Criteria for gallbladder dysfunction - all of the following:
(1) episodes of severe, steady pain in the epigastrium and right upper quadrant
(2) episodes last >= 30 minutes
(3) >= 1 episodes of symptoms during the previous 12 months
(4) pain is severe enough to interrupt daily activities and to prompt a visit to a physician
(5) no evidence of a structural abnormality is found
(6) abnormal gallbladder emptying (dyskinesias) is present
The episodes of pain may:
(1) be accompanied by nausea and vomiting
(2) be associated with pain radiating to the back
(3) be associated with pain radiating to the right interscapular region
(4) be precipitated by meals
(5) awaken the patient at night
Evaluations to consider:
(1) liver function tests and pancreatic enzymes during and after an attack
(2) ultrasonography of the gallbladder
(3) CCK-cholescintigraphy to evaluate gallbladder emptying
(4) ERCP with or without evaluation of the sphincter of Oddi
(5) microscopic evaluation of bile collected at the Ampulla of Vater
The extent of the workup depends on the severity of the condition. An invasive investigation may be appropriate for a person with severe or frequent symptoms or with attacks accompanied by significant abnormalities in liver function tests.
