Finally I'm getting around to writing about the gallbladder. Don't know what took me so long, seeing as how, next to hernias it's the thing upon which I operated most (if you don't count breast biopsies). And I liked it. When a person came to see me with a clear-cut gallbladder problem -- which was the case at least 90% of the time -- I could be quite confident that I was going to make him or her happy and, most likely, have a little fun while doing it. But there's the rub: it's not always a Tenantoid "slam dunk," nor is it always fun. A mysterious little bugger is that bag of bile: perhaps more than any other organ it's able to elude or confound diagnosis despite such apparent simplicity. And more than any other category, I sent people home from my office without surgery despite being referred with the idea of separating them from their gallbladders. Rocks get in your head.
First, some basics.
Among the many functions your liver performs for you (in addition to feeling neat) is the manufacture of bile, which is a clarified-butter-yellow liquid of complex composition and which serves to help with the absorption of fatty substances into your bloodstream. (The ancients believed it had something to do with emotions: "melancholia" means, literally, "black bile.")
About a quart of bile per day is produced and flows from the liver through a tube called the bile duct, entering the duodenum just below the stomach. Of that quart, a few tablespoons are sidetracked into a pouch that hangs under the liver, and is called the gallbladder. It doesn't make bile; it stores a bit of it, with the intention of squirting a dose into the intestine once in a while, particularly after eating a fatty meal. (The picture to the left, by the way, is not to scale. It makes the gallbladder look much huger than it usually is.) There's some complicated anatomy involved, particularly since the south end of the bile duct passes through the pancreas, where it's joined by a duct therefrom, carrying digestive enzymes made therein. We'll get around to the implications thereof, later.Here's my theory: the gallbladder evolved before refrigerators, when people might starve for a day or two or three while they hunted their next meal. After a kill, they'd gorge on a big greasy meal, at which point a supplemental blast of bile was useful. (During starvation, the gallbladder can get impressively large and full of bile.) Compared to those days, we eat more or less constantly: two, three, four meals a day, a few snacks. Bile remains a necessary component of digestion, but storage isn't really called for. Our food sort of steadily drips into the intestine, so constantly dripping bile works fine. Which is why the vast majority of people who have their gallbladder removed never miss it at all.
Bile is composed of many chemicals which are supposed to remain dissolved in the liquid medium.
In some people, for various reasons (genetic, diet, certain prior operations, certain blood diseases, etc) one or another of the components of bile are in too high a concentration to remain dissolved, and they precipitate out, forming crystals, which tend to grow larger and larger -- like sugar candy on a string. Stones. Trouble.Well, not always. Some people have gallstones all their lives and never hear from them. It's muscular contraction of the gallbladder that sends the bile into the bile duct. If a stone happens to be near the opening of the gallbladder when it squeezes, it clamps down and cramps up on the stone, gets plugged up, and that hurts or causes other problems. If the stones are out of the way during the squeeze, there may be no symptoms at all. Which means not everyone with gallstones needs surgery, a decision made easier with the use of a crystal ball. I'll see if I can do justice to that, and other concepts, in the next few posts...
[UPDATE: many readers who find this post by a web-search may be unaware it's the first in a series. The others are here, here, here, and here. Answers to remaining questions might turn up within them. Please check them out.]
391 comments:
«Oldest ‹Older 201 – 391 of 391No-stones. Path report showed thick (vicious) bile with yellow streaks. I had Hida one day before surgery. No one seems to know what caused the gastroparesis. Never had any sxs before. No vomiting-just doesn't empty and severe bloating. Tried all the meds for gp-nothing works. Did not tolerate tube feeds so now tpn for since Dec07. I just think how long can you live on tpn. Miserable way to live. Thank you so much for responding
t3h: Most of the drains used nowadays have a receptacle so there isn't any leakage to care for. But since drains generally aren't used routinely, and since there are several types, it's a question best addressed to your surgeon.
Great, Thanks! My biggest fear is that if I did have one I would keep whacking it with my arm causing huge amounts of pain. I'm a huge sucker for pain...
Great blog, I'm definitely buying your book!
Good afternoon everyone...
Im scheduled to have my GB removed on 7/30. Ive been having issues with it for over a year and a half.
A year ago I was diagn. with a malfunctioning gallbladder with my ejection fraction at 22%. I decided to hold off on surgery and see how Id do sort of changing my diet.
Since then Ive had 3 attacks, the last one being horrendus. Im also occasionally queasy and bloated. I always chalked that up to my mild gastrits and GERD.
Well...Im finally getting the gb taken out.
The last attack pushed me into it. Im 28 and totally scared that Ill have to live my life with the attacks, so Im going for it.
BUT...I cant help but doing research online for the last few days and read horror stories of people with terrible diahreah for the rest thier lives afterwards. People that cant eat hardly anything, can never have a drink again, can never have spicy foods.
This pretty much has given me a ton of anxeity about having the surgery.
Is this the norm at all? And if for some reason I do develop these issues post surgery long term, what would my options be? I just would like to live a normal digestive life :)
As I said in my series on the gallbladder here, and several times in the comments above, the vast majority of people who have their gallbladder removed have no digestive side effects at all. Some have diarrhea, especially if they eat a very fatty meal. For most of that small number of patients, it's easy to control with diet or the occasional diarrhea pills. The ones that have severe problems are rare; on the internet you see their stories. You don't hear from the literally millions (over250K/year) who have no problems.
And I'd be one of the literal millions.
If I've any dietary problems, they're apparently "problems" that don't mind an accidentally far too spicy vindaloo, nor extra-cheese pizza. I've even been -trying- to see if there's anything my gallbladderless system can't stand, and I've yet to find a single thing.
I was diagnosed with gallbladder dyskinesia in 2007 after a hida was 23%. I've had normal ultra sounds too. My doctor advised me to have my gallbladder removed but i didn't fearing I might develop chronic lifelong diarrhea like some people I read about. Although I still have some pain, it's not as bad as it once was. Last month I had another hida because I decided if it too came back bad I would have the surgery as was previously suggested. However, this one came back 61% and the CCK didn't really bring on the pain, just slight nausea. I understand this is a difficult question but do you think it's possible for someone to ever recover from a dysfuctional gallbladder without surgery? If I didn't have the dull, annoying upper abdominal pain I would be just aces. But I'm at a point where I dont really know what to do and I have my doubts the surgery would help me even if I had it. -Charlie
Charlie: as you may have seen in my other posts in this series, gallbladder dyskinesia is difficult to diagnose with certainty, and to the extent that it's a real entity, I'd have to say it's not very well understood. I think there are more things that cause slow emptying on a given HIDA scan. And whereas I have no way of judging your particular situation, I can say that as a surgeon I'd be extremely hesitant to operate on a person with a scan showing of 61% and no reproduction of pain. By my criteria, at least, whether you had dysfunction in the past or not, it's hard to say there's any now. But having said that, your doctors are in a much better position to understand your situation than I am, so the best decision can only come from your consultations with them, not from me!
I had an my gallbladder out 17 days ago for some pylups. 5 days after surgery I had the worst pain I've ever experienced and was diagnosed with a low grade bile leak due to the doc nicking me during surgery:( I was in the hospital for 6 days and have now been home with a JP drain for a week. I am feeling better but the drain is the worst part of this whole nighmare!! I drain bile mostly @ night when I try and sleep. The output is between 50-75ml per day for the last two days. My question is when can the drain come out? Do I need another hida scan to prove the leak has healed prior to removing the drain? @ what point does the drain pose a risk for infection? I am angry and want my doc to be accountable. Her comment is "this happened because you are a nurse and both doctors and nurses make the worst patients". Can you believe her? One last question, once the drain is out what are the possible longterm issues I might face? Thanks so much, your site is great:)
I can't comment on a specific case because I have no knowledge of your particular situation. But in general the drain comes out when there's no more bile leaking. It's not usually necessary to get another scan, etc: the proof is there to be seen in the drain. Any drain poses some infection risk, but the body sort of seals around the tube within a few days so the risk is pretty low. Once the drainage is over and the tube is out, there is generally no long-term effect of having had the leak in the first place. It depends a little on where the leak was coming from.
Hi Doc! I have just been diagnosed will gallbladder disease from a HIDA scan I had last month. I have been in severe pain with attacks, nauseau and chills a few times this week and I can't even get a consult with a surgeoun cause they're so booked up. I'm tired of the attacks(since Feb) and I am about to go to the ER. Will they be able to remove it asap if I go in during my next attack? They are starting to come on even if I eat extra healthy. It sucks and I don't know if I should go to the ER. I only want to go if they take it out. Will they, after they see my records that I do have to have it removed?
jms: when you go to the ER they still have to call a surgeon to see you. Whether a surgeon would consider it an emergency depends on your status at the time: if there's evidence of significant infection in or around the gallbladder or of a stone in the bile duct, then some kind of urgent action would likely be taken. It also depends on what surgeon they call: how busy he/she is, etc.
Given the fact that most gallbladder attacks resolve on their own, it's only a small percentage that are done as an emergency. It'd take more info than I have, or could have, to make an accurate prediction.
I have to have my gallbladder removed in a few days. The hida scan showed no functioning what so ever of the gallbladder. I never even go through the whole test. After 4 hours that was it for me. It showed infection of cholecystitis or somothing similar to that. Can i have surgery with symptoms present. Such as belching, diarrhea, mild pain and discomfort, naseau, fatique and such
anonymous: short answer, yes. It used to be felt necessary to wait until the acute inflammation was gone. More recently it's been shown that in most situations there's no particular advantage to waiting, in terms of complications, etc.
Hi Doc, its me again! The strangest thing is happening now. I slowly started eating some fatty foods and I've had no attacks or pain! Now I eat anything I want and still, my gallbladder is completely fine except it seems to jump or pulsate here and there. I finally got a consult for Sept 3rd and am nervous about having unnecessary surgery. MyHIDA did show chronic cholisystitis(spelling?). My Dr said I def needed it removed. Is this the quiet before the storm(a really bad attack!)? What do you think?
jms: it's the nature of gallbladder problems that they come and go. Some people have trouble every time they eat; others, once in a while; still others go thru periods where there's lots of trouble and then it subsides for a while. There's no way to predict in an individual what will happen next, or when. People who have attacks tend to keep having them, at some rate, over some period of time.
Hello Doc
I too had a hida scan done about a month ago. After several months of pain right in the middle top area of my stomach, I deceided to ask my doctor about that pain. It radiates to my back some. The other night it was burning so bad it woke me up in the middle of the night. I have terrible indigestion, gas symptoms, a lot of naseau especially right after a meal ( moreso no than before) My hida scan too showed no functio. My primary acted as if one day I am dying and then my consult with the surgeon was not for 4 weeks later. He suggested I have it removed. Hovwever, I was almost like he was leaving it up to me to make taht decision. So , I don't want to have unneeded surgery if it can wait. I also have high blood pressure and I am concerned it will be a problem with the surgery.
I operate a small group home with children and can't be off an extended amount of time. But i know i must take care of me to take care of them.
WIth the symptoms increasing , should i wait or go ahead with it . From what you have read what would you do??
Also, I don't respond well with anesthesia. I always wake up acting silly and go get sick from it
Thanks,
Molly
molly: I'm sorry but I'm really in no position to make specific recommendations for a particular person, about whom I have no way of knowing all the necessary facts. I try to give general information, but really need to avoid individual advice.
Dr. Schwab, Thanks for your informative blog. I wish I would have found it before my gb surgery. I too was one of those looking online for info about gb surgery and came across horrible stories of pain and symptoms after surgery. I am 34, mother of 3 and petite. I was shocked to find I had gallbladder problems. My HIDA scan showed 10% function, no stones or infection. I didn't have terrible pain other than a dull ache in my side and back and bad heartburn and indigestion. I also had pain on my left side. A low fat diet helped for a while but the symptoms came back. I was completely against surgery because I wasn't in terrible pain. My Dr., who is also a friend of the family, said the gb had to come out. I was terrified of surgery, like many, because of the risks and the question, "will this really make me feel better?" I was worried about becoming one of the people who feel worse after surgery. I am now 5 days post-op and a satisfied customer. I am still sore and tired but happy with how fast I am healing. I am eating light and low fat and having some bathroom issues which is normal. Hoping the healing process continues to go this smoothly. I also had a weird feeling of movement in my abdomen after surgery like one of your bloggers, but I just assumed it was the CO2. How long can the CO2 stay in your body? It has been bothering me more than the incisions. Also, why do you think gallbladder disease is so common? Is this just a problem in the U.S. or is it prevalent around the world.
TLC: CO2 can stay for several days; it may or may not be the cause of what you're feeling but it sounds like you're doing well.
There are lots of risk factors for stones, some genetic, some dietary, some drug-related. It varies among populations, but it's common nearly everywhere in the world. Intelligent design?
Having myriad of typical gallbladder symptoms and an EF of 96%. One MD advised me that this was supranormal and not allowing my gb to empty completely causing my problem...symptoms are worsening...has been about 3 months of torture. Any comments on high EF?
anonymous: I've never heard anyone say a high EF is abnormal. Sounds like you need another opinion, perhaps with a gastroenterologist.
Any thoughts on a supranormal EF of 96% with typical gallbladder symptoms? EGD was perfect. Hida Scan reproduced symptoms. Thanks for taking time to help so many people.
Sorry for the duplicate question about high EF of 96%. My GI doc suggested that it could be causing my gb to not empty completely, being in a hyperstate. He admitted that there was little research on this problem, henceforth all other diagnostic tests are being run which at present are normal. The normal range of gb EF if 30 to 75% according to him. In the meantime, symptoms are only relieved by no fat diet. (pain under right breast that radiates through to back, sore feeling when I breathe, pain between shoulder blades which is beginning to wake me at night, constipation to lots of stooling, strong taste of bile several hours after eating, absurd amount of gas that gets trapped in my chest). I'll continue to work with my GI doc. I am now curious about other people who have EF in the 90s. Thanks.
Thank you in advance for your insight. I am a 44 year old woman. About a month ago, I had nausea and pain (ribcage - upper and lower abdomen) which was dominant on the right side. After a week (thinking I had a stomach flu), my husband who is an eye surgeon sent me for blood work since my pcp was out of town.
