Gallstones or Ulcer or Mallory Weis Tear or what!

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.

  

[Kevin Pho, MD]

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.

[Debi H]

One more bit of information....I had an endoscopy in October (pre-op) and was diagnosed and treated for H.Pylori.

[krisg]

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!

[surgeon]

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.

[Debi H]

My suspicions are now confirmed, and I have known all along thia this is not an ulcer or gastric bleed.  After all, if I had internal bleeding the blood would, at some point, have to come out of me - which is hasn't.  In your opinion, how should I pursue being treated?  Right now I'm in "HMO limbo" going from dr to dr, and I have a gastroenterologist consult in 2 weeks.  From there, I'm sure he will do an endoscopy, only to find that it is, in fact, gallstones and the gallbladder needs to come out.  Unfortunately, that puts me at about 4 more weeks (at best) of this pain.  As you well know, 4 more weeks and I could be a whole lot sicker than I am now.  Any suggesstions on what I can do or say to get this taken care of in a timely manner?

[tessa0825]

Hello, I am ONE day post gallbladder surgery...I spent the nite and came home this afternoon...Your attacks sure sound exactly like mine did....I had a dull,constant, bruised like, pain in the upper R quadrant area...directly over from my sternum....When I started having attacks they would double me over and make me vomit sometimes for three hrs, when there would be no food or liquid left to come up then I would have all the same actions of vommiting but obviously nothing left to come up.....The surgeon told me this morning that my gallbladder was full of stones, he said most of them were about the same size and shape as jelly beans and that several were larger than that.....Anyway, I am on vicodin right now and of course Iam sore but I am doing much better than I ever imagined I would be doing this soon post op...He allowed me nothing to eat or drink (not even water) all day yesterday and only clear liquids this morning....I hope you get your situation resolved soon and it sure sounds like GB......Take care...Tessa

[Debi H]

Thanks for your post.  I feel like I;m crazy because these drs are treating me like I have a bleeding ulcer and that is clearly not the problem -- especially since you can see the stones in the ultrasound!

Did you have constant pain?  Mine is fairly constant and the ntensity is what changes.  At times is is so dull that I don't even think about it.  Other times the pain is so raw that I can't even think.  Last night I had to leave class in the middle of an exam because I was in so much pain.  I can't sit thru another 4 weeks of this.

[tessa0825]

Yes, I had CONSTANT pain...It was in the upper R quadrant area...Just right of my sternum....When I found out I had barretts esophagus and active ulcers, I thought the pain was from the ulcers, but when they had healed still that pain continued..I still kept thinking it had something to do with my esophagus and the problems there...After I started having the big attackes it was my GI Spec. who suspected gall stones and ordered the ultra sound and sent me to the surgeon...I hope you can get this taken care of and get well soon....take care....Tessa

[lynnette]

Debie...

The sysmptoms you are describing are the exact symptoms of "gallstones. I had the same symptoms as you, and I have found out that they are very serious.

You must be very careful taking medications.
Here is what happened to me:

I had no doctor and no health insurance because my husband was laid off of work. I went to a health type of market with whole foods ...I went to get some Manuka honey which heals stomach ulcers - I thought I had an ulcer

While there, I met a nurse that was promoting a special new enzymne called: "Zymactive" by Dr. Michael Murray.

I told her my symptoms and she was absolutely positive that I had gallstones. She told me to take 2 tablets of Zymactive 20 minutes before each meal. She told me to stop eating "fatty" foods. That meant a TOTAL change of diet - which means you eat lots of tuna, fish, veggies, wheat germ, etc...very low fat eating...

The first 2 days that I took the enzyme, I felt tiny little sharp pains in my right side I guess the enzyme was helping me to pass the gallstones. [not nearly as bad as the 8 months of
attacks I was having! Some of the attacks I had lasted for hours and caused me to pass out sometimes from the pain]

It has been about 2 weeks, and I have not had even "1" gallstone attack.

After doing a lot of research on the internet regarding gallstone problems, I now realize that nurse had saved my life!

If you are afraid to try these enzymes I mentioned, at least stop eating "too much" fat...especially "saturated fat"...most food labels list this. Read all the labels.

It is important to "keep" your gallbladder working, so a little fat in your diet is very necessary.

You can also drink "mint" teas, such as peppermint [best] and spearment tea. I also found [at a health food store] another natural formula by Dr. Michael Murray called "Peppermint Oil Complex" that is also helping.

I feel great now...but I know I have to eat healthy from now on!
The low fat food I am eating is somehow becoming quite tasty! Probably because I no longer have the pains two hours after eating.

Debie, I wish you luck, I wish you love, I wish you healing...
Lynnette Monrean
p.s. I wanted to try to help you because someone special helped me!