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]

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

[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.

[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.

[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

[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

[delta03]

Thanks again...my doctor said pretty much the same thing, i.e., that he is certain I have GB disease and that if I wasn't pregnant he'd be scheduling me for surgery.

However, being pregnant, I'm managing it with diet.  Up until the last week, I had been eating dairy and fats.  Now that I've virtually eliminated these, I do feel better.

As for thinking about getting pregnant, good luck to you!  So far so good for me, all signs go...

You mentioned ejection fraction on HIDA I think it was...is this a test to determine GB functionality?

Thanks for all comments.

[surgeon]

Having taken out a couple of thousand gallbladders, including many with acalculous disease, biliary dyskinesia, and several during pregnancy, I think I actually do know what I'm talking about. I'm well aware of non-stone disease of the gallbladder. I'm also aware that with pregnancy it is nearly always associated with stones if it's the culprit. I also know that low ejection fraction alone, especially if it isn't also seen than injection of CCK reproduces the pain, has at best a 50-50 chance of meaning improvement with surgery (toss a coin)(and check out all the posts on this board from people who've had their gallbladders out with no improvementin their various symptoms). I'm also fairly sure most people wouldn't want to order a nuclear scan during pregnancy if it could be avoided. So what I said stands: in the absense of stones or gallbladder wall thickening the odds are it's not the gallbladder causing symptoms in this pregnant patient. Nothing is 100% in human beings. Nor can any of us not actually seeing the person give an accurate diagnosis, even the non-medical people who post. But it's close to 100% that you'd find very few surgeons who'd like the idea of gallbladder surgery in a pregnant patient when the ultrasound was completely normal, unless she was unable to nourish herself adequately and everything tried had failed.

[JR200]

Hi Delta:

Yes, HIDA scan determines gallbladder function, and the results show an ejection fraction in a percentage.  Anything under 35% is considered abnormal.  Mine is 33% and so it is pretty borderline.  I really don't want to have surgery, but may have to consider it in the future if things can't be managed with diet alone.  You won't be able to have the HIDA scan while you are pregnant because it is a nuclear medicine scan involving the injection of a radioactive tracer and the hormone CCK to stimulate gallbladder contraction.  However, once you have delivered your baby, you definitely should have this test done before considering gallbladder removal.

Good luck.  JR

[tessa0825]

Hello, I would hope that everyone that comes to the web looking for answers understands there is no way anyone can be 100% certain of anything when dealing in such an evasive environment...However, you and Dr. Kevin give excellent advise under these circumstances....As for us "non-medical poeople" who post on the boards...I think many times it is just another way to deal with the stress of a serious illness....I'm certain Im not 100% accurate in my feelings about certain things but if I can use the "little bit" of knowledge I have gained about my own medical conditions and share that with others who may be facing the same things,then maybe my experiences will help them seek help when they otherwise wouldnt. If only one person who listens when I talk about dangers of untreated acid-reflux, from my experience, and they seek help early enough and prevent a possibe EC diagnosis later down the road, then I really dont care if the rest of the people reading them think Im full of ****...If I had been told 25 yrs ago about complications of acid reflux, I maybe wouldn't have to be having a tube ran down my throat monthly now, and waiting around for a new set of biopsies to tell me if I am REALLY high-grade or if the last set was just read wrong.......On a differnt note, This board has allowed me to make and form friendships with people who are fighing or have fought the exact same things I m now facing in a world where noone,in REAL life, ever heard of Barrett's esophagus!!...Im so thankful that this board was created......Tessa

[GI.PA]

All in all..no one wants to operate without clearly defined risks (preg and all) and benifits (want to be dang sure it will help).  Perhaps you and your OB look at non-gallbladder causes and work with those while the risk of surg is high, particullarly when the ultrasound give no reason for surg at this moment.

For example, there a large number of people who have what they think is gall bladder disease and it is really acid related (acid reflux, ulcer, dyspepsia..ect).  A simple trial may be one of the PPI's (Prevacid, Preg cat B) for 2 weeks.  It may completely eliminate your symptoms or may not make any difference at all.  If this is ineffective one could consider a trial of antispasmotics (again talk to the OB about safety) to see if it may be bowel spasm in origin.

A GI referal may be indicated.

Surg while preg is a last resort.

Erin
GI.PA

[JR200]

I assume your last post was directed to me, and if you were offended, I apologize.  That was not my intention.  However, my post still stands as well, and given the presence of symptoms before pregnancy occurred, it is still entirely likely the problem is a dysfunctional gallbladder (assuming reflux and other etiologies have been ruled out).  Further, assuming someone else is "non-medical" is an erroneous assumption.  I think we can all definitely agree that surgery during pregnancy is to be avoided if at all possible.
JR

[delta03]

This is very interesting to me...I am finding out a lot through this site.  I will of course follow up with my docs, and am in process of getting 2nd opinions, asking questions, etc.