My liver amylase and Lipase were elevated to 139 and 69 respectively. I was then sent for an ultrasound which revealed only an 8mm polyp in the gb.
The gi doc then sent me for an MRCP which revealed "3-4 filling defects in the fundus of the gallbladder - consistent with cholesterol gallstones or gallbladder polyps."
It has been now a month since my onset of gi symptoms and my pancreatic enzyme levels are the same. I continue to have daily constant pain in my abdomen - soreness in the ribs and upper back.
My gi doc is sending me for an mri of the pancreas with contrast tomorrow.
My husband is very concerned that the pancreas enzymes remain elevated. He worries that I may have a stone that was not detected, stuck in the common bile duct. One general surgeon told him often the so called "polyps" are really immobile stones.?
In case this is relevant, something that I did prior to the onset of symptoms (which may or may not be important) was I took a high dose of "tumeric" supplements for 2 days prior (for chronic muscle pain). I have since read that tumeric is quite effective at both increasing bile production and making the gallbladder contract.
I truly appreciate any guidance you might offer.
Not sure if I should remove the gb... consider sphincter of Oddi issues... or look for other causes of pancreas enzymes and sympoms? Thanks so much!
Would you have any thoughts on my case?
Dr. Sid, Just wanted to be more clear. My liver function tests were normal. Only the pancreatic enzymes were (and still are) elevated. Also... there were no other findings on MRCP or sono...other than the stones/polyps. Ducts looked normal with no dialation or distention. Hopefully will have more info after today's MRI.
With Appreciation - Robyn
robyn: gallbladder "polyps" are a sort of borderline finding of questionable significance. They can in fact be stones that aren't rolling around and therefore appear stuck to the wall as polyps are. If they are indeed polyps, then it's rare that they are a cause of problems. WIth normal liver tests and bile ducts it seems unlikely that your pancreatic enzymes reflect something going on the the gallbladder. But the fact is that from this far away anything I say is not very useful, since I can't know all the details. It sounds like your GI doc is on the case in a deliberative way and will be a much better source of help than I. Good luck!
Thank you so much for your thoughts. I did have that mri yesterday (different machine w/contrast).
The radiologist only detected the 8mm ployp (immobile stone) as was seen on sono. She felt the MRCP which was an open machine picked up "artifacts" and that they were misread as stones or polyps. Frustrating hugh?
Everything else appeared normal.
Here's one for you though... saw a general surgeon today who does a lot of gb surgery. He explained that very often "sludge" is not detected on the mri - and crystals can irritate the duct - enough to raise pancreatic enzymes. His suggestion was to consider my getting an ERCP (perhaps after my enzyme levels reduce some)... to check for such a situation. He will confer with my gi doctor about this.
Personally, I hesitate getting an ERCP given that I understand it is invasive and can cause new problems...including acute pancreatitis. At the same time, I would love to solve this mystery and regain some sense of well-being!
I know there are no easy answers (especially across cyberspace) .... but do you have any gut feelings about a case like this? Not sure how to proceed.
Much Thanks,
Robyn
ps: I showed hubby your blog and he thought it was terrific. He said it was a truly wonderful creation. I agree. Beautifully done!
robyn: thanks for your kind words about my blog. In this case, however, flattery will get you not much. I really don't have a basis for a gut feeling, and hesitate to go further than I have. In the context of this blog, I can't go deeper. It sounds like you have two people working on it with you; hopefully, the right answers will be forthcoming.
Dr. S - Thank you for your kindness...
Yes.. yes... I was so hoping you would have said -"Well... if you were a patient of mine..." !!
I do completely understand your position.
Still think your blog site is amazing, and I just ordered your book - which I know we will love as well. It is so uplifting to encounter a physician with as much brilliance, integrity, compassion and creative spirit as you obviously have!
Hello Dr,
Pcp told me I have large amount of gallstones and a fatty liver after an ultrasound have had pain for years but chalked it up to just how it is. I have an appointment with the surgeon on the 24th but was wondering if you could maybe answer some questions for me before.
1) Will the fatty liver cause any complications?
2) I have 3 months before I em eligable for FMLA and it would be better for me if I wait until the exact day that starts In this day and age I can't afford to put my job in jeapordy and I don't have that much time off work. If I end up having to have the open surgery I'll lose my job and will be evicted. Do you think that it would be safe to wait for that amount of time? It didn't seem like it was that much of an emergency to get me in right away as there is over 2 weeks from ultrasound to surgery consult.
Thank you for your response and I found you page quite helpful and that you for talking in a way that makes sense to people who haven't been through medical school
sam c
sam c: fatty liver is most often seen in overweight people. When very severe and long-standing it can cause problems, but in most cases it's not very significant and usually not an issue in terms of undergoing surgery. Your surgeon should be able to address it better, because he'll know more about you.
Timing of surgery, when there's no emergency forcing the issue, is usually a matter of convenience, and to some extent, of looking in a crystal ball. Meaning, there's always the possibility of something happening that could make matters worse, but I generally told people they should (assuming they want to have the operation) pick a time that works best for them. If a more urgent situation came up, we could deal with it. But once again, since I know nothing of the specifics in your case, it's a question best answered by your surgeon when you see him/her.
Weird question. If someone suffered a tramatic injury to the liver, let's say a grade II-III Liver lac, with a subscapular hematoma, appearing not to have active hemorrage, and the ct showed such as above, including a completely flattened gallbladder, why would the gallbladder be completely flat. The person presented with distended abdomen,non-tender passing gas, but also had constipation.Person had elevated liver enzymes, and bilirubin levels. Could there have been an injury to the gallbladder too, undiagnosed? if so how would a gallbladder injury present? sorry for the convoluted questions.
A "flattened" gallbladder most likely just means it had recently emptied itself, which they do several times a day, typically. Injury to the gallbladder would cause bile leakage, which is usually pretty painful, and which would show fluid around the gallbladder area on sonogram or CT scan.
I have to say that I was about to have my gallbladder removed, after a severe attack (my first), many stones were shown in my ultrasound..but, after talking to my surgeon, doing lots of research(I'm a registered nurse, and have a grandfather who rode along on a horse and buggy with his dad, a doctor)etc...I prayed and someone showed me where to go to remove my stones, heal my hormone issues..and also loose 70 pounds in the process!!I can now eat anything and not have an attack! My gallbladder function is now 75%, I plan to do one more flush..after guidance with a Naturalpathic. This problem would have NOT been remedied, had I taken out my gallbladder! You have to remove the stones, and restore the function. Please DO NOT REMOVE YOUR GALLGLADDER!! (Unless it is an emergency due to infection, etc..)But, if they tell you to schedule a time for surgery, DON'T! Contact a naturalpathic about breaking down these stones, preventing infection,and assessing your liver. The bile flow was obstructed, and therefore, prohibited me from loosing weight, no matter how healthy I ate, or how much I daily exercised! When you get that bile to flow, then you can break up the fat, instead of storing it! Your digestion will improve, your hormones will regulate, your pancreas will function better, etc... God Bless!
After you have had all your tests done, Robyn....Please seek help from a Natural pathic who had lots of experience with removal and restoration of gallbladders.. I lost 70 pounds after my natural pathic assisted me in removal of stones, and restored bile flow (to break up fat)...not any amount of exercise and eating right will substitute for returning bile flow to normal...and restoring gallbladder function! I did my homework, and allowed God to be my guide...and, canceled my surgery...it's been 7 months and I now have 75% function, and can eat any foods without distress! You'll need to break down the stones first, and then prevent infection...and also, promote function of gallbladder...all with natural stuff...then, you may do a flush at home..when it is safe...you'll have to do 2 -3 flushes...but, it will save your gallbladder and pancreas...also your entire health!! And, aside from doing a flush once or twice a year...YOU"LL be Done with this topic. You will feel and look 20 years younger. Please don't be fooled into opening a can of worms. I did do my homework. (Please do not take offense to my comment...Doctor...just trying to help and guide these people as I have been...)God Bless!
The above comment is nearly completely devoid of understanding of gallbladder and bile physiology. To each his (or her) own: but based on the misconceptions alone, one might well conclude that the above recommendation is to be taken with significant skepticism. Stones in the gallbladder do NOT obstruct bile flow, for one thing...
For another, it'd be most interesting to know what a repeat ultrasound would look like after the flushes. You know what I predict!
Gallbladder attacks are very unpredictable. Some people have stones forever and never have problems. Some have one attack and no repeats. Some have them frequently. Some have pain but no infections or obstructions; others get very sick. My guess is that the above individual would have had the same result had she done a flush, stood naked in the moonlight, or burned incense.
Hi-I just came across your site. Thank-you so much for it.
I have been having RUQ pain for 5 years now, several attacks, heatburn, full feeling, can't sleep, weight gain and just ALWAYS feeking soooo bad. To my insisting and after checking everything else-I had a Hida scan done and it showed my gallbladder functioning at 9%. I have an appt. tomorrow to see a surgeon. Are you telling me that it is possible that if I have this thing taken out that all of this pain and sick feeling will stop??? Because if you are I could kiss you! And if it's true, then WHY are the doctors so nonchalant about it???? I have literally gotten to the point of suicide with this pain and been to the ER several times where they see nothing on ultrasound. Is it because they think I'm a crazy middle age woman (50)???!! I'm not too happy right now. AND I'm an RN to boot. You wouldn't believe how I have suffered and to top it all off I'm hooked on pain pills now. Sigh....Thanks again for this service. If this all turns out good---I'm thinking about doing something in the field to help people....this type of cavalear attitude regarding severe pain because there is not something obvious on an ultrasound shouldn't be going on.
girlnurse: well, it's tricky. Some people do indeed have trouble from their gallbladder even when there are no stones. The HIDA scan is a useful tool in diagnosing it, but it's a long way from 100%. Your surgeon will hopefully explain better than I can, based on knowing all the details of your case.
If you didn't already, you could read this and this from my other posts on the gallbladder.
Dear Dr.
My 87 yr. old mother was experiencing some nausea along with some discomfort in the upper right side of her stomach. After an ultrasound, it shows she has many stones in her gall bladder.
I've heard about a procedure that uses radio waves or other means to dissolve the stones. Have you heard of this procedure and do you think it's better for her than surgery based on her age?
Also, she is toying with the idea of doing nothing and just living with the discomfort for as long as she can if not for as long as she lives. I don't agree. What are the risks if she does nothing? Can she damage any other organs in her body by doing nothing at all?
Sincerely,
Daughter of Georgie
daughter: if you don't mind a few bad words, I wrote a post that answers most of those questions about those alternatives, here.
As to risks of doing nothing, no one, of course, can predict. As I have written in this blog, many people who have stones have no trouble. Some people with stones and various abdominal pains are not having trouble, since the pains can be due to something else. Some people with stones can go on to have serious infections or pancreatitis. The risk of those things, to some extent, has to do with the size of the stones a person has.
My girlfriend started experiencing a set of symptoms a month or two ago that all seemed to point to a gallbladder problem. She began feeling nauseous after meals, and having slight pains on the right side of her abdomen and back under her rib cage.
The symptoms were fairly mild at first but have gotten progressively more severe. The past 5 days she has been vomiting nonstop regardless of what she is eating, and her side often hurts so bad that she doubles over in pain.
Her Dr. was "99.9% sure" that her symptoms were due to gallbladder problems. Ultrasound results were negative for gall stones. We were certain that her problem was due to a sluggish gallbladder that would be revealed by a HIDA scan. The Hida scan surprisingly revealed that her gallbladder was functioning correctly.
I know you probably can't diagnose this online. I'm stumped, and a little scared about what the other possibilities could be. Are there many common misdiagnosed cases of this sort of thing? If so what do you think they could be?
Abdominal pain can be very easy to diagnose, or, sometimes, frustratingly difficult. She may need to see a gastroenterologist, have endoscopy or other tests to figure it out. I could list a bunch of possibilities but I don't think it'd be as useful or productive as continuing to work with her doc.
I was one of those whose doctor put symptoms to being all in my head. I went to a surgeon for pre op for bypass surgery and during my pre op exam my gb ruptured and I was told after surgery it ruptured because it contained one stone the size of a fist. I was sick for weeks after that emergency surgery, drainage tube sites became infected and it was a horrid ordeal. I am glad my gb is gone and it will not be missed.
I would like to ask a question. My wife is 38 yearsold and has had pains in her upper abdominal area, nausea, vomiting and slight fevers. She has had test after test done and all come back normal.
This has been going on for months (5). Every doctor has said that she has gastritis and given her some prescription antacid. However, the pains and constant nausea and vomiting continue. I feel like she has gall bladder disease, but no tests are pointing to that. Can someone give me some insight and what I should do? Thank you
Christopher: it sounds like she may fall into that very frustrating class of patients where diagnosis is elusive and takes a lot of patience. If she hasn't seen a gastroenterologist yet, it would seem a good idea to request a referral to one.
About ten days ago I had upper back pain and chills. The following day my upper abdomen felt like a rock, my abdomen on the upper right side was very tender to the touch, and I felt really full. Not much desire to eat. Saw my doctor the next day who did some blood work (came back normal) and an abdominal ultrasound the following day. It showed no gallstones, but inflammation of the GB. Several days later I had a HIDA scan which confirmed no stones and a 0% ejection fraction, yes zero. The doctor wants me to have my GB removed. I'm still feeling uncomfortable and have gone to a low fat diet and eating very small meals. Can biliary dyskinesia be reversed? I can't help but think this is stress related or medicine related. I also have LPR and have taken Aciphex for years. For the last month I had doubled my aciphex dose since I had to do a lot of singing to do. I read somewhere that reflux meds can cause dyskinesia. What do you know about that? My instinct is telling me I need to search further before having surgery. I'm currently scheduled for a lap chole on 10/26. Any thoughts?
It seems the diagnosis is very clear, with inflammation seen and 0% ejection fraction. (For the record, I don't think the HIDA added any information: it's expected that when the gb is inflamed, there'd almost always be zero ejection; likewise, if there had been function several days later, it wouldn't have disproved the fact that there was inflammation at the time of the episode. Also, for the record, a HIDA scan can't confirm lack of stones, or presence of them, for that matter. It only assesses function, not what's going on inside the gb.)
