The gallbladder, a small organ located beneath the liver, stores and concentrates bile produced by the liver. Bile is a fluid that helps break down fats in the small intestine. When food, particularly fatty food, enters the small intestine, the gallbladder contracts and releases bile into the digestive tract. Gallbladder ejection fraction (GEF) is a measurement that indicates how effectively the gallbladder contracts and empties this stored bile.
Understanding Gallbladder Ejection Fraction
Gallbladder ejection fraction is typically measured using a diagnostic imaging test called a hepatobiliary iminodiacetic acid (HIDA) scan, also known as cholescintigraphy. During this procedure, a small amount of radioactive tracer is injected into a vein, traveling to the liver, bile ducts, gallbladder, and small intestine. A specialized gamma camera tracks the tracer’s movement, capturing images over time. To measure the ejection fraction, cholecystokinin (CCK), a hormone that stimulates gallbladder contraction, is administered via IV injection. The camera continues to take images as the gallbladder contracts, allowing healthcare professionals to calculate the percentage of bile ejected.
Interpreting Ejection Fraction Results
A normal gallbladder ejection fraction is generally considered to be above 35% to 40%. Some sources indicate a normal range can be higher, for example, 70-90%. If the ejection fraction falls below this threshold, typically less than 35%, it suggests that the gallbladder is not contracting and emptying bile as efficiently as it should. A low ejection fraction can indicate a condition known as biliary dyskinesia, or functional gallbladder disorder. In this condition, the gallbladder’s muscles may not coordinate properly, or there might be an issue with the nervous system signals that control its contractions. While a low ejection fraction points to gallbladder dysfunction, this numerical result alone does not always mean a person requires intervention. The presence and severity of symptoms are important in interpreting these results.
When Gallbladder Surgery is Recommended
Surgery to remove the gallbladder, known as a cholecystectomy, is often considered when a low gallbladder ejection fraction is consistently accompanied by specific, persistent symptoms. These symptoms commonly include chronic pain in the upper right abdomen, which may also be felt just below the breastbone or radiate to the back or shoulder. Nausea, vomiting, indigestion, and bloating, especially after consuming fatty foods, are also frequently reported. The decision for surgery is made when these debilitating symptoms are present alongside a low ejection fraction, and other potential causes for the symptoms have been thoroughly investigated and ruled out. Healthcare professionals will evaluate the patient’s overall health and symptom history to determine if a cholecystectomy is the appropriate course of action.
Life After Gallbladder Removal
Most gallbladder removal surgeries are performed using a minimally invasive laparoscopic approach. This involves several small incisions through which surgical instruments and a camera are inserted. Recovery from a laparoscopic cholecystectomy is generally quick, with many individuals able to go home the same day or within a day. Full recovery typically occurs within one to two weeks, although it can take up to six weeks for some. After gallbladder removal, the liver continues to produce bile, but it flows directly into the small intestine rather than being stored and concentrated in the gallbladder. Most people adapt well to living without a gallbladder and can resume a normal, healthy lifestyle. Some individuals may experience a temporary adjustment period where they might need to make dietary modifications, such as initially avoiding very fatty or greasy foods. Gradually reintroducing different foods helps the digestive system adjust, and many individuals find they can eat a regular diet over time.