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pain after gallblader(gallbladder) removal
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pain after gallblader(gallbladder) removal

hi my name is maryjane, i had my gallbladder removed jul 2009, a week or so after surgery started to get a tightness of pain in my stomach which has gradually got more severe, it starts of with stomach pain then wakes me through the night and is like a tightnin of severe pain at the top of my rib cage sometimes to my back, lying down makes the pain worse, i need to walk about and take deep breathes to ease the pain, sometimes up all night, can affect me 2 to 3 nights. i have been admitted to hospital and kept in a few days with severe pain and vomiting,my blood results was all about liver fuction but then got home when the results were normal. reocurring pain can somebody help
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You could possibly have sphincter of oddi dysfunction or pancreatitis . Both of these can come on after GB removal.   It also could be something completely different like a stone stuck in your duct but more testing is needed to find out.  

  SOD is typically pain on the right side and back and pancreatitis can be on the right or left and back.  You can google john hopkins sphincter of oddi for more info or chronic pancreatitis to see if this matches your symptoms and start from there.

I have SOD and it was hard getting diagnosed.  My GI dismissed me as well said ibs.  I finally went to er one night with a bad attack of pain they gave me dilaudid and it made it worse. They again sent me home and I went right back because I kept throwing up. They tested my liver levels and it was 10X normal.   MY GI then had to admit something was wrong and he referred me out to DR Cotton at MUSC in SC.  He specializes in bilary issues such as SOD and pancreatitis.

Has your  liver levels seem to be elevated during an attack of pain correct? Do narcotics make the pain worse?  Narcotics typically invoke the pain of these attacks in most with SOD because they raise pressure in the sphincter.  

There are 3 types of sphincter of oddi .  There is Type 1 dialted bile duct and elevated liver levels and pain, Type 2 elevated liver levels or dilated bile duct and pain  or Type 3 Pain only.  So if  you do not have elevated liver enzymes during attacks it does not mean you not have it.  Type 3 is just pain only.  Unfortunately this is the most difficult to treat. Type 1 has the best prognosis with a sphincterotomy and type 2 is more a 50/50 chance of relief.

Mine typically bothers me when my stomach is empty but others it bothers after they eat.  I suggest talking to your dr about this . and possibly getting a referral to a Dr that specializes in SOD and pancreas issues. They know what to look for and are the best.  Most GIs will not venture into diagnosing or helping these type of patients.  Most tend to say IBS or you are making it up.  This is maybe because this syndrome is not something most GIS deal with and most GIS are not comfortable with ERCP since it is dangerous.

  The best Drs are  at MUSC in SC Dr Peter Cotton, Univ of MN Dr Freeman, and Univ of Indiana Dr Sherman.     You can even try to make an appointment directly with them.

The test to check for SOD  is MRCP to look at your ducts and see if they are dilated or have stones.  The other test is  ERCP with manometry to measure the pressure in your sphincter.  The ERCP is risky and can cause severe pancreatits which could land you in the hospital months.  That is why it is critical you only get this done at a center that specializes in this procedure such as those I mentioned.  If your pressure is high then they can make a cut in your sphincter to relieve the pressure.  This helps some.  In others it has to keep being repeated.  There is no real cure that works 100%.  Some people find relief from nitroglycerin, or levisin to help with the spasms .  Some even find a little relief with amitryptiline.  These drugs can help a small percentage of people so you could try it first.  Sphincter of oddi also sometimes goes along with chronic pancreatitis so they can check out this possibility as well with the ercp and and EUS procedure.  Eus is not as risky. Its more like a endoscopy.    Chronic pancreatitis or SOD do not always show elevated enzyme levels so more procedures are usually done to get a clearer picture of the problem.

If you have any more questions just ask :)
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