It's possible there are small stones that didn't show up. It's also possible that this was, indeed, acalculous cholecystitis. Dyskinesia isn't really the issue any more: the term refers to having gallbladder "attacks" without inflammation or stones or diagnostic criteria to prove gallbladder source beyond doubt. That's not you anymore. You've had cholecystitis, which is a clear-cut diagnosis.
I have no way of saying what might have caused it, or what the future holds. Because a high percentage of people who have had cholecystitis tend to have more episodes, and because it's a more severe condition than simple episodes of biliary colic (ie, transient pain that lasts a few minutes or a couple of hours, without inflammation) I generally recommended surgery for those who've had it. Having had chills, by the way, suggests infection, which is even more serious. Is it possible you'll never have more trouble? Yes. Is it possible you'll have continuing or even more dangerous troubles? Yes. Is it possible you'd have side effects from having the gb out? Yes. Is it likely you'd have no side effects and be prevented from further trouble? Yes.
Hi, I have a question to ask. My son was losing weight quickly on the atkins diet and got sick one night with a gallbladder attack. He currently weighs 350 pounds and I was wondering if the surgery can be performed laproscopic on someone with a larger belly area. The ultrasound showed several gallstones. The doctor said it should be ok, but I would like your opinion on the matter. He is still losing weight on a low-fat diet and maybe it would be better to lose more weight before the surgery?
Thanks
Whereas it's always nicer for the surgeon to operate on someone who's not overweight, we're used to it with gallbladder surgery, because obesity is in the profile of the patient with gallstones. Laparoscopic surgery can be done on people his size, and much larger; and it is, all the time, with bariatric surgery.
On the one hand if he were to lose more weight before surgery, it would be desirable in some ways; on the other, while waiting he could have more attacks, with or without complications. It's a crystal ball thing.
I never insisted people lose weight before gallbladder surgery.
Hello Sid,
Recently found out during an Ultra Sound that I have one Gallstone measuring 1.6 cm. My symptoms have been pain in the middle of my chest, lower body pain, pain radiating to my left arm and pain in my back. Belching and acid reflux seems to accompany these attacks. Severe back pain has occured 3 times in my life and seems to be classic Gallbladder symptoms where it's directly in the middle of my back and last for hours. This back pain wakes me up out of deep sleep and I can't get comfortable and end up pacing in pain.
To rule out other issues, I have taken a Stress Test, Labs, Endoscopy, and Ultra Sound. Everything came back normal except for the Gallstone.
Since these test 2 months ago, I have lost 20 pounds eating much more healthy and have had no severe attacks but still seem to have mild heartburn.
I have received three opinions from very qualified surgeons. Two said that gallbladder removal was recommended and the other said diet, and exercise is needed. He went on to say the symptoms I'm experiencing would be completly different if it was caused by my Gallbladder. He also said it's very rare that my GallStone would block the Cystic Duct and cause complications. He said Gerd is the source of my problems not the Gallbladder. And losing weight and exercise is what I need to do.
One of the Surgeons that recommeded Gallbladder removal said that the Gallbladder is not innocent here and is contributing to my symptoms. He said you still may have Gerd but here are some reasons why he diagnoses Gallbladder disease: Gerd does not cause the severe back pain your describing, it's your gallbladder. Having as many attacks as you have you will most likely have more and could cause my gallbladder to become inflamed, infected, etc..and could involve major surgery if it gets to this point. Gallbladder cancer while rare your at much more of risk if you have gallstones. Also the surgery will most likely cure many of your symptoms and the Gerd Symptoms I'm experiencing could go away. He said with me traveling for a living with work having a Gallstone attach would be a bad situation. Finaly, he said proving the gallbladder is not innocent is I have been on a diet and have felt alot better.
My questions to you Sid, is if your in my shoes which doctor diagnosis would you trust? Most important question!!
If you say surgery, then the Surgeon I would choose does the one incesion procedure which is less invasive. Is this the right way to go or is the traditional 4 incision safer?
I did not have a Hida Scan. Should I have this done to see how well my Gallbladder is functioning?
Last question, with the removing of the Gallbladder I have seen a chance for chronic diarrhea, constant lower abdominal pain, more prone to Colon cancer, and you can't absorb the essential nutrients as well. How much of this is true?
Thank you so much,
Whereas I've answered these questions many times in the comments threads in my gallbladder posts, I know they may be hard to find, given the number of comments.
I don't want to be a deciding voice in a patient I don't know. I'd say the symptoms you described were very consistent with gallbladder pain. Heartburn, as opposed to the severe pain that wakes you up and makes you pace around (quite typical of stones), may or may not be related. Having not seen your endoscopy, I can't say.
As I've said many times, the main reason to remove the gallbladder is to relieve symptoms; people who manage to control their symptoms without surgery aren't in a category where they MUST have surgery, but there is indeed risk of future problems, which may or may not be more severe than what you've experienced. No one has a crystal ball.
HIDA scan, in my opinion, is useful when a person doesn't have stones, or when they do but it's not clear the stones are causing symptoms. You are not in a category where I'd likely order one.
Diarrhea can happen. You hear about it a lot in forums online; you don't hear from the tens of thousands who have the surgery with no problems. It's not common, and it's usually easy to control. No guarantees.
I'm aware of the cancer thing. It's a low risk, but prudence would indicate people who've had their gallbladders removed should discuss screening. The other question is why it's true. No one knows. My thought is that the sort of bile that forms stones also is more irritating to the gut. So it may not be the surgery that causes it, but the nature of the bile, with or without surgery. I'd like to see a study of people with stones who don't have surgery, and see what their rate of cancer is.
I'll not comment on surgical options.
Thank you so much replying...
Not responding to surgical options between 1 incision vs 4 incisions can you at least let me know if there is pro's and con's to both or your not exactly sure?
And is it true your body can't absorb some essential nutrients as well after Gallbladder removal?
Thanks,
I prefer not to get into the pros and cons of the surgical choices, because I don't want to, even indirectly, influence the choice of a person I don't know.
It's not true that your body can't absorb some essential nutrients after gallbladder removal.
I am 29 years old, I have had three children. I was told after getting the HIDA Scan done that my gallbladder is only working 15% so I met with a surgeon and he is going to remove it in two weeks.
My question is this: I haven't had the ultrasound of my gallbladder done. Is this test necessary? I have read on your page about other people discovering hemangioma on the right lobe of their livers. Would an ultrasound reveal if there are other problems such as hemangioma, or is it mainly to tell you if you have gallstones?
I just want to make sure that the doctors find out if there is anything else causing all of my pain. I have had bad pain in my back, stomach and chest for three months. I've had a lot of pain with breathing and the pain has been classic gallbladder pain and on the right side but also on the left.
The surgeon I met with said it is possible I may have two different things going on and asked if I had the endoscope test done and I told him no. Any advice on tests that should be done with the symptoms I have described? My medical coverage ends at the end of the month so if there is anything to be done, I would like to do it as soon as possible. Thank you for your help.
You ask some good questions, which I really have no good way of answering without knowing a great deal more about your situation. They're best directed either at your surgeon or the doc who sent you to him. I'd say it's unusual to have had a HIDA scan before an ultrasound. But it's impossible to judge from this far away.
Thanks for answering so quickly. When I originally went to see the doctor in January he did a ct scan and an upper GI and then gave me an antacid and said sorry I've ran tests and haven't found anything.
The next doctor I went to said try this spastic colon med (dycyclomine) and if it doesn't work come back and we'll order a colonoscopy. I couldn't get into to see him so I went to a different guy in the practice who right away said I needed a HIDA scan. So glad I saw him!
I told the first doctor that I thought it was gallbladder. I felt like he thought it was all in my head and he gave up on me.
I wondered why I didn't have the ultrasound done as well. I don't think the colonoscopy is necessary but I think I will call the surgeon's office and ask if I can get the ultrasound done just to make sure there isn't anything else going on. I just wondered if the ultrasound would show if there are any other problems that the surgeon may not see when he goes to remove the gallbladder.
I have history of gallbladder disease and pancreatic cancer in my family. My grandmother had her gallbladder removed but had stones in her bile duct and developed pancreatic cancer. Anyway enough rambling. Thank you for listening. I really appreciate the site.
Sorry, anonymous. There's plenty of crazy stuff about gallbladder to be found all over the internet. I prefer to keep it to a minimum on my site.
Your blog is very helpful, thanks! I'm happy to see you debunk many of the myths out there on the web about gallbladder surgery. I had my gallbladder removed almost three weeks and started developing a rash last week. The rash started around the incision sites, but has spread across my stomach. I've tried hydrocortisone and neosporin, but neither seem to help. Any other suggestions? On the bright side, this seems to be my only complication/post surgery effect.
A rash is one of those things you can't really diagnose or suggest treatment for without looking at it. You should show it to your surgeon.
Hi- I just recently had a Hida Scan which came back as 0% ejection. 15 yrs. ago I was in the hospital overseas w/ URQ pain, back pain & unable to eat. They never got to the bottom of it & 5 months later(in the USA) a mistaken US came back w/tumor on my pancreas. Second US came back with pancreas filled with cysts/stones. So I guess I had acute pancreatitis back then overseas. Since then the URQ tenderness has never gone away. It starts from middle abdomen along/under ribcage to my right side between the ribs with sometimes severe pressure there. I wonder if the GB comes out, maybe the cronic pancreatitis will not be an issue? I no longer have cysts in the pancreas.
My diet is relatively clean w/o alcohol, red meat, most fats, rich foods or sugar due to the pancreas. I have Systemic Scleroderma(no external skin involvement other than Raynaud's) that developed since then too & have severe reflux w/o the typical heartburn. I cannot tolerate onions or green/red peppers. I have no problem with diet soda or coffee though.
I do have all the symptoms of GB problems including severe diarrhea daily, but no vomiting & live on crackers for over 2 months now.
My question to you is...when they injected me during the Hida scan, I felt the constriction in my gallbladder. It felt like it was being wrung inside out & hard to breathe, yet the injection fraction was 0%. Is it normal to feel this and have 0%? Could there possibly be something else going on with a blockage or due to my Scleroderma, the muscles no longer function(rigid) in the GB and I felt it because it was trying to contract?
Thanks for any insight! It is truly appreciated. Marie
Marie: the severe intermittent pain of biliary colic (as opposed to the more chronic pain of cholecystitis) is caused when the gallbladder squeezes against an obstruction, which is entirely consistent with what you described. If the cystic duct were open, you wouldn't have severe pain, and the ejection fraction would be more or less normal, assuming no other issues.
Constant diarrhea is not, in my experience, a frequent symptom of gallbladder disease; it might be due to something else, including scleroderma.
Hello Sid,
Love your blog. Just came across while searching for info on symptoms one might have post-lap chole. I'm an RN here in Canada. I had a lap chole done yesterday morning. I'd had stones for years and had been having increasing attacks (and last US a couple of months ago showed thickening to GB; all labwork good, though). No problems post-op, luckily. No nausea, had broth as soon as a got home, really no shoulder pain today as I've tried to keep moving a lot. This afternoon I was walking around and began to feel sort of like a "stitch" in my right side, below ribs and to the side; sort of feeling like the kind of muscle cramp you can get if out of shape and running. Then I could feel this sort of (hard to describe) gurgling sensation to this area; it almost felt like the crackles you hear when auscultating someone's lungs. It's not something I (or anyone) can hear, it's just the sensation. The strangest feeling. I feel this sensation more when breathing deeply. The spot is about a hand's width above the hip bone, to be specific. It's definitely not impacting my ability to breathe/deep breathe, but I feel this sensation when taking a deep breath. Just gas inside maybe? I've had previous laparascopies over the years and am no stranger to the nasty right shoulder pain so I was up and around the house a fair bit this morning (last night, even), trying to help with this. Took a Simethicone this morning, too.
I've had no nausea, and I tolerated a bowl of high fiber cereal for breakfast and a tomato/pastrami/cheese sandwich for lunch, no problems at all.
I was given 5mg of Morphine IV in recovery yesterday, and prior to being discharged I only wanted 1 Tyl#3 (very constipating). Today I've managed to just have 600mg of Ibuprofen; pain hasn't been that bad and I don't want issues w/ constipation. Drinking lots of water, too. By all accounts, I'm doing very well!
I was searching around online to see if anyone else has ever experienced this tenderness and "inner gurgling/crackling" sensation to the above mentioned area. I realize you can't diagnose anything but some possible suggestions would be great; I have no qualms about trying to reach the surgeon tomorrow to inquire...
Many thanks!
Lisa
Lisa, given all the other parameters you mention that indicate a normal and rapid recovery, it's not likely that there's anything significant happening. I don't have a specific suggestion as to what it might be: inflamed peritoneum from surgery might be extra sensitive to peristalsis; or maybe it's related to the gas still present from the surgery, which can take several days to absorb; I really can't say.
But as long as all the other criteria for smooth recovery are in the green zone, it really doesn't sound like something of concern.
As you suggest, it's best -- particularly this soon after surgery -- to direct your concerns to your surgeon. Absent increasing pain, fever, distention, etc, I'd guess this sensation will steadily disappear.
Hey Doc....your blog is so very helpful thank you so very much for taking time to answer our questions...
I have been suffering with gb attacks over the last 10 yrs or so. They started in my back and would last about 6 hours. However, they are now coming more frequently. I had an acute attack at 3 am on Sunday. It is now Tuesday and my upper right abdomen is still very swollen and tender. Is this normal for gb attack? And lastly, how are docs able to tell if someone is having an attack of the pancreas or the gb? Do the symptoms mimmic, or is it mainly through testing? ..
Thank you so much!
Hey Doc....your blog is so very helpful thank you so very much for taking time to answer our questions...
I have been suffering with gb attacks over the last 10 yrs or so. They started in my back and would last about 6 hours. However, they are now coming more frequently. I had an acute attack at 3 am on Sunday. It is now Tuesday and my upper right abdomen is still very swollen and tender. Is this normal for gb attack? And lastly, how are docs able to tell if someone is having an attack of the pancreas or the gb? Do the symptoms mimmic, or is it mainly through testing? ..
Thank you so much!