Thanks to all for your comments.

One thing my doc did say is that it is a little difficult to tell pregnancy symptoms from gallbladder disease symptoms.  However, he told me that if he felt I needed to have it out immediately, he would "put his foot down."  

Surgeon, like you, he has taken out hundreds maybe thousands of gall bladders, and seems to think my symptoms are classic.  I hope it's not something different, actually.  My liver functions were good, and I'm told that's a good sign, meaning something more serious isn't going on.

Theresa, I don't know anything about your condition at all, but I suspect that like the GB symptoms, it's hard to separate from pregnancy symptoms, as many many pregnant women have indigestion and reflux.

Again, thanks for all comments, it really is very helpful to me.

Delta

[ConcernedGB]

Hello.  Are the causes of acalculus gall bladder disease or biliary dyskinesia and gall bladder disease with stones the same?  If not, what causes the type without stones?  Does the risk for gall bladder disease go down once the baby is born or does it increase with each successive child?  Is chronic acalculus gall bladder disease associated with gall bladder cancer as strongly as the type with stones?  Thanks.

[surgeon]

biliary dyskinesia means the gallbladder is anatomically normal, but its muscular action is uncoordinated such that when the gallbladder muscles squeeze to push bile out, the muscles that hold it in don't open properly. It's not known why some people have it. It's controversial the extent to which it really exists, is under- or over-diagnosed. It's sort of like spastic bowel: a coordination problem of the muscles. Acalculous gallbladder disease means disease without stones. Biliary dyskinesia is one form. Acalculous cholecystitis, where the gallbladder is actually inflamed (thickened and swollen and red) (it's not inflamed with dyskinesia) is different. It's also unknown why it occurs, although it can be associated with other illness; possibly things that get you dehydrated can cause changes, for example. Stone disease is altogether different: some people have a body chemistry such that the bile has an imbalance of constituents, leading to the forming of crystals in the bile. The crystals form in the gallbladder, where bile is stagnant and thickens up. The crystals grow. When big enough, they can plug up the opening of the gallbladder. So the causes are very different. Gallbladder cancer, which is very rare even in people with stones, is associated with long-standing presense of gallstones; not with acalculous disease. It's also true that people with stones may have minimal or no symptoms and live forever with them; or have recurring attacks. Acalculous cholecystitis, the inflamation (inflammation) thing, may not be a recurring thing because it may occur due to an associated problem. But when it occurs, it very often is severe enough that it gets operated on after the one and only episode. Biliary dyskinesia is a recurring thing and since there are no stones and since diagnosing it is most often a process of elimination, most people have lots of episodes before getting surgery. As I already said, despite other posts, HIDA scan -- which is the "best" way to diagnose it nowadays -- is far from a definitve test. In my experience if the ejection fraction is very low (like 10% or less, as opposed to 30% referred to above) AND if the injection of the hormone CCK during the scan EXACTLY reproduces symptoms, the chance of relief by surgery is very good. But far from 100% guaranteed. When the ejection is only a little bit low, and the symptoms aren't reproduced (many people get cramps and/or nausea with CCK injection no matter what their gallbladder is doing) then it's really a **** shoot.

[JR200]

Your comments are actually quite interesting to me, as the physicians in my group really disagree with the numbers you provide, and believe that anything below 35% on HIDA should produce desirable relief with cholecystectomy.  I actually like your post better than what my colleagues are telling me, as this would seem to suggest that gallbladder removal may not be in my best interest after all.  Do you have research studies that I could refer to that support the figures you are providing, so that I have something I can share to base my discussion on?  Since I actually find myself in this situation, I certainly don't want a surgery that isn't going to solve the problem.

[ConcernedGB]

Thanks again sir for taking the time to share your expertise with me and others who read this board!  The information really helps!

[surgeon]

I was referring to my personal experience: the ones who have been improved by surgery are those with a very low ejection fraction AND reproduction of symptoms with CCK. Most published reports talk about ejection fraction mainly, and indeed refer to numbers in the 35% range. The problem is partly in the fine print. Statements like "some" relief, for example. Length of followup. I've had patients see me post op feeling great, and I hear from their gastroenterologist in a year or two that they are having symptoms again. There's no doubt in my mind that the syndrome of biliary dyskinesia exists, and that people who have it will get better with surgery. In my opinion, the ability accurately to diagnose it is suboptimal. The parameters I mentioned seem, in my experience to be fairly solid. Within the rest, there's a very grey zone. The other side of the coin is that most people aren't made any worse by cholecystectomy; so if a person is at the end of their rope and wants surgery even being in a grey zone, it makes sense to go ahead, with the blessing of their gastroenterologist.

