Biliary dyskinesia is when there is gallbladder dysmotility, which is defined as a gallbladder ejection fraction < 35%. It was first described in the 19th century. In 1981, Gerbail T. Krishnamurthy described a technique for measuring the ejection fraction of the gallbladder.


  • Symptoms of calculus biliary disease
  • Intermittent RUQ pain → biliary colic
  • Nausea

Physical Exam

  • Murphy’s sign


  • LFTs
  • Bilirubin
  • Amylase
  • Lipase 


  • US
    • Findings: no evidence of stones or sludge
  • CCK-stimulated HIDA scan
    • Findings: EF < ⅓ at 20 minutes after CCK administration in patient without a stone is considered diagnostic
  • CT and endoscopy may be used to rule out other diagnoses


  • Cholecystectomy: > 85% of patients show improvement in symptoms
  • ERCP: if nonresponsive to cholecystectomy

Relevant Information

  • Normal gallbladder ejection fraction is ≥ 35%

Scoring System