As I've tried to explain, there is biliary colic, which is a transient obstruction of the gallbladder opening, causing severe pain but pain which generally lasts only a few minutes or an hour or two. Then there's cholecystitis, where the obstruction remains, and the gallbladder becomes inflamed. In that circumstance the pain and tenderness can go on for days, and sometimes can turn into a serious infection.
Pancreatitis may have similar symptoms to cholecystitis, or may be quite different. Blood tests, and sometimes imaging studies, usually make it clear.
Hello again!
I am a 42 yr old female; had a lap chole done on Apr 6, good recovery...but on day 4 post-op, began feeling a lot of pain to about 2 inches to the left of the umbilicus. All incision sites healing just fine, no sign of infection. As the days progressed, this pain turned to a burning pain and the only time I don't have this pain is when lying down on my back. Long story short, I was able to see my surgeon this morning; he suspected the pain was either a hemotoma or nerve entrapment. A CT of Abdomen was done; it ruled out anything serious so he concluded my pain was due to nerve entrapment. He was not able to talk for long as he got called into surgery, so I didn't have much of a chance to get much info regarding whether this pain will go away on its own and how long it could take. He ordered me off work for 10 more days and told me the pain would go away "in time." It's so uncomfortable that I have a difficult time walking upright, sitting upright or standing. I'm scheduled back at work on Apr 26 but from the little info I've been able to find on nerve entrapment following laparascopic abdominal surgery, everything I've read seems to indicate that either nerve blocks or surgery to the nerve (once they specifically identify which nerve) is the only way to treat. Nothing I have read indicates that the pain will subside "in time." I'm not sure what to do. I don't want to wait until middle of next week, only to have this pain and still not be able to return to work; I don't want to do that to my employer, so I'd like to be proactive if I can but not sure what to do. What do you think the odds are that this pain will resolve over the next couple of weeks on its own? What actually causes the particular nerve to become entrapped in the first place? Is there anything I can be doing at home to help things along?
Many thanks
Lisa, RN
Lisa: such things happen once in a while. In my view, it's because you can't help injuring some little nerve somewhere occasionally when you cut things. The healing process is dynamic: on day zero there's no healing, and on each successive day for a few weeks there's a building up of healing response.
As tissues get more inflamed (healing is like inflammation in many ways) and thick, nerves can get pressed on; or, if they were slightly injured, as they go through healing response, they can get irritated.
I'd rarely if ever consider intervention this early in the process, because, as your surgeon said, the odds are that as things progress the symptom will subside. It might be that taking anti-inflammatories, like ibuprofen, or applying a heating pad to the area will help in the meantime.
It's only for a nerve entrapment that doesn't go away after several weeks that one would generally consider exploring the area. Trying a steroid/anesthetic injection could be done sooner, but there's a risk of doing damage to the nerve with the needle.
If you can stand it, the best advice is to wait, and it's very likely it'll go away.
For chronic neuropathic pain, there are also some drugs that can be useful, like neurontin or dilantin or others. But, again, it's too soon for that.
Thank you so very much for taking the time to answer my questions. You are a wonderful person for giving of your time and wisdom to those of us who write in with questions. I really can't thank you enough.
I have been told I need to have gallbladder surgery. I have a stone that is 2.5 cm. Will they be able to get that out without a larger incision, if all else is okay? I was thinking about doing the cleanse where you drink apple juice for 5 days then you drink some epsom salt, olive oil... I was hoping that would be the miricle cure but obviously that wouldn't work with something as large as I have. But would it have worked if they were small?? Thanks you for doing this blog,it has been very helpful for me.
Lorry: I guess you didn't read this post about gallbladder "cleanse," or "flush." Totally bogus, I promise, no matter what size the stones are, and no matter what else you hear about it.
2.5 cm is an inch, and it shouldn't require a larger incision to get it out. If it's tight, usually the stone can be crushed a bit, and removed in pieces.
Hi Dr Schwab,
Thank you so much for sharing your expertise. Your blog is such a good read! I actually have 2 medical conditions that are tough to diagnose/treat, and I'm wondering if it's possible they're related...
I've just been diagnosed with gallbladder dyskenesia, following 2 nearly 24-hr long attacks about a month apart. During first attack, I went to the ER, CT scan showed everything normal EXCEPT "mild thickening of the distal appendix w/subtle infiltration of the adjacent fat." Ew. Was sent home and told I'd be back later if it was, indeed, appendicitis. Nothing ever happened. Further exams: no problems on ultrasound; blood levels showed inflammation(?); normal colonoscopy; upper endoscopy showed mild gastritis; HIDA EF was 20%. I felt MILD cramping during HIDA, nothing bad at all. The following night, however, had an attack that lasted for hours and also cramped a lot in appendix area. My GI recommends surgery but says I should be ok to wait while I treat my original medical problem...
Part2: I have been struggling with infertility due to many fibroids, (incl submucosal) and good-sized endometriomas on both ovaries (3 & 4cm). I was diagnosed w/endometriosis 8 yrs ago after an umbilical hernia. Endo was popping out of my belly button! I was scheduled to have a hysteroscopic myomectomy but had to cancel because of 2nd GB attack. Now I'm planning on a bigger surgery to get everything out, and because someone needs to take a look in there.
My questions for you: Is it possible I have chronic appendicitis and that is causing GB symptoms? Is it possible one of the cysts on my ovaries is touching the appendix, causing doubled-over pain? Finally, could endometriosis be messing with my gallbladder??? Are any of these things related?
If you've made it this far, thank you so much for your time!
p.s. I'm 38, 130 lbs.
Jenny P: as usual I really can't make any sort of diagnostic opinion from so far away, but I can make a few statements:
Absent typical gallbladder symptoms, an abnormal HIDA alone can be hard to interpret. It's possible, for example, that having a flare of chronic appendicitis could affect the test.
Chronic appendicitis with flareups can occur. If I were your doctor I'd look carefully at the CT scan that showed something going on in that area.
I've not heard of endometriosis affecting the gallbladder, but I suppose if there were an endometrioma attached to it it could cause symptoms in that area. Of course, endometriosis pain tends to relate to your menstrual cycle.
It's a complex picture, with the endometriosis making it hard to separate pain from appendix or gallbladder. If I were your surgeon, I'd be hesitant to remove your gallbladder until things were clarified.
Given the various possibilities, I'd even think diagnostic laparoscopy would be a consideration, although I'm not much of an expert when it comes to the role of laparoscopy in the dx/rx of endometriosis.
Thank you! I know you can't diagnose anything over the internet, but your opinion helps me form some questions for both my gyn and GI doctors.
I'm having a lap in August! Thanks again...
Hello Dr. Sid,
You were kind enough to answer questions I had in the past, before and after my lap chole (April 2010). I'm back.
My lap chole was uneventful, other than having some nerve entrapment to the area around my umbilicus and a lot of pain due to same but it resolved in about 3-4 weeks and I've been fine since. Strangely though, I'd developed constipation since having my gallbladder removed (seems a lot have the opposite, diarrhea). But 2 weeks ago that seemed to be resolved.
24 hours ago, I developed a major headache and mild nausea. I awoke at 1am, very nauseated, ran to the washroom and threw up a little. Remained feeling nauseated through out the night. All day yesterday, feel waves of pain (a very intense, wave-like ache) to my upper mid abdomen that radiated a little to the left (right under ribs). The nausea persisted throughout the day; feeling that bitter build-up of saliva one feels prior to vomiting, but unable to actually vomit. Alternating between having chills and feeling hot/sweaty. No fever. Had a very large and normal BM the morning before and that morning. I'm an RN and started to think that this was more than just a stomach bug, concerned I was having symptoms of pancreatitis. Went to the local Urgent Care Centre.
They gave me a litre of NS IV, IV Maxeran and IV Toradol and a Pink Lady. Did bloodwork, which I assumed would include lipase and amylase but sadly it didn't. WBC elevated some at 13.7 (high end of normal range is 11). Told liver enzymes and lytes good. 3 views of abdomen done. Told my pain and nausea is due to a partial bowel obstruction. I was shocked, to say the least, as I've had very good large BMs the last couple of days, and definitely had not been feeling bloated or constipated.
I was told that I could go to the local Hospital and be admitted, have NG tube inserted and be NPO for a few days.....or go home and have nothing more than clear fluids for 1-2 days and hopefully things will pass but if increased pain, vomiting, fever or rigors, to get to hospital.
I'm still concerned this is related to my pancreas and I will try to reach my family doctor tomorrow to ask about having lipase/amylase done.
I've read that it's not uncommon for people who've had their gallbladders removed, to have issues w/ pancreatitis - months to years after.....but can't really find out why. One article stated it could be due to a stone being stuck in the duct. What could other possible causes of pancreatitis be, in someone who's had a previous lap chole?
I just don't feel my pain and nausea are due to bowel issues....considering my BMs have been so good.
Thanks for any info you can provide.
PS - the Maxeran and Toradol really didn't do very much for the pain and nausea.
Lisa
Lisa: I'd say it's not at all common to have pancreatitis, remotely after gallbladder removal, unless they'd had problems with recurrent pancreatitis before the surgery. It can happen, usually for the reason you mentioned: retained stone in the bile duct. It would be rare to have pancreatitis due to that cause and have normal LFTs. The other common causes of pancreatitis are alcohol and certain medications.
Of course I can't say what your trouble was. "Partial bowel obstruction," based on plain films, is often mis-diagnosed, in my opinion. A little ileus, due to any number of things including "flu" can look similar. Fever wouldn't usually accompany a true mechanical partial obstruction, at least not early on. However, anyone who's had abdominal surgery is at some -- if small, in your case especially -- risk of obstruction.
If your amylase and lipase are normal a few days after the episode it won't rule out pancreatitis.
That's about all I can say: I have no way to diagnose your illness from here. If there is in fact evidence it was pancreatitis, and if alcohol isn't a possible cause, then some form of investigation of your bile duct would be in order.
Hello
Thank you very much for providing this blog and in advance for your assistance.
For the 6 months I have been suffering with agonising pain in my abdomen and have been diagnosed with Gallstones. I’m female aged 36 with a 18 month old child.
As I am literally terrified of surgery (my mother died age 36 in surgery, not for GB)I have been trying oral medication prescribed by my Dr. This doesn’t seem to be working as I’m still having attacks about once a week. I am now again considering surgery again although still terrified.
Prior to this all starting I lost over 6 stone in 6 months by embarking on a rigorous dieting and exercise program after having my baby, I know I did too much, and hardly ate during this time.
My Dr suggested this could be the cause of my stones being formed. Is this correct do you think? And if this caused my stones, does this mean in essence my Gallbladder could be Ok and it was just the dieting that caused this to happen? And so maybe the damage can be reversed if i didnt do this extreme dieting again? I don’t want to go through all this if my GB is healthy.
Thank you again, Julia
Julia: generally stones form because of bile chemistry and not because of abnormalities of the gallbladder. Stones can cause inflammation of the gallbladder, but it's not the gallbladder that's the initial problem.
Pregnancy can precipitate stones, as can rapid weight loss. So an argument can be made that if the stones were able to be dissolved by certain pills, and if the precipitating condition were not to recur, then dissolution might be followed by no more problems.
The problem is that the pills don't work very well. If they do for you, then it could make sense to keep your gallbladder and see what happens. But if the stones remain, you remain at risk for problems from the stones, and you'd need to make your decision based on how bad your symptoms are and what you think of the possible complications that can occur.
It's hard to fault someone who's terrified of surgery: it's scary. But nowadays the safety of non-emergency surgery is extremely high, and the chance of side effects from removing the gallbladder is very low. Remember that in discussions like this you tend only to hear from people who've had problems. The vast, VAST majority don't.
Thank you so much for taking the time to reply to me, and so quickly, your comments have really helped, Julia
I have had gallbladder attacks for 11 yrs now, finally diagnosed in May 2008. Have had two babies since then and was unable to have anything done. I am currently seeing a GI for my plan of treatment. I went to the er about a month ago after 2-3 weeks of constant pain, the er dr had mentioned that it wouldn't suprise her if I still developed stones after having my gb removed?
Is there any info you can tell me about still developing stones? Where might they form and what risks might they pose? This is the only thing still holding me back from surgery, I have accepted the risks of diarrhea, cancer and all the other horror stories,thankful for your blog to hear some of the good results.
jecka: forming stones after gallbladder removal is so rare as to be nearly a non-consideration. Your ER doc is very misinformed.
There are some that have problems with stones in the main bile duct after gallbladder removal, but that is nearly 100% due to them having been left behind when the surgery was done. Nowadays, however, when that happens (not common) it can almost always be taken care of by non-surgical means; ie, removing them with a scope.
It's really not an issue. Your er doc needs to go back to school.
Hi
I made a post here a couple of weeks ago (10/17/2010) in relation to gallstone attacks. I thought about what you said, and decided even though I was terrified of surgery what you said was right, and that I needed to make my decision based on how bad my symptoms were and the possible complications that can occur if I did, or didn’t have surgery.
I decided to have the surgery and was booked in for the week after. I was absolutely terrified and can’t really say I was brave about it and after much tears and panic I made it into the surgery room and kept telling myself ‘ the safety of non-emergency surgery is extremely high’.
Its been nearly two weeks now since surgery and already I feel amazing. I haven’t had any problems at all. I feel like I have got my life back. I’m not scared of eating, I’m not living in fear of another attack, not constantly feeling scared and anxious all the time incase things get worse, and I’ve put all the horror stories of everything that can go wrong behind me.
And when you said the vast majority don’t have problems, I think that’s true. Before, when I searched discussion groups it was full of people who have had problems after having there gallbladder removed, I thought this was the majority of people, but I’m learning its not, I think the majority of people just got on with there lives after surgery, and the small few who have still have problems discuss them in discussion rooms.
I understand now how lucky I am that I had the option of surgery at all. And that are people such as yourself who do care enough about your profession and people to take the time to respond to people like me and help us to take responsibility for our own health by enabling us to make informed decisions,
A big genuine thank you for helping me get my life back. Julia
Glad to hear it Julia, and thanks for taking the time to follow up here. I hope others will read it.
Hi Dr
I am from Australia and came across your blog regarding gallstones.
