Pregnant with gallbladder disease

[delta03]

I am 16 weeks pregnant, have had an abdominal ultrasound which shows no stones or sludge.  I have been on a low fat diet for about a week, and am still experiencing low level pain in GB area as well as solar plexus and under right shoulder blade.

The diet has, however, helped with indigestion and nausea, of which I'm having much less.

My doc says that unless an US shows signs of stones, he is not going to consider operating because I'm pregnant.

The questions I have:
1) how soon can I expect relief from pain on this diet (if at all)
2) what are the warning signs that I may need surgery?
3) what if things get very bad in 3rd trimester, will they still operate???

Thanks for any comments/answers.

[Kevin Pho, MD]

Hello - thanks for asking your question.

1) It depends on where the pain is coming from.  For gallstone prevention, a low saturated fat diet is recommended but a little fat may be necessary to help the gallbladder contract and prevent stagnation.  A diet that is high in fiber and calcium also helps.  It is impossible to guarantee whether your diet will or will not relieve the pain.

2) Warning signs requiring surgery include intractable abdominal pain that cannot be controlled with non-invasive therapies.

3) Laparoscopic removal of the gallbladder is possible in pregnancy. In the latter stages of pregnancy, the uterus may be in the way and the older "open" approach must be used. The best time to do surgery is the second trimester; risk of miscarriage from surgery is low, and the uterus is usually still small enough not to interfere with the laparoscopic approach.

The risk of miscarriage during a cholecystectomy increases in the third trimester and surgery is generally avoided.

One diagnostic consideration would be a HIDA scan with CCK stimulation.  This would evaluate the ejection fraction (i.e. function) of the gall bladder.  If low, then cholecystectomy may be an option.  

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.

[JR200]

Delta:

Good luck.  I actually have the same problems you do with my gallbladder (no stones with ultrasound, normal CT scan, but dysfunctional gallbladder) and have been contemplating a pregnancy as well, but have been really anxious about it.  I hope your pregnancy goes well.

JR200

[surgeon]

Given the normal ultrasound, it's likely the symtoms have nothing to do with your gallbladder, and I'm sure no surgeon would want to operate under the circumstances.

[delta03]

Thanks for your comment JR...

Yes I have had an ultrasound just last week to rule out gall stones, and it was totally normal.  

I knew I had this problem before getting pregnant, and had an ultrasound and a CT scan last fall which came up perfectly normal!  So my plan is to stay with the dietary changes and have acupuncture treatments which I have found helpful.

I would definitely prefer not to have surgery!!!

Thanks again.

[JR200]

Surgeon:
Actually, your comment isn't true.  Gallbladder dysfunction, also called gallbladder dyskinesia or biliary dyskinesia, or if the gallbladder is inflamed it is called acalculous cholecystitis, is one of the reasons many surgeons remove gallbladders.  It has been shown in most research that if the ejection fraction of the gallbladder is low on HIDA scan, relief is often achieved by removal of the gallbladder.

JR

[JR200]

Hi:

Gallbladder problems are pretty common in pregnancy due to the changes in hormone levels, especially with higher levels of progesterone.  The dietary changes can help, especially if you eat smaller, more frequent meals throughout the day instead of trying to load up on a lot of food at once.  Have you actually had an ultrasound to rule out gallstones?  Gallstones are actually quite common in pregnancy, and often times have been known to resolve after delivery, so even in the presence of stones, your doctor may want to take a wait and see approach.  Generally, doctors try to avoid this type of surgery during pregnancy if at all possible, but if it has to be done, it is preferable to do it in the second trimester.  Serious signs to look for are vomiting, severe right upper quadrant pain, fever, chills, and abdominal tenderness to the touch.

Good luck with your pregnancy, and I hope you feel better soon.
JR200