Q:

A 35-year-old female presents with typical biliary colic symptoms, however her sonogram shows no gallstones. Which of the following statement(s) is/are true concerning her diagnoses?

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A 35-year-old female presents with typical biliary colic symptoms, however her sonogram shows no gallstones. Which of the following statement(s) is/are true concerning her diagnoses?


  1. Chronic acalculous cholecystitis or gallbladder dyskinesia is seldom associated with classic biliary colic symptoms
  2. The most specific test for diagnosing gallbladder dyskinesia is CCK-enhanced cholescintigraphy with assessment of gallbladder ejection fraction
  3. An ejection fraction greater than 75% is considered abnormal and indicative of gallbladder dyskinesia
  4. Cholecystectomy is not indicated for chronic acalculous cholecystitis

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b. The most specific test for diagnosing gallbladder dyskinesia is CCK-enhanced cholescintigraphy with assessment of gallbladder ejection fraction

Motility abnormalities of the gallbladder and cystic duct present with symptoms suggesting gallstones. The most common presentation for patients with gallbladder motility disorders such as chronic acalculous cholecystitis or gallbladder dyskinesia is recurrent biliary-type pain. Currently, the most specific test for diagnosing gallbladder dyskinesia is CCK-enhanced cholescintigraphy with assessment of gallbladder ejection fraction. CCK is infused intravenously 15 to 30 minutes after ejecting an analogue of 99MTC imminodiacetic acid and calculating the ejection fraction of the isotope by the contracting gallbladder. An ejection fraction of less than 35% is considered abnormal and cholecystectomy may be indicated. Most patients will have relief of symptoms following cholecystectomy. 

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