I am a female and 30 years old and for over 10 years I have been having unexplainable nausea, vomiting, heartburn/indigestion and pain in my back and episodes that will come on all of a sudden where I feel like I have a fever and the only relief is to lay down or sleep it off (if I can fall asleep).
I have been to see multiple GPs and specialists and have had many blood tests, endoscope, colonoscopy and other tests done and all that came back was possible Lupus or IBS. Sometimes I thought I was imagining it or being overly dramatic or sensitive.
In November last year I spent two days feeling very unwell including having a fever and about 3 hours late in the evening where the abdominal pain was so intense that I almost called the ambulance as it felt as if it could have been a possible heart attack! The GP recommended I have some more blood tests done including seeing if I had stomach ulcers. The results of the blood tests came back all clear but I had an elevated bilirubin count which had been present for all previous blood tests. My GP recommended an ultrasound on my liver and yesterday I received the results that show I have gallstones.
I am booked in to see a specialist upper GI surgeon this week and hope the diagnosis is the removal of my gallbladder. I, like a lot of others, am nervous about surgery and potential after effects but after 10+ years, I am ready for a potential resolution.
One question I have is in regards to gallbladder/gallstones and exercise. I love exercising and I constantly find that I have nausea, my heart rate always accelerates rapidly, sometimes up to 106% of max HR (even with increased fitness), feeling of breathlessness and I feel a bit feverish or clammy. Can a gallbladder or gallstones cause or exacerbate these symptoms?
I am very grateful to have found your blog and to have had an opportunity to read all the comments.
Katrina, I'm glad they finally got around to checking your gallbladder; it's certainly highly suggestive that that's the problem.
I don't know of a relation between your exercise symptoms and gallstones, unless you were having infection or inflammation at the time of the exercise. If it's a regular occurrence, I'd think it's not related. Pushing yourself too hard? Some sort of intrinsic heart problem? Something to mention to your GP, I'd say.
Meanwhile, we're enjoying watching the Australian Open...
Looks like most of the comments are pretty old. So maybe this isn't active anymore. But I'll try anything at this point. My future wife started having nausea about 2/4/11. Then pain in her upper right abdomen. We have been to the ER twice, a GI and a surgeon. The untrasound, CT, hidascan, xray, bonescan, upper GI. All we are told are normal. But she continues to have severe pain and is upset to her stomach. Can't eat unless she takes nausea meds and then it is 50/50 if she can keep it down. The pain is contant and she can only sleep with sleeping pills and pain pills every four hours. Everything still say GB to me but no one will do anything. Any advice?
Niki & amp; family: as a surgeon, I too would be reluctant to suggest gallbladder removal when everything tests normal. Since none of our tests is absolutely infallible, it's possible that gallstones could turn up at some point. But operating with no evidence has a significant likelihood of not helping.
I assume she's been tested for pancreas problems (and with severe pain, it would likely show on the CT scan if it were pancreas), and for pregnancy and kidney stones.
It can get very frustrating as likely explanations are eliminated and rarer ones are considered. All I can suggest is either to stick with the docs you have and keep pressing them to look into it further, or find other docs who will; possibly at a tertiary care center like a hospital associated with a med school.
Sadly, such situations aren't rare -- having symptoms that elude easy diagnosis -- and they require patience on the part of the suffers and persistence on the part of the docs involved.
I wish I could be of more help, but the only reliable sources are those able to examine her and her records directly.
As a natural health expert, I get numerous e-mails asking, "Is gallbladder surgery absolutely necessary?" I usually respond with the answer, "sometimes." I then explain that most gallstones can be naturally dissolved and flushed (around 85%) but the other 15% should usually opt for an alternative treatment or as a last resort, gallbladder surgery. I always, always, always recommend to try gallstones remedies and avoid gallbladder surgery at all cost!
Reference:
gallbladder surgery made easy/
gallbladder problems
Mike: I hope you'll read what I wrote about flushes. I can assure you -- although I doubt you'll ever believe it -- that it's entirely bogus, demonstrably so. And it's wildly wrong that they can be naturally dissolved, especially in the numbers you suggest.
There are indeed pills that may dissolve stones, assuming they're of a certain chemical makeup, and are small enough. However, in nearly all cases, after dissolution they'll eventually reform.
I usually don't even allow comments that link to certain kinds of other sites, but the ones to which you link have some accurate information in them, and the inaccurate stuff, from my brief and incomplete perusal, seem fairly harmless.
I'm waiting for a single naturalistic/homeopathic practitioner to take me up on the proposal: document stones in a patient with ultrasound, apply your flushes or herbs, repeat the ultrasound, report back. For your own sake, and the sake of your patients, you should. It'd be revelatory, even if you never tell us what happened.
Paint conditioner: I treated your comment as spam, because it links to a commercial site and because the answer to your question can easily be found in my posts on the gallbladder.
Thank you for this blog...I hope it is still current. I am scheduled to have a section of my colon removed as well as my gall bladder. I have had chronic inflamation as well as diverticulitus for years. What can you tell me about the surgery, recovery, etc.?
Yes, the blog is sort of active, in that I respond to comments.
In your case, I really have to demur: your surgeon is the best person to answer your questions, since he/she knows exactly what will be done, and how. You are entitled to have every question answered, and shouldn't hesitate to ask. Making sure you understand fully is part of the surgeon's job.
At minimum, call his/her office and tell them you have questions and need a call back from the surgeon. Or make another appointment.
Fabulous blog and been really reassuring for me. :) Surgery due in 6 days, large stone. Been in pain and feeling rubbish for months (female 41) and just want to feel better! My question is this...I have left side pain, where my kidney is (therefore kidney pain I guess!) it's bad and is getting progressively worse. Now my Nan, who has had gall bladder surgery says, and I quote, that when your gall bladder is knackered (I'm quoting!) your liver and kidneys work harder to compensate, and that this pain will be resolved after, and generally I'm going to feel amazing after recovery. I love my Nan dearly. :) And I want to believe her, and as such haven't had the kidney pain checked out as I am hoping it will indeed resolve.......however, I can find nothing online to suggest that what she is saying is right :/
I'm pawing around in my brain and I can't seem to come up with teachings that include a knackered gallbladder.
Yet we must love our nans, and they must love us, so I hesitate to contradict, lest it call her into question; however, assuming "knackered" translates across the pond to damaged in some way, I'm afraid the lady's best intentions have exceeded medical knowledge. She's wrong about that.
Assuming the pain you describe comes from your kidney might or might not be true. It probably needs a definitive diagnosis at some point, assuming it persists.
Yes, damaged. :( They don't really do function tests on the UK NHS. If you have stones and symptoms they just take it out, but I suspect the function would be very low. I have zero tolerance of ANY fat, lately more or less any food. classic pain after eating, referred back pain, etc etc, although I must add, HEADACHES!! Ugh! The only non classic thing is this assumed kidney pain. I was praying there weren't two things wrong with me but I think deep down I suspect there is. :( It's a pain in my left side, waist level, in the back.
Btw with all the negative stuff written in the net about gall bladder surgery and poss surgery in general (first ever op haven't checked, but I'm sure it's true) this page was truly amazing to find and I really appreciate the time you have taken to do this. Its a worrying time for most. Getting factual advice from someone that knows is invaluable. I was considering backing out of surgery until finding this page. Thank you.
Day 4 post surgery. I didn't respond very well to the anaesthetic and spent one night in hospital, then felt like I had the worlds worst hangover for 2 days! But apart from this minor hiccup I have no complaints so far :) Scars are tiny, pain was virtually nil! Some gas pain in the shoulders and even neck, it moves from one place to another, but is totally bearable and indeed I stopped pain relief within a couple of hours post op. I'm up. Eating, drinking and totally relieved at how easy it all was. My back pain has gone! I'm not exaggerating when I say I could cry with happiness. From the second I've woken up to the moment I've fallen asleep that pain has dominated my life for the past two years. One big stone (16mm) and a poorly sick inflamed gb removed. :)))) No 'kidney' pain so far, no night time toilet trips either..... my Nan more knowledgable than we gave her credit for? ;) .... but I've been dehydrated post surgery, so who knows. I THINK that a lot of people that have problems post surgery may have small stones and may have 'escapees' in their system. But then it suits me to think that cos I had one large one and thinking positively never hurt anyone! Had to share here as it was only due to this blog I went through with my surgery :)))))))
Excellent news! Thanks for letting us know.
Thank you so much for the time you have invested into helping people. The bad information on the internet has terrified me.
That being said, I do have a few questions. I am a 56 F who has been diagnosed with one 1 cm stone and a thickened gall bladder wall.
I have never had surgery other than a tonsillectomy as a child back when they used ether and it made me very ill post-op.
Does age bring any particular problems to laparoscopic surgery for the gall bladder?
Have you ever heard of vision blur and lightheadedness along with chills, vomiting, diarrhea as symptoms? I feel like I'm in a fog.
Have you ever heard of people using beano (yes it's a legitimate question) to help resolve the air trapped after lap surgery?
I am most concerned about the effects of pain medications on me afterwards. I don't like them. Is there a way to get my surgeon to LISTEN to my concerns regarding this? I'd like to know how to get a busy surgeon I've never met to listen to me before I see him.
Does age bring any particular problems to laparoscopic surgery for the gall bladder?
No, it doesn't. Age can be an issue with any operation, but not specifically laparoscopy. 56, I can say looking well back on it, isn't old. And the issue is general health more than age.
Have you ever heard of vision blur and lightheadedness along with chills, vomiting, diarrhea as symptoms? I feel like I'm in a fog.
Certainly fever, chills, vomiting, diarrhea can be associated with gallbladder infection; the others are more likely secondary to being generally sick and weakened by it. But I'm not in a position to say specifically. You should bring it up with your doctor.
Have you ever heard of people using beano (yes it's a legitimate question) to help resolve the air trapped after lap surgery?
The air trapped after laparoscopy is not in the bowel, but in the abdominal cavity itself; beano affects intestinal gas production, so I'd think it'd have no effect in this case.
I am most concerned about the effects of pain medications on me afterwards. I don't like them. Is there a way to get my surgeon to LISTEN to my concerns regarding this? I'd like to know how to get a busy surgeon I've never met to listen to me before I see him.
The way to get him to listen is to talk to him about your concerns, and make sure he knows how important the issue is to you. But taking pain meds is up to you: I assume he'll prescribe them. You needn't take them unless milder drugs, such as ibuprofen or acetaminophen aren't working. Many people do fine without narcotics after lap surgery. I did.
Thank you for answering me so quickly. You have already answered so many questions on this site about gall bladder problems and removal.
Is there anything the surgeon can do better to minimize the problems connected to co2? Is there anything the patient can do better to minimize the problems connected to co2?
56 isn't so old, you're right! I was driving past a retirement center not long ago and heard rock n'roll music coming out from some party they were having and realized the rockers are there now. hahahahaha
I am not looking forward to gall bladder surgery and recovery but I sure am looking forward to health again. And that is the ultimate goal.
Toda!
I think you're making more of the CO2 than you need to. Worst case is some shoulder soreness that can be helped by using a heating pad on the shoulder. It goes away on its own pretty quickly. Some people experience it, some don't. For those that do, it's usually not a big deal. Searching the internet leads you to those who had problems with whatever it is they're writing about. Most people don't have problems, and don't write about it.
Surgeons routinely do maneuvers to release as much CO2 as possible at the end of the procedure. Some squirt a long-acting anesthetic under the diaphragms before finishing, which may help.
Other than the heating pad and some sort of pain med, there's nothing a patient can do to speed the process. It goes away as the gas is absorbed naturally.
Dr. Sid, again I thank you for answering. I am the 56 f and I have one last question before my surgery upcoming on Monday (3 days from now.)
How severe is pain after laparoscopic surgery for most people? I've read so many horror stories about people who awakened in recovery in excruciating pain.
As I've suggested, the stories you hear online and elsewhere are those of the people who had a bad experience; you don't hear from the 90% who didn't.
Typically, the small incisions that are made are injected with a long-acting anesthetic, so on awaking, usually there's no pain at all from them. The shoulder pain that some have from the CO2 is variable; from none to uncomfortable. In most cases it's pretty mild or non-existent.
After such surgery, many people return to work in a couple of days; most are up and around, at home, taking minimal or no pain meds within a day or so. There are always exceptions, and there's no way to predict. The odds are you'll be pleasantly surprised.
This is 56 F and I had my gall bladder removed laparoscopically on the 6th. I did extremely well except the anesthesia and post surgery morphine kept me in the hospital an extra day. After that I did not take one narcotic...and tylenol only a few times.
I have done remarkably well. I had no problems with the co2. I have been up and about since day one and it's been amazing for such surgery.
I again want to tell you that I truly appreciate the time you devote to this blog. It sincerely helped me find positive information in a sea of bad reports.
Thank you so very much!
Glad to hear it; and thanks for taking the time to let me know.
Maybe you have addressed this...sorry for the repeat question if you have.
I recently (as in 4 days ago)had my GB removed (path report indicated "chronic cholysistitis") and am recovering just fine -- just waiting for my small softball size lower abdomen to deflate (when will that happen???).
Naturally, everyone now has an opinion for how the rest of my life will -- as far as digestion. Several people have strongly recommended taking "digestive enzymes" -- forever.
Are you able to comment about this?? are they necessary post GB surgery to "properly" digest everything I now eat?
Thanks -- love your blog!!
Yes, I have addressed it, CG, but I suppose it's buried, several times, in the comments. Anyhow, since all the bile you ever made is still being made, and since removing the gallbladder has no effect on the production of digestive enzymes, which are mainly produced in the pancreas, there's no need to take them.
Most people notice zero adverse effect on digestion after gallbladder removal.
Hi Sid,
Looks like it's been awhile for comments. You've had a much deserved break:) Your blog is fantastic and I've learned a lot.
I'm a 42 yo male. I've had RUQ pain for years now. Ultrasound showed multiple larger stones. EF was borderline on two hida scans. I opted for Ursodiol starting about 6 months ago. Going for ultrasound soon. My question is have you seen much success with the dissolution route and although the general rule is it works better on smaller stones, is there a specific size that it just probably won't work. Lastly, if dissolution dd work, are you taking a large risk of getting the dissolved stones stuck in the bike duct once they shrink to a certain size before complete dissolution?
