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Neonatal Cholestasis
Joseph Junewick, MD FACR
over 6 years ago
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Gallbladder Ejection Fraction - US

Case Detail

Anatomy: Gastrointestinal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Normal variant
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: US
Activities:
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History

Teenage female with right upper quadrant pain.


Case Images


Diagnosis

Normal gallbladder ejection fraction by ultrasound

Clinical Notes

Nuclear medicine hepatobiliary scan showed delayed visualization of the gallbladder. Time constraints did not allow the patient to stay to complete the ejection fraction.

Findings

US – Gallbladder volume was calculated after an 8 hour fast. Gallbladder volumes were calculated at 30 and 60 minutes after ingestion of a fatty meal (1 can of Ensure).

Discussion

Gallbladder contraction is mediated by CCK which is released endogenously by duodenal mucosa in response to a fatty meal. Gallbladder contraction is initiated when the serum CCK reaches a threshold. CCK also relaxes the sphincter of Oddi, allowing bile to empty into the small bowel. The physiologically active portion of CCK is its C-terminal octapeptide.

Biliary dyskinesia is a motility disorder that affects the gallbladder and sphincter of Oddi. Patients with this condition present with right upper quadrant pain and no gallstones., and investigations show no evidence of gallstones in the gallbladder. The diagnosis is made by evaluating the gallbladder ejection fraction. A normal ejection fraction is greater than 35%.

Ultrasound with volumetric calculations may be a “radiation-free” alternative to determine gallbladder ejection fraction and evaluate for biliary dyskinesia. This could prove beneficial especially in children and young women.



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