post cholecystectomy diarhea

[crkm]

My 18 year old son is 4 months post op following a cholecystectomy for abdominal pain x 3 years.  His ultra sound was negative for stones and his HYDA scan results were 17%.  His pre op symptoms included general abdominal pain, not necesarily specific to the upper right quadrant.  The pain occured most often in the morning though was not limited to the a.m. and seemed to only be releaved by time and/or a bowel movement.  Antiacids and acid reducers seemed to have no effect.  The occurances tended to be 3-6x per week.  The pain was always associated with eating.  Post op results were said to be a malrotated gall bladder with chronic cholycistitis.

Immediately following surgery and for the first 5 days post op, my son was completely pain free except for surgical pain and was able to eat anything.  In order to get off of the percaset, we switched to 400-600 mg ibuprofen 2-3x per day.  Within 2 days of such (day 7 post op), he had severe indigestion.  On day 8 post op, we began treating with nexium, mylanta, and tagamet.  This immediately began relieving the indigestion and burning symptoms but by day 14 post op, the preop symptoms of vague abdominal pain and diarrhea with meals had begun to return.  

He is now on daily nexium only and seems to have no "burning" or indigestion type symptoms.  However, he seems to have the abdominal cramping followed by diarrhea about every 2-3 days.  Once his system has "cleaned out", he seems to be able to eat anything he wants for the rest of the day with no symptoms.  The diarrhea episodes seem to be be pretty consistant in occuring at about 1 p.m. regardless of what he eats for lunch.  He seems to have fewer symptoms on days he eats breakfast, though that is not always true.  He is aware that fried foods set him off as do syrup, high sugar foods as cookies and even granola.  However, spicy foods don't seem to bother him.

He is open to a discussion on diet and meds though he is quite resistant at this point to anything more invasive.  Do you have any ideas on the source of his pain, whether he can every hope to be pain free, dietary suggestions or medication suggestions (especially over the counter that we might be able to try on our own)?

[fd145]

While I would check w your family doc. There is something called "dumping syndrome." This is the occurance of bloating and severe diarrhea after eating. Once the diarrhea is "done" a person feel better-til next time. It happens sometimes after removal of the GB. Diet can help it. Not what he eats but more how he eats. Drinking only a a small amount of liquids w meals and eating small meals, avoiding very hot or cold food may help. Some bread w meals may help soak up the liquid but otherwise avoid carbs. He can drink all day but not chug fluids. Eating smaller, more frequent portions may help. If the diarrhea continues, he shoud see his doc. It's no fun to be stuck in the BR. There is a medication that goes under the tongue (hyscomine) that can be given. It may make him sleepy so he needs to  be careful and see how it affects him. Of course, this is all based on if dumping syndrome is the problem. Good luck.

[CalGal]

After GB surgery many people find they're unable to tolerate fats in the same manner they did before the surgery and it could take some time to adjust. Diarrhea can be an outcome of ingesting fats. He may want to consider following a low fat diet for several months to see if that's of help.