I'm hoping dissolution will work but want to realistic on chances of a successful outcome. My doc said it probably won't work, but we could give it a college try.
Thanks in advance!
I wrote briefly about dissolution here, although you have to wade through a rant to get there.
In my experience, ursodiol is not a long-term solution, in that people who form stones form stones; ie, if they do go away, they'll likely come back when you stop the med, although restarting it may re-dissolve. Etc, ad finitum.
As to size, I recall reading somewhere that it takes about a month per millimeter; ie, a once centimeter stone takes nearly a year. And, yes, there have been instances of problems with stones passing from the gallbladder and getting stuck in the bile duct when they get small enough. Can't give you numbers on that.
If you're not having unpleasant side effects from the drug, like nausea or diarrhea, and if you aren't having significant symptoms from the stones while you wait to see what happens, there's generally no reason not to try.
Because most people with stones, no matter of what size, don't have severe, dangerous complications without a little warning, I never tried to talk people out of taking actigall if that's what they chose. But for a healthy person with a lot of years left in them, I didn't see it as a long-term solution. Or dissolution.
P.S: before my wife points it out, I should have said ad infinitum.
Oh you know the wife would catch that ;)
I ran across this:
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=19287
Partial stone dissolution occurring within 6 months of beginning therapy with ursodiol appears to be associated with a >70% chance of eventual complete stone dissolution with further treatment; partial dissolution observed within 1 year of starting therapy indicates a 40% probability of complete dissolution.
So the next ultrasound will be telling.
No side effects from ursodiol past first week so that's good. Only strange thing is RUQ pain when it has reoccurred has gravitated more towards navel and has been milder.
I'll let you know how ultrasound comes out.
Thanks again for your blog.
Yes, I'd very much like to hear how it goes. Good luck!
Hi Sid,
So the ultrasound came back and drum roll please...no change in number or size of stones. So the consensus now is there are too many and too large for dissolution. And probably too old (been 10 years). But, I'm glad I tried. Next step is keep the low fat diet and go speak with some of your colleagues for consultations.
Thanks again.
Thanks for the followup. I appreciate it.
Hi!
I have been having abdominal pain - feels as if there is a tennis ball under my right side of rib cage. I am so uncomfortable.
My doctor set me up with two appts. An ultrasound of gb and a HIDA scan.
My ultrasound showed gallstones.
My HIDA scan is two days away.
My question is: I don't go back to see my dr. until after the scan - but since they did find gallstones - and have been so miserable with this pain - do you think it is still necessary to have the HIDA scan done?
I can't say much about your specific situation, not knowing enough about it. But I can say I rarely ordered HIDA scan when there were already confirmed stones, unless there was strong reason to suggest that stones weren't the problem.
Hello Doctor:
I had an ultrascound that showed a lot of gallstones; and then a HIDA scan. There was no 'thickening' so they don't think surgery is necessary. They think the pain I am experiencing is due to ulcers or gerd.
However, other than being nauseous at times, my main complaint is pain under my right rib cage - feels like there is a ball under there. So uncomfortable! I don't have what I consider to be heartburn, or acid reflux.
Is there ever a case when they remove the gallbladder just because of gallstones - without thickening?
I am in no hurry for surgery, to be sure, but this pain is causing me many sleepless nights.
Do you have any thoughts? I would appreciate them so much!
Thank you
Thickening occurs when the gallbladder becomes inflamed. Typically that implies "cholecystitis," which is a more significant illness that what's generally called "biliary colic."
Colic is the intermittent pain that occurs when the gallbladder squeezes down on a stone that happens to be near its opening. This causes pain that's usually fairly strong, but which lasts only a matter of a few minutes or an hour or so, then goes away. Studies done when the pain has let up usually don't show much other than that there are stones.
If a stone gets lodged in the gallbladder opening, the pain continues and the gallbladder wall gets inflamed, thickened. In that case the pain is steady, lasts for many hours or days, and can lead to infection of the gallbladder.
I'd say most people who end up having their gallbladder removed do so because of recurring colic (it often happens at night, waking people up), and never have much in the way of inflammation or thickening.
I have been reading some of the blogs and find them very interesting - I am a 33 year old female. Prior to a week ago, I didnt know much about the function of the gallbladder and I wasnt concerned about. I am from Canada and while on vacation in Mexico last week, I started having extreme back pain that, over the course of the day, radiated to the right side of my chest. After hours of pain I decided to go to the doctor and before I knew it, I was being sent to emergency for surgery to remove my gallbladder! (A vacation nightmare). An ultrasound discovered that I had a very large stone lodged in one of the ducts. Prior to this day I NEVER had any problems with my gallbladder, never had any pain and didnt know I had stones. It was a total shock. I told the surgeon that operated on me that I couldnt believe I was having surgery now because I had been exercising, following a fairly healthy diet and losing weight over the past 6 months.
Anyhow, right now I am recovering from the surgery - My body is retaining mass amounts of fluid, I mean 10+ pounds worth! Otherwise it is a manageable recovery. Eating has not been too much of an issue, my surgeon told me within 2 weeks I should be able to return to a normal diet. I hope this is helpful for anyone who is scared about going into surgery. Believe me, I was TERRIFIED. I had never been in the hospital prior to this, never rode in an ambulance, never had an IV, and I was so scared of the anesthetic...and on top of this, I was very far from home! I survived :)
Thanks for sharing your harrowing experience. I'd have been worried, too, having surgery in Mexico. (No offense to Mexico: my experience comes from my training days, long ago, when I handled a couple of patients that had been operated in Mexico and returned home... 'Nuff said.
Sounds like you're doing fine.
Hi there, not sure if my case is rare or different but I suffered from gallbladder pain for almost 10 years, started in pregnancy in 2003. Had every test, xray, ct, mri, eus, blood test etc. Everything came back normal.EUS in Aug. 2012 came back minimal sludge, but GI speacialist said it was normal and told me I had "visceral hyperalgesia" and to take an antidepressant. Finally convinced a surgeon to take gallbladder and what he found shocked him.My gallbladder was completely covered in adhesions and attached to bowels and liver. It was white and pulled straight down to bowels and held in place. If you are interested I have pics. It is quite amazing.I am 3 days post op and feel so much better already. It was very painful to live like that before. Maybe you could write about other gallbladder problems or things that can happen so someone else doesnt have to suffer as I did and for as long as I did. Thanks
First, I must say that you are an amazing man, answering the hundreds of questions on this blog, over a period of years. Hats off to you! I'm going to keep it going I suppose.. I am 5 days post gallbladder removal and I still have this pin prickly rash that I developed about 36 hours after surgery. It began only (and exactly) where the betadine was... A very distinct line of orange along the outer edges of my abdomen. The rash occurred between my belly button and my breasts. Last night I noticed it on my forearms as well. Is it possible to have a little reactive rash to the anesthesia (my first gen anesthesia) or to the Vicodin (which I only took 3 in all)? Or is it likely related to something else? I don't have my post op with the surgeon until next Wednesday. Thanks so much in advance!
Most rashes due to allergic reaction to a drug would be all over; the way yours started sounds like a reaction to the betadine. But with rashes, it's impossible (for me, anyway) to diagnose without looking at them.
If there aren't other symptoms, like fever or breathing problems, it's probably not a big deal; and if you're not taking any meds anymore, there's not much else you can do about it for now. If it itches, hydrocortisone creme might help. And it's always best to let your doctor know when things are happening post op that concern you.
Thanks... I assumed it was from the betadine, just by the nature of its location. Have a great weekend!
51 year old female here... complete surgery (and hospital) "virgin" (having acquired my children via adoption and the others via marriage). So, I've NEVER had ANY procedure at all And I am not on any meds except for Nexium which was a recent thing. So, despite having worked as secretarial support for physicians and residents in hospitals, and having run the front office of an Urgent Care in a busy part of the city, I, personally, am totally unaware of how surgical procedures work. One night about two weeks ago I had a bad bout of pain and vomiting and then I went to my family doc who ordered an ultrasound which found a 1cm stone somewhere near my ductwork which caused my family physician to refer me to Dr. Oon, who has been taking out gallbladders in our town, half the time I've been alive. So Thursday, I go for my turn. But I have to admit, I'm apprehensive. And Dr. Oon is a no-nonsense Asian kind of guy who is difficult to understand (for this southern ear) (but who, I hear is great with a scalpel) and so having this blog to read makes me feel as if I've set down with a surgeon and had a little "discussion" that I should have had with Oon, except that he's not prone to discussion. Thank you very much for the info. -Apprehensive in Applachia. : )
Thanks for taking the time to write, Apprehensive. Bet it'll be a piece of cake!
Hello there:
I am having surgery tomorrow. Very nervous about it. I am just hoping it will get rid of my symptoms.
I have had an ultrasound showing lots of sludge, a CT scan (normal), EGD (normal), HIDA scan (0% EF), I had minor cramping when the CCK was injected, not too bad.
My symptoms are horrible pressure in my stomach and back after eating anything. Sometimes the pain is in my chest. Extreme bloating and burping. And a weird one, especially about 4 hours after eating any fat, skipped heartbeats.
I had the heart tested, and its fine.
I have read your blog posts, just wondering if the chances of feeling the exact same after the surgery are high?
Hi there:
I am getting my gallbladder removed tomorrow. I am a little worried after reading your blog that it wont help my problem.
I have had an ultrasound showing lots of sludge, a normal CT scan, a normal EGD, a 0% on my HIDA scan with minimal pain during the CCK part, just some uncomfortable feelings.
My symptoms started after losing 50 pounds in 2 months. Horrible pressure in my stomach and back. Sometimes my chest. Bad bloating and burping after eating. Lots of gas, diarrhea and constipation. One weird symptom I get is skipped heartbeats about 3 hours after eating too much fat.
I am just wondering if there is a good chance this wont be fixed by surgery?
I can't really put a number on it; but from what you describe I'd be pretty optimistic it'll do the trick.
I had my gallbladder removed Tuesday. Since then I have noticed the pains in my back and stomach are gone. One thing that is occurring right now though is very bad gas pains in the stomach. They give me intense pressure, but it's finally starting to move a bit. Is this normal? I get some pains in my shoulder which I knew was from the gas they put into you.
I hesitate to diagnose issues from so far away. You should call your doctor's office and ask them. The operative fee includes post op care and visits, if you're worried about being charged.
I did. He said it was normal. I was just looking for another opinion. Could just be a side effect of the pain medication. It's only been a day and a half since surgery, probably too early to tell.
Is it normal to have some bloating for a few weeks after your gall bladder removal?
If by "bloating" you mean a distended abdomen, I wouldn't say it's "normal" several weeks after surgery. It might not be significant, but I'd say it's something to address with your surgeon.
Hi Sid , I definitely have 6 gall stones ( from ct scan and and sonogram) . I have the classic upper right abdomen pain but I also have it on the upper left and some middle and lower ab pain. I wouldn't call what I have an attack, as the pain has probably never been above a 4-5 and then just in short spurts. However it is constantly in the 1-3 range and is very annoying and uncomfortable . Sometimes there is also burning sensations in the side of my ribs, and in the back ribcage as well. I have seen a gastro , and no ulcers or anything . I realize the upper right ribcage pain is probably caused from the gal-bladder. Could it be causing the other pain as well . It is kind of a stinging burn pain ..........Thanks Sam
With human beings and their gallbladders, all things are possible. It's known that pain originating from the gallbladder can be felt just about anywhere in the abdomen, so, in general, it could be.
On the other hand, other than extensively ruling out all other explanations, I don't think there's a way to know for sure. Even then, "ruling out" only goes so far.
The other way to know is to have the gallbladder removed, in which case it ought to become clear. I'm not in a position to recommend it one way or the other, though; only to transmit information based on what I know in general.
Dr. Schwab,
Is it possible to develop gastroparesis after laproscopic gallbladder removal.
Thanks, Walter
Walter, I can't think of any anatomic way for that to happen; not, at least, as a long-term problem. Delayed gastric emptying can occur after nearly any abdominal procedure, for varying amount of time and for various reasons. But it'd be expected to resolve in a matter of days or a few weeks.
So I realize this is an extremely old post, but I can't find an answer ANYWHERE online. I am 31 weeks pregnant and Monday I am having my gallbladder out. I've been having problems for months but the OB just blew it off as pregnancy pains. When they finally ultrasounded my I have a contracted gallbladder with over 20 stones that appear to be right at the canal and 4mm so the perfect size to get stuck. My doc thinks I will do great. However, I just found out they have an entire NICU staff on stand by and are keeping me a week in the hospital afterwards. What are the odds that doing an open gallbladder procedure at this point in my pregnancy will result in preterm labor?
W.B: I've always hated quoting statistics, because they apply to large groups, and not one person. As you seem to be aware, the risk of preterm labor is highest in the third trimester. I assume that's why they plan to have NICU staff available, which would seem to make sense.
The decision to have the surgery at this point depends mostly on symptoms, as a general proposition. As it is with premature labor, it's impossible to predict what would happen if you delay surgery till after birth.
I'm in no position to make recommendations from so far away. I've done cholecystectomy on pregnant women; and I've waited with others till the birth, and have done the operation immediately (a day or so) after. There's no obviously "right" decision, absent the sorts of complications that demand immediate intervention in anyone, pregnant or not.
Amen. I have crohns and sod and have looked for 5 yrs all over this country and im just getting worse and now must go see dr galloway at atlantas emory! Everyone wants to do the tpait
I wish there was better diagnosis for sod and care at the ER as we are treated so horribly. Every panky facebook group deals with the same exact stories of abuse from drs or just no lab results so we are dismissed and now, on to see dr galloway at emory in a desparate attempt to get help AGAIN! I hVe been all over this country and upmc even was taken aback by my condition altho dr david whitcombs research there is wonderful and his youtube video on pancreatitis is amazingly helpful, most of us are either railroaded into having a tpait or we are abandoned after a tpait goes awry or we just never get an accurate diagnosis no one is ever on the same sheet of music it seems and so little is known about our disease.
Everyone ends up getting their gallbladder out first but these horrible symptoms remain and it takes yrs to get diagnosed. WHY?
