Post ERCP with Biliary sphicterotomy Nausea Leaves and Comes Back

[nauseatedsusan]

Hello.  In April I had my gallbladder removed....All was going well with a little nausea and pain once in awhile and then BANG it was alot of nausea and stabbing pain on the upper right side. I had elevated liver enzymes, which is a first for me, upper right quadrant pain, nausea, lots of it, and misery.  I found a very good doctor who listened and said that we needed to find out about my biliary ducts and my sphincter of Oddi.  Well, when he went in to do the drainage test everything was the right color except the sphincter of Oddi , which was bright red.  He found dialated bile ducts and performed the biliary sphincterotomy.  All went very well...no pancreatitis, etc.  I went home and went to bed;  I felt so much better the next day because of no nausea that I called him and asked him what my activity level could be.  He said anything so  I wandered around San Francisco for hours and enjoyed no nausea and just that achoy pain in the surgery area.  He told me that he made the perfect cut and cauterized it.  The night after all my activity I got stabbing pain in my Oddi area and by the next day the nausea started again.  I do not have pancreatitis.  It has been three days since my adventure and the nausea is still with me....I called the doctor and he said that the nausea often goes away immediately and he does not know what I could have done to bring it back on.  Do You have any ideas?  He is going to check my liver and pancreas levels just to be sure...he said maybe it is something else....I know that I felt the stabbing pain right there where the surgery was and the nausea came the next am.  Could I have inflammmed things.???  I am a fibromyalgic.  He did say that the pain from the surgery could wax and wane for a few weeks but that he wasn't sure about that nausea coming back again.  I hope someone has heard of this.  Thank you, susan

[Kevin Pho, MD]

Three days after surgery is relatively soon to make any conclusions whether the procedure was successful.  The doctor is correct in saying that the discomfort could wax and wane for weeks.  

An MRCP or repeat ERCP can be considered to take another look at the biliary tree and sphincter of Oddi.

You can consider other causes of nausea - including the various causes of dyspepsia or gastroparesis.  An upper GI series/upper endoscopy or a gastric emptying scan can all be considered as part of the comprehensive workup for nausea.

These options can be discussed with your GI 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.
http://www.straightfromthedoc.com

[beth g.]

Hello.
I had very much the same experience. The day after my ERCP for SOD I was so happy the nausea was finally gone, then it began to slowly come back, but not anywhere near as bad. I occaisionally still do get some RUQ pain, espescially the DAY after fatty food, like ice cream. Still, not like before however.  I did have a gastric emptying study which was moderately long (185 minutes) I am on reglan and protonix now and MUCH better.I do not know how that relates to the SOD, and neither does my GI doc, but its something to think about. HAng in there.

[astros18]

You do need to be on a hi lipase digestive enzyme since you don't have a gallbladder. Once your gallbladder is out your digestion becomes out of whack. The food enzymes should help. Peppermint is very good for nausea. You can buy some peppermint oil and put a few drops under your tongue when nausea hits. Most fibromyalgics have a systemic yeast problem. A good probiotic may help you feel better as well.

[nauseatedsusan]

Thank you for your comments.  I do watch my diet and my yeast is not an issue because I am careful.  It used to be, though.  I had a day with less nausea yesterday and was elated.  Today, it was back this a.m. and I am confused.  I started having some burping and diarrhea yesterday and normally I am a bit constipated.  I called the doc again and he said that the burping and diarrhea was normal and would settle down.  What I worry about is that whether I did any permanent damage when I did so much the first day.  I take hope in the fact that the doctors say this will wax and wane.  I do not look forward to another ercp but would want to do it to know if I scarred anything.  I asked the doctor about the drainage of the bile, now, and he said that it was now constant and I guess more at meals...I don't know.  I just know that after my GB surgery I felt great in three weeks...and of course, this has been six days.  ugh. Anymore help is always appreciated.  susan

[nauseatedsusan]

Hello,
Thank you for replying.  Did you go through the ups and downs after the sphincterectomy?  My surgeon said it could take weeks.  Yesterday I woke up without the nausea...yeah!  Today, after a "discussion" with a friend I could not sleep and had nausea again.  Also, did you feel feverish after the surgery?  It is hot over the area, which of course is inside and cannot be seen.  I also started having the burping and burning yesterday which my doc said was normal and would "settle" as the cut would settle.  He said that I could not have done any damage to the surgery and I am scared.  Do you, with your experience , think I could have done damage?  Also, what do you think of the nausea going away again?  It is much better now than this a.m....in fact, it is not there,.  just the burping and gastritis...I hope it is a positive thing that the nausea is getting better.  Mine is usually worse in the morning and has nothing now to do with eating...no matter how greasy....Do you think you can rip what they cauterized???/  I had one of the best in the US. He says not possible.  I hope he is as smart as I think he is. Thanks for your input, susan

[beth g.]

I think that you probably do need to hang in there a little longer.  Something you might ask for is Questran (a bile acid sequestrant).  Once the sphincter is open, its sort of like a faucet that drips bile all the time.  The questran is a medicine that sops up the bile.  It helped me in the first few months to feel better when I got burning pain and nausea.  Again, reglan at night really helped my nausea also.  i am finally feeling good now and I had my chole in late december and the sphincterotomy in MARCH! I too was intermitantly nauseated after the sphincterotomy, in fact I lost another 10 pounds, (plus the thirty i lost from dec to march!!) hang in there, soy milk and cereal kept me going!

