Do hida scans always show gall bladder issues?

No: Hida scans are good for showing cystic duct obstruction associated with acute cholecystitis. It can also show complete biliary obstruction. It can suggest chronic cholecystitis with delayed gallbladder uptake and can suggest hepatocellular disease with delayed excretion. Gallbladder polyps or tumors are among the gb problems not well defined by hida scan. Ct, MRI or mracp scans may be needed.

Ultrasound first.: A hida scan is a functional test. It should be performed after u/s which is a first line imaging tool for biliary disease. In the setting of a negative u/s and hida, the likelihood of significant biliary diseae is extremely low.