We need commited followup and even if lipase isnt high, we are still suffering.
I have daily pain- every meal- i take liquid dilaudid its just so horrible and feels like youre being eaten alive and dr rilo says its because WE ARE! Someone please help us.
Ive joined sphincter of oddi dysfunction facebook support groups and we ALL SUFFER SO MUCH AND NO ONE SEEMS TO KNOW WHAT TO DO WITH US.
Dr schwab, i have luckily found your old website with this information on it when i first got sick with it. I have told so many of your wonderful explanations and how great and compassionate you seem.
If you see this, please do what you can to help us. We need awareness and i have volunteered now with the natl panky foundation in getting a dr here in nc (as nc hasnt one) to go an speak with drs so that we are cared for properly and not called alcoholics (like an 8 yr old w this is an alcoholic) and telling my state representative. I can only do so much. Please help us!
I m a 32 yr old female. I am having gb attacks since a month. I m otherwise healthy. The ultrasound found my gallbladder full of stones. I went to the medical specialist and he said that my birth control pill is the culprit, gave me a low diet plan and nexium 40 mg for a month and he says that my issue might resolve with this treatment. Is it possible??? Can I get rid of all the stones and symptoms so simply??
In a word, no. In another word: NO!
In a few more words: as I've written, some people can control their symptoms with diet; and, in general, I told my patients that the main reason to have surgery is to address symptoms. Not everyone with stones has surgery. But there are problems that can occur, and they're more likely to occur in people who have symptoms from their stones. So another reason to have surgery is to prevent future problems.
But even if your BCPs played a role in producing the stones (possible) it's extremely unlikely they'll go away by stopping the pills.
Since January of this year (2014) my health has declined steadily. I've been tested, retested and tested again. Lost 21 lbs, unable to eat without pain in stomach area. Gastro doc diagnosed gallstones but my GP discouraged surgery because he saw no inflammation/infection noted on the test results, also was concerned that my symptoms were not classic Gallbladder symptoms. Had an attack that sent me to ER, they did a CT Scan, told me my GB was FULL of gallstones and referred me back to my GP. He ordered an UltraSound and set me up with a surgeon saying my GB was FULL of stones.
Had surgery three weeks ago. At my post-op appointment, I asked surgeon what he found. . he said "No stones, but your GB was so scarred from infections that it was not functioning". This is confusing to me. How did these two test show full of stones but surgeon said no stones when he operated?
And by the way, what does it mean that there was major scarring?
shirl
I can't explain the findings of stones on CT and sonogram (and can't really see why the second ultrasound was necessary). It's possible that the bile had become so concentrated (it's what the GB does, and when it's obstructed, even more so) that it became reflective like stones.
In any case, the good news is that if there was extensive scarring, it suggests that the GB was in fact acting badly and makes it likely you'll notice a positive difference. When there's inflammation, in many cases the organ that's inflamed develops scar tissue as part of the healing process. So I find the surgeon's comments perfectly in line with the concept of a gallbladder that's been repeatedly inflamed; ie, causing problems.
Sorry, "anonymous." Not gonna post a cut and paste job full of unsupportable statements and undocumented claims. My blog, my choice, my standards.
I had gallbladder surgery by keyhole 6 days ago. The post op pain is ok now and I am becoming less tired every day. Movement is slow and I haven't tried to drive yet. I will leave that until after my stitches are removed on day 11. My problem is diarrhoea and pain. I had a terrible episode which lasted for almost 24 hours. Initially I was constipated post op and then I had a horrendous time. Now it has settled a bit but is still diarrhoea and I cant move far from the toilet. I haven't eaten much to aggravate it. I had porridge, toast, jacket potato, rice, vegetables and a couple of crackers over the past 6 days. I dont have much appetite as I'm not sure what to eat. Will this all settle down? Is there a timescale? I'd hate to think that I wont be able to eat out occasionally and enjoy my food.
Symptoms in the early recovery period aren't really predictive of the future, Jo Taylor. But it's best to let your surgeon know what's going on.
Thanks. I went back to my GP as I also had some issues with ibuprofen. She took my bloods to see if there was anything going on, but just said that things might settle down. I do t have a follow up appointment with the surgeon as its not standard procedure apparently. How long do you think I should give it before I go back to the GP? As I understand it, the best thing to do is to eat a low fat diet and introduce fats and 'new' foods slowly. Is it too early to start doing that? I am going on holiday all inclusive in 9 weeks time, but hardly think that there will be much that I can eat! We are camping too in 5 weeks and was hoping for BBQ.. Maybe I will take a sandwich instead! Lol! Any advice on foods, timescales and how to introduce foods will be gratefully received. I have read some reports saying that people went out for a curry or burgers 1 week after surgery-really? Oh my, I am no where near this!
Interesting -- and surprising! -- that it's not standard procedure to follow up with one's surgeon. I not only insisted on it, I didn't want any #$%^ GP messing with my early post-op patients.
The colon curves right past where the GB used to be, so, laying in the surgical field, it can sometimes be irritated for a while, which can lead to unpredictable colon behavior early on. I don't like to make specific recommendations for specific cases since I have no way of knowing if what's going on is usual, or a sign of other issues, like leaks, infections, etc (unlikely!).
What I told my patients who had diarrhea early on, when I wasn't worried about other issues, was to take medications like lomotil or immodium as needed, and to eat light, avoiding fatty foods; and when the diarrhea settles down to begin working their way back to normal. If it persisted, we looked into other explanations.
was just diagnosed with having gallstones and immediately did a flush. green apples and apple juice all day and then 2/3 c. warm olive oil with 1/3 c. fresh lemon juice. go to bed and lie on right side. for the person who said flushes are bogus, please tell me then why i passed 20 dark stones and 10 emerald green stones this morning? before you say something is bogus, you might want to give it a shot. saw my ultrasound and stones were less than pea-size. for others, be sure to check with your doctor before you do a flush.
Credulity knows no bounds, Peg. You passed curdled oil. It's as bogus as a three dollar bill, and no matter how many people do the "flush" and think they're passing stones, no matter how many times people wave the flag of foolishness, it won't change the facts.
How 'bout this idea: get another ultrasound. See if there are fewer stones. Or this: do like the people in the British Medical Journal study: take your "stones" to a lab and have them tested. You'll discover they're curdled oil and have nothing in common with gallstones. Sure, it'll cost you some money. But wouldn't it be worth it to know you've been duped? Might learning to be skeptical about "alternative medicine" b.s. possibly save your life in the future? And, were you to do it, and post the results, just think: you might save the lives of others.
But as you'll learn, if you haven't already read my post "Flush" and the gazillion comments therein, there's no convincing those who wish to believe in nonsense. Also, there's none of them who've taken my challenge. So I wish you well and hope that you don't get complications from your untreated stones.
Thanks for dropping by.
Dr. Schwab,
I've been diagnosed with a distended gallbladder "completely" full of stones. I am also pregnant. I met with a surgeon at 17 weeks that told me my 2-3 time a week attacks with violent vomiting wasn't a big deal and I should wait it out and that no one would do surgery unless it was an emergency. I am now 22 weeks and having attacks 4-8 times a week with intense vomiting and a burning pain in my entire abdomen with sharp pains in my right side (but only during attacks). I am looking to get a second opinion, but wanted to get your take on the chances of surgery during pregnancy. Is it true that no one will operate on me while pregnant? I would love to be able to wait, but I am to the point of nearly passing out with each attack and struggling breathing and I just feel this cannot be good for the baby. Thanks so much.
Melissa
I disagree that "no surgeon would operate," Melissa. I've operated on several women during pregnancy, in situations where it's become intolerable, or is affecting the nutrition of the mother. It's true that if a pregnant woman is found to have stones and is having minimal to no problems with them, most surgeons wouldn't operate. But it's well established that it can be done safely during pregnancy, and you're in the ideal time. It's considered best not to operate in the first trimester, because of potential effects on early fetal development; and in later third trimester there's some risk of inducing early labor. (Which can be dealt with, usually.)
So it's in the middle trimester that most agree that if it needs to be done, it's the best time. As to your specific situation I'm not the best source of opinion, because I can't know enough about the situation. But I think it's reasonable to seek another opinion in your area.
Thank you so much.
Hi, this is an old thread so not sure whether you're still replying - but here goes! My dad has been having gall bladder problems for the past 7 months. He's had probably half a dozen attacks of pain since last July - had a camera down to look at his gallbladder in December and no stones found but sludge observed. The surgeon put him on the list for gallbladder removal. Then in January he was readmitted to hospital with acute pancreatitis. Thankfully he was only in hospital for a few days and it was categorized as "mild" not "severe" - we are now waiting for the follow up clinic appointment. He is 77 and type 2 diabetic, taking Metformin. At the moment he's following a very low fat diet but is still experiencing discomfort after eating - a feeling of "chills and general unease" after food as opposed to severe pain. Obviously we are concerned and are hoping that there won't be any repeat attacks of gallbladder pain (or pancreatitis) before he gets back in to see the Consultant. Are these symptoms consistent with someone who has gallbladder sludge? Is it anything to worry about? And finally - could it be related to the Metformin? I know that that particular drug was stopped when he was admitted to hospital but he is back on it now. Could this be exacerbating his symptoms? Thank you! Great blog, by the way. I've been scouring the internet and this stands out!
Thanks for the blogliments. As to your dad's issues: I can't be specific since I don't know him or the details of his pain syndrome. However, as a general comment I can say that when there's "sludge" there's often small stones; and small stones are the ones that escape the gallbladder and can cause pancreatitis. Diabetes and history of pancreatitis are both factors when considering what to do about gallstones: both are on the "have surgery" side of the ledger in the opinion of most.
Metformin can certainly cause intestinal sorts of symptoms, most of which occur when starting the drug and most commonly disappear with time; I'm not aware of it causing pancreatitis. I'd assume the reason it was stopped in the hospital was to have more timely control of his blood sugar. Can't say for sure, obviously.
Thanks for the quick response! I'll pass that on. We're hoping the follow up suggests surgery too...
I recently had an ultrasound which my GP says showed "muliple sludge balls"...this term sounds a little funny to me. However, for the past several mths I've been having all the typical symptoms. My GP set up an appt with a surgeon, which I go to Thursday. My question is...are these sludge balls reason enough to go forward with a removal or will they eventually go away after awhile with diet restrictions? My symptoms are bothersome to the point of interfering with my daily routines, most of the time. I just don't want to jump right into surgery if it's something that might eventually go away with diet changes. I did have a HIDA scan also but don't know the results yet. Bottom line question...do these go away or is it something that I'd be fighting until removal? Are these as serious as stones? Thanks in advance for your insight.
Denise, I don't make specific recommendations to individuals on this blog, but I can provide generall comments.
First, "sludge balls" is a term new to me! Sludge, in general, is a sort of grey-zone finding, although it's toward the end of the spectrum where stones fall. I guess I'd consider "sludge balls" even further in that direction.
I usually only ordered HIDA scans when there was suspicion of gallbladder problems but without confirming evidence on ultrasound. If a patient had symptoms suggestive of biliary origin, and if there were findings on US that support the idea, the findings on HIDA wouldn't add much: if abnormal in the way I've described elsewhere on the blog, i.e., if it showed significantly delayed emptying, AND if injection of CCK (the stuff that makes it contract) reproduced the pain syndrome, AND if the pain syndrome was typical of biliary colic, I'd expect high odds (not 100%) of resolution after surgery. But if there were stones or other significant suggestions (like sludge balls?) on US, I wouldn't order it, because if it was normal it wouldn't rule anything out.
You've said your symptoms are "typical." I think your surgeon will better be able to evaluate that than I, and his/her thoughts on the interpretation of the US findings will be more on point than mine as well. When I saw patients with typical symptoms and findings on US that I considered significant, I'd generally say I thought they'd be improved by surgery. However, except in particular extra-risk situations, I emphasized that the reason to have the surgery was to relieve symptoms. If the person preferred living with them to surgery, I didn't press; but I pointed out the possible future problems, and the fact that no one can predict with certainty if or when they might occur.
I wish you were still writing. I was diagnosed with gbc (T2N0) on 1/8/16. 47 yo female otherwise healthy. Non smoker etc. I woke up in the middle of the night with pain bad enough to want to kill myself, and I'm tough. It was pancreatitis and puzzled the med team as they could not see any gallstones after multiple imaging and imaging with contrast but they did find a tumor on gb. Ended up resected. I feel lucky at T2N0 but confused because the prognosis still looks bleek. Tumor board was 50/50 on adjuvant therapy but oncologist really pushed for chemo and rt. Is median survival really 38 months? If chemo buys me 6 months but takes 6 months and making me sick (I've been feeling 100% since surgery ) why am I doing it? I wish someone would just give it to me straigh
I understand your dilemma, Patricia, and you've hit upon a central problem with cancer treatment: we can quote statistics for large numbers people, but to make a perfect recommendation for an individual is impossible. Some who undergo chemo and/or radiation will be cured by it; others won't. Some who undergo it would have already been cured without it. At this stage in our understanding, we can't test an individual in advance to know. This applies to pretty much any cancer, not just gb.
You're right that you're lucky to have been found at an early stage. I assume that your surgery included taking a swath of liver around the gb. That's, I'd say, considered the minimum requirement in most situations. If not, then radiation is a strong consideration.
Chemo, as I suggested, is sort of a crystal ball thing. Given the generally aggressive nature of the tumor, I'd guess you'd find a majority of opinions favoring it. As you've said, it could be a waste of time and a source of misery if, in fact, you're already cured, or if you're not and the chemo won't make the difference. There's no perfect way to decide, and, having had many patients in similar situations (though mostly with other kinds of cancer) I sympathize with you greatly. Some day, I have no doubt, there'll be ways to determine much more specifically which people will benefit from which kind of treatment, and which won't. At this moment in our understanding of cancers and their treatments, you're forced to make a decision based on recommendations, trust, and, I guess, gut feelings.
Dear Dr. Schwab,
Thanks for much for this blog and for continuing to respond to comments. These gallbladder posts have been a nice oasis of solid information in a sea of gallbladder flush recipes.
So, my question is basically whether "subtle sludge" would be enough to account for what I think is biliary colic?