[nauseatedsusan]

Thank you again for the "hand holding"....I do have a call into the doctor about the heat that seems to emminate from the area of the surgery every a.m.  Yes, dripping like a faucet...that is probably true.  He thinks it will self regulate.  We shall see.  I know, seven days after surgery is not much.  But, If i had not done so much the next day i do not think I would be having all of these problems.  Did your doc tell you to rest or to resume all activity the next day?  just wondering, susan

[beth g.]

My doctor gave me no activity limitations. I felt so lousy that night, however I stayed home from work for two days. (and on the couch!!)

[Jazmin]

I have had a very similar problem.  I have had terrible nausea for the past 3 months. I ended up having an ERCP and they also had to perform a sphincterotomy. During the ERCP they found sludge from the gallbladder.  Then I had my gallbladder taken out on July 1 (6 weeks ago) and I still have nausea.  The nausea is worse in the morning and seems to fade away by late evening. Isn't related to anyhting I eat.  Since the cholecystectomy, I have had a strong burning sensation in my chest, that radiates to my neck, shoulders and down my arms.  The burning seems to be getting worse with every day and the morning-afternoon nausea hasn't let up.  Any suggestions?  I've been miserable for the past 3 months and need some hope!

[livingwithit]

Hi, I too live with nausea just about every day. I had my gallbladder removed back in Sept of '01. My gallladder nearly ruptured and I was septic when they admitted me to the hospital.Prior to this one attack, I had never had any problems with my gallbladder in the past. The ER actually tried to send me home, saying I had the flu. I knew it was more than that and insisted on a sonogram of my gallbladder (I work in Healthcare and have a little bit of knowledge about the body and how it works, so I already suspected my gallbladder). They did one and agreed that I needed to have it removed. Sent me home with a name of a surgeon. The following day at the Drs office, he was appalled that I was in the condition that I was in, I was still in severe pain, had the chills, vomiting, ghostly pale. Couldn't believe the ER sent me home like that.He had an ambulance take me to the hosp right from there. Anyway, all was well until about 2 months later, I started getting severe URQ pain attacks. They actually doubled me over, broke out in a sweat and or chills, turned white,felt lightheaded, sometimes I had loose stools as well, and very nauseated with vomiting at times. Nothing I took to relieve the pain would help, so I eventually stopped trying to take anything for it and just waited it out. Contacted my GP Dr, he referred me back to surgeon. He thought I had adhesions from surgery (also had 2 c-sections in past). Well, I ended up having 4 of these lap surgeries to remove adhesions, because the pain would continue to come back over and over, sometimes just days after surgery. This surgeon even said that he was finding less adhesions with each surgery and it couldn't possibly be causing my pain. So he suggested I see a shrink, because the pain was all in my head, and that I shouldn't contact him anymore.Back to my GP Dr, he referred  me to Johns Hopkins in Baltimore, I seen two of their GI Drs with no luck until finally the 3rd one said she knew exactly what was wrong with me. I had Sphincter of Oddi Dysfunction. I actually broke down and cried on her shoulder, I felt such relief. She referred me to another JH Dr who specializes in this and I had an Hida Scan, MRCP and then a ERCP. The ERCP with sphincterotomy sent me into acute pancreatitis and kidney shutdown. I spent 3 weeks in the hosp (Oct'04) and 4 months home recovering. I had feeding tubes in my arms and home nurses to take care of me. Thought it was finally all behind me, but shortly after being allowed to go back to work part-time, the old familiar pain came back, not as severe at first, but exactly the same.Back to my GI Dr and he says I can repeat the ERCP sphincterotomy or have open surgery sphincterotomy, both are very risky as far as throwing me back into the pancreatitis, which I don't think I can go through that again, it nearly killed me the first time. The surgeon I seen for the open surg told me that if I were his wife or daughter he wouldn't allow her to have it done, risk is too high. Told me I should learn to live with it and accept the fact that I will probably have it the rest of my life. I told him I am 37 yrs old, not 87. I am a single mother of 2 girls, every aspect of my life is affected by this. I hear them telling people about moms "attacks". We have to leave places because of it, sometimes I can't even drive them home and have to call for a ride. Getting thru work each day is unbearable,these attacks leave me drained and exhausted.The naausea is unrelenting. I feel like I have no way out of all this, no help. I'm sorry this was so long, but just to "tell" my story has helped alot. Does anyone have any suggestions for me? I am right now taking Nexium and Hyoscyamine. The Hyoscyamine does help sometimes with the pain, and then other times it doesn't do anything.

[ltchick]

I too have been living with SOD for 3 years (had ERCP, sphincterotomy, pancreatitis, reoccuring pain, and repeat ERCP). It is all consuming and you do wonder if life will be the same. I am in the healthcare field and at times that has been a challenge. What has gotten my life back on track was insisting on a referral to a pain clinic. I am now able to function as before with just a few flare-up's. I take a long acting pain medication, an antidepressant, nausea medication and medication for stomach cramps. It was trial and error for awhile but we finally found the right combination. Hang in there, be persistent and educate yourself about your disease. Also seek out a physician you can trust. I have found better luck with nurse practitioners than anyone else. Best of luck.

[livingwithit]

Thanks for replying. I wonder if you would mind telling me the name of the "long acting" pain  and stomach cramp meds you are taking? I spoke to my family doctor the other day after a very horrific attack and he suggested a bybass surgery to totally avoid my sphincter altogether. Well, I talked to my specialist and he says that I'm not a good candidate for that because my pancreatic ducts are not dilated- whatever that means... (I have to look into this).Anyway, he wants to see me again and talk to me about this and what else I might be able to do, but can't get me in until mid November. He also wants me to cut back my work hours to 6 a day, which I have to tell you,is impossible. I'm barely getting by now. I'm still catching up from being off for 4 months and part-time for another 4 months. Any help, I'd appreciate, Thank you.