the bile to "back up" into the bloodstream. This causes a yellow discoloration of the skin and eyes. Stones can also block the pancreatic duct, which drains into the bowel at the same point as the common bile duct. In this case the pancreas can become inflamed, leading to other life-threatening complications. Because of all these problems related to gallstones, we recommend surgery for patients who have developed symptoms related to their gallbladder.


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## charlie (Jan 15, 2000)

hi msbwell it seems as though both ibs and gallbladder might have the same symptoms in some people,it depends how far along your gallbladder is,i started out burping all the time,i did not think much about it at that time almost 2 years ago,then some pain started to set in, you know belly ache kinda of stuff,then all of a sudden when i would go do my thing in the morning BANG out it came, as time went on my bowels started doing strange things a little d then some cthis went on for almost 1 year but everything turn to c, as i kept going along things got worst,stool color change the last color was almost (white) shoulder pain,big time stomach cramps,achey right calfback aches,and at lasta nice shade of yellow,(skin) these are some of the symptoms of ibs! not all!! and i was told by everybody that it was in my head,or they just blew me off,until emory told me it was ibs, well as we all know by now it turn out to be my gallbladder 2 years later!so i guess it was all in thier head! now this don't mean everybody has a bad gallbladder, but it should not be ruled out as a problem along with the standard ibs test with one exception that is a hida/cck test along the other gallbladder test to rule out gallbladder, now kathy don't read this part, i am about 95% better now,i still have a potty problem,BUT it took me 2 years to get my gallbladder removed,and i know rome was not built in a day, for those 2 years i had all those test done to me that we on this board know all about! plus tons of meds,now what and how long does it take for your insides to settle down from all that?so as far as my opinion ibs and gallblader at times can feel the same, i hope this helps you. charlie


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## charlie (Jan 15, 2000)

hi lindai am so glad you posted that again







it tell the whole story







well only 2 days,it will be all uphill from there







you will be able to eat all the #### that me and kathy are eating now ha ha ha ,just think how nice you are going to feel in about a week







charlie


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## Guest (Apr 12, 1999)

Hey Linda - good summary - except you left out one part of gallbladder disease which is the most difficult to diagnose - Biliary dyskinesia - A gallbladder with NO stones which has simply gone bad. A gallbladder with stones is EASY to diagnose, often (but not always) with an ultrasound. Biliary dyskinesia can be present with a flow rate of better than 50% in some people. My surgeon told me that there is quite a bit of controversey in the medical field (For everybody's Information) that a lot of people being diagnosed with IBS actually suffer from biliary dyskinesia - (not ALL IBS will be attributed to gallbladder - but more than people think). Gallbladder disease without stones is extremely difficult to diagnose and biliary dyskinesia can present itself with (and this is info from my surgeon) the exact same symptoms as IBS. Only in advanced biliary dyskinesia will the symptoms of pain in the upper right quadrant and yellow stools present. As I said above, a diseased gallbladder can have a decent flow rate (the rate at which bile empties into the digestive system). He told me that he has removed gallbladders in people with 40% flow rate and their symptoms have disappeared (then again, he said that some have gone on with their symptoms). My surgeon explained that the liver and gallbladder are essential for a healthy digestive system, and if they are not working together the way God intended, then, voila, IBS! As I said, he stressed this is theory and he hasn't bought any of it 100% himself, but it IS interesting. He thinks in the years to come, there will be more definitive answers to this.When they looked at my gallbladder (which, today, is still the ONLY way they can fully diagnose biliary dyskinesia) after removal, Charlie (my surgeon) told me that it was covered with scar tissue from healed lesions (YEARS worth of gallbladder sickness) as well as open lesions. He said that my gallbladder had to have been sick for a long time to look that bad. It wasn't until last November that my symptoms became extreme with pain and yellow stools.Anyway, hope this helps, MsB!Kathy


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## LindaB (Feb 13, 1999)

Biliary Dyskinesia:A Study Of More Than 200 Patients and Review of the Literature Anthony J. Canfield, M.D, Stephen P. Hetz, M.D., F.A.C.S., John R Schriever, M.D., Hubert T Servis M.D., Trent L. Hovenga, M.D., Paul T Cirangle, M.D., Brian S. Burlingame, M.D. The diagnosis and treatment of biliary dyskinesia, defined as symptoms of biliary colic in the absence of gallstones, remains controversial and has been the subject of several previous retrospective reviews. The diagnosis and treatment of biliary dyskinesia based on the CCK-HIDA scan, and the outcome with cholecystectomy for billary dyskinesia, are reviewed. We add more than 200 cases of cholecystectomy for biliary dyskinesia, and compare our results with those of previous reports. We retrospectively reviewed 295 patients with biliary dyskinesia who underwent cholecystectomy at three military hospitals between 1988 and 1995. All patients had symptoms consistent with biliary colic and preoperative evaluations that revealed no evidence of cholelithiasis. Pathology specimens were reviewed for cholelithiasis and pathologic changes. Data were retrieved by chart review and clinic evaluation of new patients. Individual follow-up of each patient was attempted. Follow-up was achieved in 218 of the 295 patients for a rate of 74%. The mean duration of follow-up was 506 days with a range of 22 days to 6 years. Two hundred patients (92%) had CCK-HIDA scans with an ejection fraction (EF) <50%. Eighteen patients [8%) had an EF >50% but did have reproduction of their symptoms with CCK injection. In the group with an EF <50%, 94.5% were improved or cured with cholecystectomy. In the group with an EF >50% and pain reproduction, the improved or cured rate was 83.4%. CCK-HIDA scans are useful for diagnosing biliary dyskinesia and predicting improvement after cholecystectomy. Patients presenting with biliary dyskinesia and an EF <50% on CCK-HIDA scan have 94% improvement or resolution of their symptoms after cholecystectorny. CCK-HIDA scans should be employed early in the evaluation of billary colic with no evidence of cholelithiasis [i.e., with a normal ultrasound scan). When test results are abnormal, cholecystectomy should be performed, since the results in this setting approach those of cholecystectomy for stone disease [>90% cured/improved). In the current climate of cost containment, these excellent results would obviate the need for extensive and expensive medical testing before surgical therapy is recommended.


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## LindaB (Feb 13, 1999)

Bottom line is that there doesn't seem to be even an accurate set of symptoms for IBS let alone a bad gallbladder. Just reading the posts here, where almost everyone has been "diagnosed" with IBS, you can see that the symptoms are all over the place - some with C, some with D, some with both, some with nausea, some with pain left side or right side or somewhere else. The diagnosis of IBS seems to me to be a diagnosis of it isn't A, B, or C, and we either don't have the time, patience, or authorization to check for D, E, and F so we are going to call it Z because we don't like to admit that we don't know or that we are wrong!


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## Guest (Apr 13, 1999)

Thank you everyone! LindaB, Charlie, Heykate.God bless you all.Read my post for today and you will see what took place.


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