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Gastroenterology (Expert Forum)
Inflamation causing narrowing?
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
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.
Inflamation causing narrowing?
by stiman, Feb 21, 2006 12:00AM
Hi there,
First of all thankyou for looking at my question. I am a 27 yr old male. I was diagnosed with a 3cm gallstone 3 years ago. We named it "the floater". This was because it was not causing any symptoms and we found it when doing a routine check as i suffered from alot of reflux.
Two years go by and i start to get back pain and sometimes sharp pain in my right side after eating. We did an ultrasound again and found that the Stone was now impacted in the neck of the gallbladder in front of the opening to the cystic duct. The short of it was 4 weeks ago we removed the gall bladder and found that it was a "tricky" removal because the stone had pushed itself into the systic duct and the cut was very close to the end of the duct and common bile duct.
4 weeks have gone by and i have had very dark urine. Lots of itchy skin. We did a blood test that showed high liver function and billium in the blood (jaundice, great.). I underwent a MRCP that showed a narrowing of the bile duct in the area next to the operation. My Surgeon has said that this will go with time as the inflamation (inflammation) will disappear and the pressure on the bile duct will become good. Does this really happen?
I went to get another opinion and he said that he would need to do an ERCP as the MRCP showed no stones in the duct or dilation above the narrowing.
He said that there is an 80% chance that he will have to put a stent in to make sure no more narrowing occurs and to hold it open.
Is that really nessary, or is it just a precaution? Is there any merit to the inflamation (inflammation) case?
Been watching it for 2 weeks now, blood tests show reduction in the ALT and AST(700 to 200, 388 to 94), but the ALP and the GGT levels have stayed dorment at 244 each, gradually increasing from 214ish.(obviously showing a blockage of some sort?)
Its been a week since that last blood test, had another one this morning and report the itchyness has died down, back has tightened up again between the right side shoulder blades & still have same dark urine. (when i drink heaps of water, it isnt clear, more yellow the way i guess it should always be when not drinking so much.) Its wierd the urine in the bowel starts off the right color but then as it gets concerntrated it becomes quite dark (orangy tea colour)
Any advice to the questions would be fantastic!
Thanks
Steve
First of all thankyou for looking at my question. I am a 27 yr old male. I was diagnosed with a 3cm gallstone 3 years ago. We named it "the floater". This was because it was not causing any symptoms and we found it when doing a routine check as i suffered from alot of reflux.
Two years go by and i start to get back pain and sometimes sharp pain in my right side after eating. We did an ultrasound again and found that the Stone was now impacted in the neck of the gallbladder in front of the opening to the cystic duct. The short of it was 4 weeks ago we removed the gall bladder and found that it was a "tricky" removal because the stone had pushed itself into the systic duct and the cut was very close to the end of the duct and common bile duct.
4 weeks have gone by and i have had very dark urine. Lots of itchy skin. We did a blood test that showed high liver function and billium in the blood (jaundice, great.). I underwent a MRCP that showed a narrowing of the bile duct in the area next to the operation. My Surgeon has said that this will go with time as the inflamation (inflammation) will disappear and the pressure on the bile duct will become good. Does this really happen?
I went to get another opinion and he said that he would need to do an ERCP as the MRCP showed no stones in the duct or dilation above the narrowing.
He said that there is an 80% chance that he will have to put a stent in to make sure no more narrowing occurs and to hold it open.
Is that really nessary, or is it just a precaution? Is there any merit to the inflamation (inflammation) case?
Been watching it for 2 weeks now, blood tests show reduction in the ALT and AST(700 to 200, 388 to 94), but the ALP and the GGT levels have stayed dorment at 244 each, gradually increasing from 214ish.(obviously showing a blockage of some sort?)
Its been a week since that last blood test, had another one this morning and report the itchyness has died down, back has tightened up again between the right side shoulder blades & still have same dark urine. (when i drink heaps of water, it isnt clear, more yellow the way i guess it should always be when not drinking so much.) Its wierd the urine in the bowel starts off the right color but then as it gets concerntrated it becomes quite dark (orangy tea colour)
Any advice to the questions would be fantastic!
Thanks
Steve
Doctor's Answer
by Kevin Pho, MD, Feb 21, 2006 12:00AM
, Feb 21, 2006 12:00AM
It is encouraging that the liver enzymes have reduced after the procedure.
However, if the symptoms are continuing (i.e dark urine), or the bilirubin remains elevated, then there may be a possibility that the stent may be necessary to move any blockages.
I agree with the ERCP and the possibility of stent placement.
Discussion of this possibility with a second GI opinion can be considered.
I am not sure if the back pain is related to the biliary duct condition. A musculoskeletal cause of the pain can be considered.
These options can be discussed with your personal physician.
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.
Kevin, M.D.
kevinmd_b
However, if the symptoms are continuing (i.e dark urine), or the bilirubin remains elevated, then there may be a possibility that the stent may be necessary to move any blockages.
I agree with the ERCP and the possibility of stent placement.
Discussion of this possibility with a second GI opinion can be considered.
I am not sure if the back pain is related to the biliary duct condition. A musculoskeletal cause of the pain can be considered.
These options can be discussed with your personal physician.
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.
Kevin, M.D.
kevinmd_b
