2. ABNORMAL cholecystokinin (CCK) release. REDUCED cholecystokinin (CCK) receptors or sensitivity. INCREASED cystic duct reseptors or sensitivity. IMPAIRED smoth muscle contractility

3. DIABETES MELLITUS CIRRHOSIS OF THE LIVER IRRITABLE BOWEL SYNDROME CELIAC DISSEASE OBESITY INHERATANCE Liver Gall Bladder Large Intestine Appendix Splee n Stomac h Small Intestine

4. 25% of patients with CHRONIC CHOLECYSTITIS DO NOT HAVE STONES!!!!!

5. ✓ VIRAL. ✓ OPIATES. ✓ ATROPINE ✓ NIFEDIPINE ✓ INDOMETHAZINE ✓ PROGESTERONE ✓ THEOPHYLLINE ✓ BENZODIAZEPINE

6. 90% OF PATIENTS with Biliary Diskenesia have evidence of Chronic Cholecystitis,

7. NUCLEAR MEDICINE STUDY 99m Tc-IDA 1991 FINK-BENNETT Journal of Nuclear Medicine (Retrospective). YAP-COWERKERS Journal of Gastroeneterology

8. CCK Infused 2.0 ng/kg/min Duration of Infusion = 10 minutes HIDA CCK

9. ACTUAL STUDY Ejection Fraction (%) = 12.7 Ejection Period = 17.0 min. Latent Period = 11.0 min Ejection Rate = 0.7 %/min Normal Values (>35%) (8-12 min) (<3.0 min) (>3.5 %/min) Percentage of GB emptying plotted against time