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Gastroenterology (Expert Forum)
Gallstones or Ulcer or Mallory Weis Tear or what!
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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Gallstones or Ulcer or Mallory Weis Tear or what!
by Debi H, Mar 18, 2003 12:00AM
I am a 33 year old female in relatively good health, other than being overweight. I had Roux-en-Y gastric bypass surgery on December 30, 2002 (starting BMI: 52) and in the last 12 weeks have lost 64 pounds. Approximately 1 month post-op I began experiencing pain right in the middle of my abdomen, just below the diaphram and, being unfamiliar with the feelings after Roux-en-Y, thought it was "something I ate". The pain has increased severely. I called my surgeon who thoight it was an obstruction-it was not. I went to ER and discovered thru ultrasound that I have gallstones and was given Actigall. It didn't help. I was scheduled for surgery, and my PCP cancelled it and sent me to another surgeon who ordered an upper GI. It showed a one cm "abnormality" and I have been referred to a gastroenter-ologist for a consult. In the meantime, I am still in AGONY. The pain is fairly constant, but the intensity is what changes. Sometimes it's a little nagging pain, other times I am doubled over in tears. The pain is right in the middle of my abdomen, straight thru to my back right at the bra strap, and when an "attack" happens the pain is also in my chest making it hard to take deep breaths. Eating & drinking exacerbates the pain. Bowel movements are regular for a gastric bypass patient, however stool is very sandy in color and urine is quite dark (perhaps from all the vitamins). CBC in ER showed a mildly elevated liver levels. The Carafate is also not helping with pain, nor is Vicodin elixer. Could this be an ulcer or is it likely gallstones requiring gallbladder removal? Also, in November (pre-op) my gallbladder was healthy and showed no stones. Any assistance would be greatly appreciated. I don't know if I should go to another ER not associated with my medical group to get another opinion or if I should just sit in [pain while they "discuss my case". I have been told it could be a month or more before this is resolved.
Doctor's Answer
by Kevin Pho, MD, Mar 18, 2003 12:00AM
, Mar 18, 2003 12:00AM
Hello - thanks for asking your question.
Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.
It is possible that your symptoms may be attributable to gallstones. Biliary colic is the most common symptom also referred to as gallstone pain or biliary pain. It is characterized by episodic attacks of abdominal pain, which is most often located in the right upper abdomen just under the margin of the ribs but can also be felt in the back and right shoulder. Biliary colic is usually caused by the gallbladder contracting in response to a fatty meal and pressing the stones against and blocking the gallbladder outlet (cystic duct opening). As the gallbladder relaxes several hours after the meal, the stones often fall back from the cystic duct and the pain subsides. Other associated symptoms include nausea, vomiting, and intolerance to fatty foods. This could explain why your pain is worsened when you eat.
Actigall is about 50% effective for gallstones - you may have to consider surgery if you continue to have symptoms.
Dark urine and light (clay) colored stools can be traced back to gallstones. A gallstone may obstruct bile flow out of the liver.
An ulcer is also a less likely consideration. To further evaluate this, you may want to discuss the option of an upper endoscopy or upper GI series.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Zakko. Overview of gallstones. UptoDate, 2002.
Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.
It is possible that your symptoms may be attributable to gallstones. Biliary colic is the most common symptom also referred to as gallstone pain or biliary pain. It is characterized by episodic attacks of abdominal pain, which is most often located in the right upper abdomen just under the margin of the ribs but can also be felt in the back and right shoulder. Biliary colic is usually caused by the gallbladder contracting in response to a fatty meal and pressing the stones against and blocking the gallbladder outlet (cystic duct opening). As the gallbladder relaxes several hours after the meal, the stones often fall back from the cystic duct and the pain subsides. Other associated symptoms include nausea, vomiting, and intolerance to fatty foods. This could explain why your pain is worsened when you eat.
Actigall is about 50% effective for gallstones - you may have to consider surgery if you continue to have symptoms.
Dark urine and light (clay) colored stools can be traced back to gallstones. A gallstone may obstruct bile flow out of the liver.
An ulcer is also a less likely consideration. To further evaluate this, you may want to discuss the option of an upper endoscopy or upper GI series.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Zakko. Overview of gallstones. UptoDate, 2002.
Member Comments (8)
by Debi H, Mar 18, 2003 12:00AM
One more bit of information....I had an endoscopy in October (pre-op) and was diagnosed and treated for H.Pylori.
by krisg, Mar 18, 2003 12:00AM
To: Debi
Sounds like you need a good gastro. doc and one who can help you solve the cause of your pain. I had my gallbladder out 5 years ago because of gallstones. If the gallstones become lodged in the cystic duct or the bile duct they can cause severe pain and a back up of bile. This in turn creates an overspill of liver enzymes into the bloodstream and elevated liver enzymes (alt, ast, alk phos.) The pain is commonly called biliary colic. If you do a search under yahoo or goole you will find alot of information to take with you to your next dr. visit. Good luck!
by surgeon, Mar 18, 2003 12:00AM
your symptoms certainly are suggestive of gallbladder attacks. Rapid weight loss after your surgery is frequently followed by gallstone formation. It's reasonable to have other possiblities checked out, but there's a good chance getting your gallbladder removed will solve it. A mallory-weiss tear is typically followed with vomitting of lots of blood. That diagnosis seems pretty unlikely. And most ulcers don't cause the kind of pain you describe.
by Debi H