Bile duct obstruction?

[eroc78]

  I am 25 yrs of age and had my gallbladder removed three years ago (bilary diskynesis) where my gallbladder had a lot of sludge in it,but no stones. The surgeon had also found that my gallbladder was stuck to my duodem. A liver biopsy was done that showed I had gilberts disease. I felt much better after surgery. I was admitted to the hospital with similar symptoms of a gallbladder attack. I have had poor appetite,bloating, lots of belching and pain/brusing feeling above my right rib cage. My total bilirubin has been around 1.8-2.1 and a ultrasound noticed a dilated bile duct,but MRCP/CAT scan results were normal. I also had high lipase count when admitted that suggested pancreatitis,but this subsided after a few days in the hospital. An ERCP is going to be done,which I am a little nervous about. My present diagnosis is gastritis,but I feel this is something else? Could I have a stone,even if my gallbladder is out? Thanks!

[Kevin Pho, MD]

Surgeon has kindly answered your question in his comments below and I agree with his assessment.



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.

[surgeon]

You could have bile duct obstruction; it's also true that many people who've had their gallbladder out end up with a bile duct of larger than "normal" caliber. It's possible you had small stone in your duct even at the time of the surgery, and it wasn't noticed, and has remained there til now. Of course, gilbert's disease can give abnormal liver tests. The ERCP should shed light; if there's a stone, it usually can be easily removed at that time.

[eroc78]

   If I had a high lipase that suggested pancreatitis, does this rule out it just being gilberts disease? Also, they attempted a ERCP while I was admitted,but it failed because of my stomach being a different shape and it was harder to do. I was told there was nothing to be concerned about that,but is why I am a little nervous the second time around. I have been referred to another GI doctor who has had more experience in doing this procedure so this should help. If MRCP is normal and shows normal ducts,but ultrasound is not. Does that also point to something there?

[surgeon]

transient elevation of lipase indeed suggests pancreatitis, which in your situation is a reason to suspect bile duct stone as opposed to gilbert's disease.

[eroc78]

       sorry to ask so many questions,but the ERCP done the first time could not be done because of my stomach being so big. As I stated in previous response, I am being seen by another GI doctor who has had more experience with this test. Should I be concerned that my stomach is bigger than most and about this test? Any ohter alternatives besides MCRP which was already done. I also forgot to mention that I have also been diagnosed about 5yrs ago with megacolon. This would not be causing my symptoms would it? I do have lots of gas/belching,but without a gallbladder I wouldn't think constipation would be an issue. Thanks for all your help and advise. This has helped me!

[ali_in_ireland]

I am 30, been complaining over gallbladder attack for 10 yrs now. They took out my gb in 1998, with two big stones. since then, more attacks, every year, around same time. ive had mri, mrcp, ercp, es, every test possible, still haven't found out whats wrong. latest lft report : ggt @ 850, alt @ 939, ast @ 489, bilirubin 189. you think you got problems !!! join the club

[sosh]

I am 24 years old and had my gallbladder removed just before Christmas 2002 as it was packed with tiny stones and eventually became infected causing pancreitis. It has almost been one year since my operation and i was fine up until 2 months ago when i started experiencing pain similar to that experienced when i had gallstones, on two of the occassions it has ended in me vomitting. My stomach has become sensitive again and i am afraid to eat when i go out for the fear it may happen again.  i have had an ultrasound which revealed an obstructed view of the bile ducts (due to gases) which are dilated to 7mm, however no residual stones from surgery appear present. Also my liver function is down and my haemoglobin levels are also down.

Can anyone please shed some light?

Sosh

[hartann]

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