[JR200]

Very interesting, and your comments are greatly appreciated.  I guess my concern is that I have suffered with a multitude of GI problems, and any time I have had a medical procedure involving the GI tract, the GI problems have gotten worse.  With many patients at the office complaining of diarrhea post cholecystectomy, I have been concerned about jumping into surgery when it is possible that the pain will remain/return afterward anyway.  Definitely a tough situation to be in, and I do appreciate your input, and will be adding your experiences to those of my colleagues in the decison making process.  
JR

[Nezumi]

Hello.  I'm currently 13 weeks pregnant.  2 days before I concieved I had a HIDA Scan.  Which showed my ejection rate at 6 %. No stones.  The ultrasound I had before that showed sludge, but no stones. Dr.'s didn't remove it because my pregnancy.  I'm getting these dull aching pains near  the g.b, really the whole right side area by g.b.  The HIDA scan showed everything else to be ok.  Do you think this increasing dull aching pain is still my gall bladder?  I'm sooo scared that it's something else.  I really would like it removed if it's indeed causing this pain.  Thank you so much in advance!
Leslie

[hhegab]

Hi,
I have just known about that great website.
Well, my wife had her gallblader removed while in her 17th week of pregnancy. She had a sever pain and vomiting the last few days (before the operation). The Doctor said she should have her galbladder removed immediately.
I could see the stones after the operation. they were more than 30 ones and on the average of 3 to 4 mm in diameter. My questions are:
1- Is this number of stones normal?
2- What should she do now after the surgery?
3- What should she eat?
4- Is it possible that she may have other consequences?

Thank you very much

[tin]

I am 20 weeks pregnant. Last week I had an attack of severe pain around the rib area and abdominal area lasting 5 hours. I was given an ultrasound which ruled out stones but the doctor could see the inflammation and constriction of the tubes.

I always eat a very low fat diet and hardly ever have fried foods. The day of the attack I had soup and salad for dinner and very low fat lunch.

What causes this gallbladder problem if it is not stones? Could it happen again? and does it affect the baby?

Thank you

[tin]

I am 20 weeks pregnant. Last week I had an attack of severe pain around the rib area and abdominal area lasting 5 hours. I was given an ultrasound which ruled out stones but the doctor could see the inflammation and constriction of the tubes.

I always eat a very low fat diet and hardly ever have fried foods. The day of the attack I had soup and salad for dinner and very low fat lunch.

What causes this gallbladder problem if it is not stones? Could it happen again? and does it affect the baby?

Thank you

[tin]

I am 20 weeks pregnant. Last week I had an attack of severe pain around the rib area and abdominal area lasting 5 hours. I was given an ultrasound which ruled out stones but the doctor could see the inflammation and constriction of the tubes.

I always eat a very low fat diet and hardly ever have fried foods. The day of the attack I had soup and salad for dinner and very low fat lunch.

What causes this gallbladder problem if it is not stones? Could it happen again? and does it affect the baby?

Thank you

[NicoleBraden]

Hi I am 16weeks Pregnant  and I have had Gal Bladder stones for 3 weeks now I went into the E R one night and they did an Aultra Sound on me and said I have a ton of them I have had a bad pain under neath my breast where my ribs are and when It hurts it is hard to breathe and It kinda makes my back hurt also I have to lay down and put a pillow or a cover close to my stomache really tight and it dont always help they admitted me in the Hospital because they said that i was Extreamly Dehyderated They have me coming back to the Obgyn every week to see my doctor he has been taking Blood everytime I am so so Scared that if they do surgery that I want be able to have my baby is that true? They said that I have Billy rubins in my urine and blood they is a sign of Galbladder Problems Please Help me email is also ***@**** Thanks.

[NicoleBraden]

Hi I am 16weeks Pregnant  and I have had Gal Bladder stones for 3 weeks now I went into the E R one night and they did an Aultra Sound on me and said I have a ton of them I have had a bad pain under neath my breast where my ribs are and when It hurts it is hard to breathe and It kinda makes my back hurt also I have to lay down and put a pillow or a cover close to my stomache really tight and it dont always help they admitted me in the Hospital because they said that i was Extreamly Dehyderated They have me coming back to the Obgyn every week to see my doctor he has been taking Blood everytime I am so so Scared that if they do surgery that I want be able to have my baby is that true? They said that I have Billy rubins in my urine and blood they is a sign of Galbladder Problems Please Help me email is also ***@**** Thanks.

[NicoleBraden]

Hi I am 16weeks Pregnant  and I have had Gal Bladder stones for 3 weeks now I went into the E R one night and they did an Aultra Sound on me and said I have a ton of them I have had a bad pain under neath my breast where my ribs are and when It hurts it is hard to breathe and It kinda makes my back hurt also I have to lay down and put a pillow or a cover close to my stomache really tight and it dont always help they admitted me in the Hospital because they said that i was Extreamly Dehyderated They have me coming back to the Obgyn every week to see my doctor he has been taking Blood everytime I am so so Scared that if they do surgery that I want be able to have my baby is that true? They said that I have Billy rubins in my urine and blood they is a sign of Galbladder Problems Please Help me email is also ***@**** Thanks.

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