### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I think my gallbladder needs removed immediately, but can t get results at ER - they just send me home. What do you think? When I looked up my urine, blood results and the ultrasound results, it shows normal except: the gallbladder wall thickness is 3.5 mm (which they say in report is normal - but online, says that is high) pH 5.5 A/G Ratio - .8 (it says below low normal) MCH - 32.5 (it says above high normal) Neut% - 68 ALP - 104 MDX% - 9 I have had gallbladder attacks since 1994 - but never any gallstones. I have also been diagnosed with asthma , fibromyalgia and Crohns (though I am overweight ). I had stopped going to the emergency room because the answer is always the same - no gall stones, so go home, don t eat fatty foods. I went to the ER last night bc I have had constant pain and flare ups daily since Oct 25, and now the pain never goes away (under right rib cage, middle of rib cage, back under shoulder blade), chills, dizziness , nausea. My GI dr told me that I should ask for the test which shows how much bile is going in/out of the gallbladder, but of course, they did not - they did an ultrasound as usual - and surprise (not) - no gall stones, follow up with GI dr. - I feel that I am in need of immediate surgery. What do you think? Some things which would indicate possible infection or other disorders are on the high side of normal: This morning - once again - dizzy, pain in the same places, getting worse in middle abdomen

### output:

Hello! Thank you for the query. As surgery is a very serious procedure it needs some indications to have it performed. Your symptoms might be caused by gallbladder inflammation without gallstones (this is very rare) but it can also be caused by peptic ulcer, severe pancreas disease or even heart problems (including heart attack). That is why before any surgery you should have abdominal CT (to make sure the problem is not pancreas), liver tests (AST, ALT,GTP, AP - if last two elevated ERCP should be performed), bilirubin level, amylase and lipase level, urinalysis. Heart ECG and heart enzymes should be performed as well (CK-MB, Troponin) to see if there is any ischemia. As you do suffer from asthma, and it very often is associated with gastric reflux disease you should also have upper GI performed to see if there is no peptic ulcers or duodenum swelling. Only after all this tests if no other reasons of your symptoms you may start thinking about surgery. Hope this will help. Regards.