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Gastroenterology  (Expert Forum)
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Abdominal Pain after fatty foods-Post gallbladder removal
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD 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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MedHelp Member's Question

Abdominal Pain after fatty foods-Post gallbladder removal

by olsonkl, Jul 21, 2003 12:00AM
I am a 33 year old female, and I just had my second child 6 months ago.  I had my first painful attack of severe epigastric pain (presumed to be a gallbladder) attack about 2 months ago (which was 4 months after my birth of my second child). At the time of the attack, I went to the ER where I had sonogram and blood work taken.  However everything seemed normal.  Upon leaving ER, tentatively diagnosed with Gastritis, however GI cocktail did not stop the pain.  Since this time, I went to see a gasteroenterologist, he tentatively diagnosed me with gallbladder problems and ordered a CCK HIDA scan.  The HIDA scan an revealed a gallbladder ejection fraction of 22%.  Based on the ejection fraction, the Dr indicated my gallbladder was bad and instructed me to contact a surgeon to have it removed.  I had my gallbladder removed a couple of weeks later.  Prior to my surgery, I did not have any more episodes of pain.  However, I did note I was unable to properly digest fats, symptoms included:  Nausea, gurgling of stomach & diarrhea.  Therefore, remained on a minimal fat diet until surgery was performed.  Pathology from my cholecystectomy indicated my gallbladder had chronic inflammation of the gallbladder and think yellow-green bile. After the surgery my ability to digest fats properly seemed to get worse.  My symptoms included a more severe case of a gurgling of stomach and severe diarrhea after ingestion of fatty substances.  In order to get around this problem, I resorted to elimination of fats from my diet, although I still had a few problems with diarrhea and GI indigestion.  My doctor also prescribed Colestid and Metamucil, and this seemed to also help, but the problem did not go away if I ate very fatty foods.  I have had an MRI and an ERCP (where they were specifically looking for a choledochal cyst).  It turns out I do not have a choledochal cyst, but I am not sure they were looking for other problems that are related to my other GI issues.  Now, about 2 months post gallbladder surgery and 2 weeks after the ERCP, I had my second episode of severe epigastric pain after eating the chicken (not the skin) from fried chicken.  I again went to the ER where they ran blood tests and gave my the GI cocktail, again nothing worked (but pain meds) and did not see anything unusual in my bloodwork.  My question to you is, what else could be causing this epigastric pain?  Is it possible it could be pancreatitis or IBS?  Would this have been evident in the ERCP, even if they were not specifically looking for it?   (I think they may have only been focused on the bile duct)  What is causing this fat indigestion?  Is this normal post gallbladder surgery, what else could it be?  Can you suggest any addition tests I could have done to rule out other problems?  Thank you in advance for your help!!!
Doctor's Answer

by Kevin Pho, MD, Jul 23, 2003 12:00AM
Hello - thanks for asking your question.



There are several considerations.  The first would be the other causes of dyspepsia including ulcers, or inflammation of the stomach and esophagus.  Another consideration would be Sphincter of Oddi dysfunction - which can manifest after a cholecystectomy.  



I would consider an upper endoscopy to look for the other causes (i.e. ulcers or inflammation) of your stomach discomfort.  A test for H Pylori would also be recommended.



If those tests come back negative, I would inquire whether the ERCP include Sphincter of Oddi manometry - this would be a test to evaluate whether any dysfunction was present.  



To answer your questions, pancreatitis and IBS would not necessarily be evident on ERCP.  Pain may be present post surgery, but not for this long period of time.  



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.

Member Comments (30)

by jepcap, Jul 22, 2003 12:00AM
Hey, I feel for you.  I had my gallbladder out at 24, five years ago and I have been living with your symptoms since then. Almost immediately after any meal that I eat, especially when I eat out I have severe cramps and episodes of diarrhea.  My GI Doctor also put me on Colostid and things have gotten a little better, but then sometimes that medicine can make me constipated.  My GI doctor told me this isn't something that is ever going to go away.  He told me to watch my caloric intake (not necessarily fat) and start excersising more.  It's unfortunate that at the time of having our Gallbladders removed that the Doctor's neglected to say you'll have these issues.  They told me I'd be fine and I didn't really need it in the first place.  Now I'm going through Liver work up, blood tests, ultrasounds and he wants to do a liver biopsy.  



My thoughts to you, is to keep pressing your Doctor's for information and Don't ignore your body.  It's definately a Catch 22.... do you want severe pain in your back and abdomen from the gallbladder or do you want severe episodes of diarrhea for the rest of your life.  I never really got all the information needed or the choice either.



Best wishes to you.

by purplekat, Jul 22, 2003 12:00AM
I am curious, are all of these problems created BECAUSE your gallbladder has been removed, or did they exist before your gallbladder was removed, but the condition was just exaserbated.  I have also had similar problems to what you describe and my GI doc says it has nothing to do with my gallbladder being removed (which I find hard to believe).



Jepcap- Are you still undergoing these tests for your liver?  Do they believe it is something inherently wrong with your liver or just the lack of the presence of your gallbladder?  



I am relatively new to this and this is so depressing to think of it as a lifelong problem.

by purplekat, Jul 22, 2003 12:00AM
Jepcap-

One more question, this is the first time I have heard of caloric intake instead of just fats?  Also I did not know exercise would help?  Have you seen that a direct relationship exists?  What types of foods have you found good/bad?

by browniee, Jul 25, 2003 12:00AM
Hello everyone,

I've been having gall bladder attacks since December of last year. I've done about 3, or 4 gall bladder flushes (olive oil, lemon juice, apple juice, grapefruit juice), and I've passed some stones. I've had one sonogram done back in April, and when I had another one done yesterday, I had about the same amount or more stones (gall bladder is about 1/3 full). I have made an appointment for surgery, but I still think there's something else I can do besides having one of my organs cut out. I am also well aware of the side effects (loose bowels, gas...etc...) that can follow having the gall bladder removed. Does anybody have any ideas about what I can do besides surgery? Has anyone here ever gone to a natural/alternative health care doctor?For those who opted for surgery, do you regret your decision? HELP!!!!!!!!!!!