Me: 44 yo woman, generally healthy, had a baby 19 months ago. I've been having pretty intense pain in the epigastric area and/or RUQ every night for a month - intense enough to wake me up. It feels like a spastic or contracting pain - reminds me a bit of my unmedicated labor. At most it has lasted an hour or two, but over the course of the month, the intensity and duration have lessened a bit. This week it's been waking me up but subsides if I get up and move around/sit up rather than lie down; heating pad helps, too. None of these attacks are accompanied by nausea, fever, etc. and I don't see a connection with eating particular foods. I'm totally fine during the day.
Had a abdominal ultrasound last week which showed "subtle sludge" in the GB and mildly fatty liver, but no other issues.
Turns out my regular GP's office is more alternative-leaning than I'd realized and their recommendation was a gallbladder flush and going vegan. Cue me looking for a new PCP, but that appointment is a few weeks off.
In the meantime, I wanted to ask whether "subtle sludge" could be responsible for biliary colic, if that's what this is, or should I be asking about different possible causes? (I will ask for a referral to a gastroenterologist if the new PCP seems stumped.) If so, am I right in thinking that sludge may resolve on its own. If there's a decent chance of that, I'm willing to wait it out for a while in the hope of avoiding surgery.
Also, how much relationship is there between fat in the diet and the formation of sludge and stones? I get that a fatty meal can trigger an attack in someone who already has stones, but does it help cause them? (Hoping I can dismiss current doc's exhortations to become a vegan....).
Thanks so much for your thoughts!
Good questions, Heather; not so clear answers.
"Sludge" is one of those findings that's hard to interpret: might or might not be significant. In my practice, though, if I was pretty convinced a person's symptoms were consistent with gallbladder origin, and sludge was the only finding, I felt fairly confident that surgery would be effective. "Subtle" isn't a descriptor I've dealt with, though.
Diets to prevent gallstones are more fantasy than fact, I think. There are some indications that, unintuitively, high carb lo fat diets are more prone to gallstone formation than the other way around.
I don't want to comment very specifically about your symptoms, because I'm too far away. But I'll say that several aspects are consistent with biliary origin. It's possible a HIDA scan would be useful; but, as you've read, they're hardly perfect. And somewhere in the process, seeing a surgeon might be in the cards, for additional input and insight.
Congrats, by the way, at having a baby at 42. My niece just did it at 44!
Thank you! I guess we'll see how things evolve and maybe get a HIDA scan? I'd really like to avoid surgery if I can. Fingers crossed.
Thanks re: the baby, too. Took a while, but we got there eventually. She was born about 6-7 weeks before I turned 43. Congrats to your niece on her little one!
Hi again,
Thought I'd give you an update. Rereading my earlier comment I realize I left out that I've also been having back spasms off an on for about a year in the upper middle of my back. Since the abdominal pain started, on the few nights I didn't have abdominal pain, the back spasms would wake me instead. I told the first doctor I mentioned before about it and he seemed to discount it. Saw the new GP a couple of weeks ago and she also discounted it. She ran blood work (normal), said maybe it's a hiatal hernia and gave me a choice between barium swallow, abdominal CT w/contrast or referral to surgeon. I opted for the CT scan (no offense) but it took FOREVER to get the insurance to approve it and get it on the schedule. (BTW, none of the exams have found any tenderness around the gallbladder.)
Meanwhile, I was still waking up in a lot of pain every night (abdominal and/or back spasms) and getting frustrated with not having answers. Out of desperation, I made an appt with my ob-gyn Dr. W. Not because I thought it was a gyn issue, but b/c he's a wonderful doctor who knows me pretty well, and I trust his opinion.
So, went to see Dr. W. and he had a totally different take: acid reflux setting off esophageal and back spasms. Apparently he's seen this before. He sent me off with prescriptions for Carafate and Protonix and instructions not to eat late at night and to elevate the head of my bed. And I have found that even just sleeping propped up has been enough to make a difference - I made it through Friday night pain-free for the first time since mid-May, and again last night. Started the meds yesterday, too. I'm really hopeful that this is the issue. And I am really looking forward to calling the hospital in the morning to cancel my CT scan!
Anyway, I just wanted to share since you were so kind to respond to my earlier comment.
- Heather
Thanks for taking the time to follow up, Heather. Sounds promising!
I read your blog for quite a few years while searching for answers before I had my gallbladder removed in 2012. I had every test known (mri hida ct x ray ultrasound etc) all came back normal.
Finally got a surgeon to take a look and gallbladder was adhesed to liver duodenum and intestines. Final diagnosis chronic cholecystitis.
I suffered terribly for 10 years and I guess because I never had "classic" symptoms (vomiting fever elevated labs)
most doctors brushed it off as IBS.
Fast forward to 4 years later and again am having radiating pain where gallbladder was.
I was able to get surgeons notes from surgery and noted abnormal cholangiogram that showed folling defect in mid common bile duct and also stated he had a difficult time shooting the dye and made 3 attempts to get it to go.
I sent this info to my current GI and he is concerned a stone may have been left in the duct and has scheduled an MRCP.
My question is
Is it possible to have a stone in the duct for 4 years after surgery or is it more likely the duct was damaged by surgery?
Far more likely, in my opinion, that if there's stone there it's been there since before surgery. Significant surgical damage to the duct would cause other things; far as I know, not stone formation.
Hi Dr. Schwab,
The saga continues! So, the benefit from taking Carafate and Protonix for reflux was short-lived. Long story short, saw a gastroenterologist who originally agreed with acid reflux diagnosis. Had an endoscopy that showed gastritis but no reflux damage. Took increased doses of Carafate for the gastritis (plus other meds - antispasmodic, etc.) but at a follow-up several weeks later, I was still waking up almost every single night in pain.
So off for a functional gallbladder ultrasound last week. And this time they found stones - I haven't seen the report so I don't now the extent of it. I just know that the radiologist nixed the idea of a Kenovac injection to stimulate the gallbladder after seeing the first scans, so they had me drink Ensure instead. I have no idea whether they simply missed these stones at the ultrasound in June or if they actually developed since then, how many or how big they are, etc.
I've requested a follow up appointment with the gastroenterologist so I can pepper him with questions and see about other options, but at this point I think a surgical consult is in the cards. As loathe as I am to remove body parts, the promise of sleeping through the night again is starting to look pretty darn good to me.
Well, Heather, maybe it's finally becoming clear! This started with a question about sludge and my comment that it was sort of gray zone stuff, but when combined with typical symptoms of stones, I considered it a significant finding. Now they see stones, which makes it more so.
Yes, at this point clarity is looking pretty appealing. And, as I mentioned, sleep. It's taken almost a year and a half since the first symptoms (upper back spasms at night only) to get what I hope is a definitive diagnosis. I was initially very leery about the prospect of surgery but at this point I may be coming around.
As I've written, Heather, people who've had symptoms from gallstones are among the most happy and grateful patients I've had. And the odds of having adverse consequences from gallbladder removal are extremely low.
That is good to hear about low chances of adverse consequences - thank you! There are plenty of horror stories online from people who've had bad experiences, but of course people for whom it went smoothly aren't very likely to bother posting about it.
I will be thrilled if the pain goes away. Like I said before, I've generally been fine during the day, but the pain at night is bothersome, and it's starting to seep into daytime hours (mostly back pain). The prospect of not having this frequent pain AND getting to sleep through the night is actually pretty exciting.
Great blog and refreshing find in all the forums and groups I am in telling me too flush!
I am a mum of 4, not overweight except when pregnant and afterwards until loosing baby weight but am now 42, fair and female :) I have a mum, grandmother needed it but had cancer so they didnt remove, two cousins who all needed gallbladders removed at a young age due to stones.
I started with chronic IBS symptoms in July caused by higher fat healthy foods such as nuts and coconut with tummy cramps. I had been paleo/primal for many years but gaining weight. after being diagnosed with IBS, 4 mths later awoke with reflux, never had an issue with reflux unless pregnant and certainly wasnt that, it stayed and lasted all day every day, meds did little to help. After seeking the Dr again, she felt my tummy and found it tender above the GB, so went for ultrasounds, Multiple mobile gallstones upto 1.5 cms have been found and I was referred too gastro in October ( still waiting and its March!)
Since then I have lost 14kg, can hardly eat most foods as it triggers IBS and/or GERD symptoms ( all this also occurred in my relatives due to gallbladder too) Constant feeling of a bruised/cramp in my rib and tummy pain. I get very little real pain, only occurring once for 2 hrs after a lamb sausage. Foods I can tolerate are getting less and less with causing reflux now. I am fine with dark chocolate though? and pork sausage? But cannot eat much else, so live mainly on chicken and rice. My specialist for another disorder isn't happy as I feel ill, I have episodes of back pain and shoulder ache over the past years but have always put it down to physical job and kids and being busy. My specialist has said I should be seen quicker so has referred me internally, that was in Jan, so will see as I am back there this month to see if I have been booked. I have been told any pain, go straight in, however I dont seem to get that knee dropping excruciating pain? The worst i had was a knife feel at xmas on a scale of about 5-6, my normal crampy bruised feel is only mild and constant. I have since had a full CT scan by my specialist but all was clear and normal.
I have been told all about how flushes will save me but I have been working with a naturopath since October and getting worse not better, taking liver and gallbladder herbs and supplements, chanca piedra tea and trying to heal whilst I wait my appointment, I have no interest in the flush which I deem unsafe. I also read about all the issues afterwards which has scared me, such as chronic bowel issues, pain, leaking bile, cancer etc.. infact told by one person I will get cancer if I remove my vital organ and be sick forever, so this blog is great and puts things into perspective.
Glad you found the blog, NatX, and that you've found it useful. Seems you have at least two live sources in your cousins; I assume they haven't gotten cancer or those other nasty things about which you've been warned.
As you must have inferred I place naturopathic remedies at about the same level as flushes. In fact, flushes seem to be a favorite of naturopaths. It's all bogus.
I can't be in the business of diagnosis here, or even specific treatment advice, nor can I or anyone predict the future; but I'd say the appointment that you need is not with a GI doc but with a surgeon.
Thanks for your reply, sadly I have to see a GI Dr before I can see the surgeon :( public health system! I am back at my specialist end of March and she said if I hadnt heard she will be on the phone.
My cousins only had theirs removed in the last few years at 20 and 35 yrs but my mum had hers out in her late 30s and she is in her 60s now, she still ended up with IBS but all reflux dissapeared. She did end up with a colostomy bag but highly likely completely unrelated, as her bowel almost ruptured after many many years of constipation and laxative use.
I am using the naturopath just for gallbladder support until I am seen but will take the surgery as soon as they offer it me. Symptoms progress to bloat after most meals ( ox bile suppliments are helping) and gas and pretty much nausea most of the time, so hopefully when i am finally seen it wont be long until they remove it!
Hi Doc,
I had one more question. I still have my gb but I'm starting to have symptoms that resemble gastroparesis. I want to get tested before I have my HIDA scan. I read a study about a group of people diagnosed with biliary dyskinesia, they had gb surgery, and most ended up with gastroparesis at some point after surgery.
What are your thoughts about this condition? Do you see this much in your practice?
Is this less prevalent then SOD post surgery?
Thanks again.
Rachel: weirdly, having gone back through about five years of comments here, I can't find your original one, so I'm unaware of any details of your situation. In general, though, I consider all of those diagnoses (biliary dyskinesia, SOD, and, to a lesser extent, gastroparesis) often over diagnosed and under-defined. Gastroparesis is a little more specific. As a consequence of cholecystectomy, it's very rare, enough so that it might be coincidence rather than a result. It's hard to damage the nerves controlling stomach musculature when removing a GB. Having done at least a couple thousand cholecystectomies, I don't recall a specific case of it.
I'd say, however, that there likely are instances of gastroparesis that were misdiagnosed as biliary dyskinesia. Maybe vice versa, too. I'd suggest there's overlap between the conditions that cause delayed gastric emptying and delayed gallbladder function, some of which are transitory: other illness, medications, etc.
Similarly, I'm not sure how many cases of SOD are real; and of those that are, which might have been caused by the operation or which had masqueraded as gallbladder disease. It's all very iffy and there are no tests that are 100% reliable.
Great thanks for your response. It's reassuring to hear that you've never had reported incidents with all the procedures you've done. Just recently I've started an ox bile supplement that's eradicated all of my gastroparesis symptoms, which leads me to believe that my gb is not functioning at all due to the lack of bile flow.
I have my HIDA scan tomorrow. My previous ultrasound revealed no stones, polyps, or wall thickening. If my scan reveals a low EF and a replication of an attack I will feel much more confident of getting that thing out :). Thanks for all the info you've provided on your blog!
Hi Doc,
I just wanted to gather your thoughts about the recent HIDA scan I had. No pain during the scan but came back as 80% EF. That night I had a gb attack in the middle of the night w/ low grade fever and chills. The pain still wraps around my back. Have you performed surgery on high EF patients? My gastro is not convinced. I am constantly in pain. Ultrasound shows no sludge, stones. Any insight would be appreciated.
Rachel: I understand the hesitancy of your GI doc. With a normal ultrasound and normal HIDA scan, it's hard to conclude that your symptoms are related to your gallbladder. OTOH, a normal HIDA doesn't rule out gallbladder origin because even when there are stones, if they aren't blocking the outlet of the gallbladder at the time of the test, it may empty normally and without pain.
I can't really go further than that. A better surgical opinion would come from a surgeon who can actually see you and your records.
Hi Doc----after a few more tests my gastro did a MRCP that showed a filling defect. He decided to do a EUS and possible ERCP for a stone in my bile duct. Turns out I didn't have a stone but my gb is full of sludge and the walls are thickened. This didn't turn up in any of my other tests (CT, ultrasound etc,). My HIDA did show delayed visualization from my gb to my small intestine. I am in constant pain. He recommended I get my gallbladder out. What are your thoughts? Is this now sufficient evidence that I need it removed?
That ultrasound is significantly different from what you described in a previous one: thickening of the gallbladder wall indicated inflammation and is among the signs considered pretty solid for gallbladder disease. Same with being "full of sludge." As usual I hesitate to make specific recommendations to specific readers; but the latest findings tell a much more convincing story.
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