Continued pain, nause, & elevated lipase after cholescytectom

[KathyM58]

My seventeen year old daughter recently had a laproscopic cholescystectomy.  Her symtoms were upper right quadrant pain, nausea, and vomiting (absense of diarrhead or constipation).  Gallbladder ultrasound was normal, no stones present.  Lab tests showed normal CBC, normal urine, negative pregnancy test, normal liver enzymes, normal amylase, slightly increased lipase 381 (normal range up to 114-286). Abdnominal/Pelvic CT scan was normal including normal gall bladder and pancreas. Hide-a-scan showed an ejection fraction of  5.  The pathology findings on the gallbladder showed chronic acalculous cholycistits with mild lymphogranulatas.  It has been 5 weeks since her procedure.  She continues to have upper right quadrant pain with bouts of nausea and vomiting. The lipase level remains slightly eleveted around 365.  She has an appointment with a perdiatric GI specialist.  What are some possible explanations for the continued problem.  

[CalGal]

You may want to try having her stay on a low fat diet. Many people have problems handling fat processing after having the GB removed.

They need to check for any sludge or stones that may have entered the common bile duct during the surgery and could have gotten lodged in the duct. You may also want to consider the possibility that she's experiencing spasms of the common bile duct or sphincter of Oddi (the muscular opening to the duodenum). She might be able to try some elevated doses of some anti-spasm meds to see if they're of help. If they are, the doc may want to consider the possibility that spasms are the cause. The condition is called SOD - sphincter of Oddi dysfunction. If it is spasms, any intake of narcotic-based pain meds can make the spasms worse.

It's also possible that the pancreas is acting up due to the presence of stones or sludge. Slightly increased lipase can suggest pancreatitis - another reason to go low fat. You may also want to ask the doc to let her try a course of pancreatic enzymes to be able to give her pancreas a bit of a rest. Make sure she's tested for autoimmune pancreatitis - it's a long shot but should be ruled out.

[Jessie76]

I had my gallbladder out a week & a half ago, our story sounds very similar. I had all the same tests except the lipase (not sure what that is) I had normal everything except enlarged pancreas, finally my HIDA showed 31% and they removed it, it was severely scarred and inflammed & my dr couldn't believe it didnt show on more tests.  Anyway, I still have had the pain and nausea and my bowels are not right AT ALL, but I have been reading & talking to lots of people and even my Dr and nurses say it can take up to 6 months to get back on track.  My first week was horrible even though I wasnt eating bad, but I studied up on the diet and have had a lot of luck with it.  I read somewhere about trying bananas, rice and applesauce and it really did the trick.  It took 3 sessions to finish the banana and the diet is boring and I added cheese crackers when I felt it was ok and now I am well in my second week and am eating real food, just leaving some things out.  Butter in or on anything really bothers me, seasoning hurts me, NO FAT at all, and dairy sends me straight to the bathroom.  But for some reason tilapia has been the best for me, I put it on the stove in a pan with just lemon juice and a splash of soy and kind of steam it in there. I also started eating salad yesterday and amazingly it stayed in, but I think a lot of it has to do with my diet before surgery. Some foods are comfort foods to some people (like fish & salad is to me)  I tried mashed potatoes though, which usually I can always eat and I guess it was the butter or dairy, they did not sit well.  Maybe trying bland food and no greasy or sugary stuff for a couple days could give u an idea if diet will improve your daughters condition.  Also, several people have told me to get on a fiber supplement, but I haven't done it because I am still in the diarhea (diarrhea) stage.  I wish you luck, please let us know if she improves

[Banned1]

I'm really sorry that you are suffering.  I'm not a doctor and I know next to nothing about this stuff but I'm learning through my own illness.  Your symptoms could be SO many things including sludge/stones in the CBD, Post-Cholecystectomy Syndrome, Sphincter of Oddi Dysfunction, Small Bowel Bacterial Overgrowth, pancreatitis, etc.  I apologize for the length of this post but I really want to help you.  

There are some less invasive tests such as the Endoscopic Ultrasound (EUS) and MRCP-S (Secretin) which can image the whole thing including pancreas and ductal system.  The EUS does require sedation and is similar to an upper endoscopy.  Once you have a Gastroenterologist, they might be willing to try an EUS or MRCP-S to determine what is causing your symptoms.   Right now, EPISOD studies are being conducted in the United States which might be a way to get to the bottom of your symptoms without the cost if you qualify.


Metamucil or a similar daily fibre product is a great help for MANY people with abdominal pain.   It does not make you go, it makes you regular by adding fibre to the watery stools, making them firm.  

Many people have great success with digestive enzymes and pancreatic enzymes.  This is something you can talk to your primary Doc about.  I'm told that they won't do any harm so really - unless you have side effects - there's not a downside to trying them.  Your Doc might even have samples.  This is something you can do now and it reduces the amount of work the pancreas has to do which will reduce any damage if damage is occuring to the pancreas.

A low-fat, high fibre diet can make a big difference.  Eliminating fried foods from your diet and starting with bland foods, you may get to a point where you have no pain.  Then you can add new items to see how you feel.

It helps to keep a journal or a blog and your welcome to read my first entry if you want but I write a lot (can you tell).  :)  It's a great way to review your situation objectively and identify patterns in your foods, symptoms, medications, bowel habits and pain level.  Hindsight is 20/20 and keeping a log might help you look at things more objectively over the longer term.  Also, if you go into Emergency, you can say, this has been the pattern...

You are not alone!  Try to stay positive and reach out for support when you need it.  Talk to your Doctor, family, friends, co-workers, church or social service volunteers or anyone you feel safe with.  

Search yahoo! groups for "Sphincter", you will find quite a few groups.  Both Maddi's and Michele's are worth joining.  There is a lot of great information there that might help you.

When you do find answers, it would be wonderful if you could let us know the root cause(s) and how you got rid of your pain.  It gives people on this site hope to hear success stories.

Take care of yourself.  Good luck and Godspeed.  All the best,

Sam