surgery?

[tina123]

Hello,
I have been having right , upper abdominal discomfort for about 5 weeks. I feel like there is a brick under my rib cage. Some days the prssure is worse than others. Ten days ago I had severe nausea, no appetitie and chills.The abdominal discomfort was somewhat worse but not painful. I saw my doctor. Abdominal ultrasound done. Liver normal in size demonstrates fairly normal echo texture. Common bile duct measures .3 cm. The gall bladder demonstrates numerous echogenic foci with distal shadowing consistent with gall stones. Spleen and kidneys normal. I had CBC, liver enzynmes, amalyse all within normal range. Urine nornal. My doctor suggest getting my gall bladder removed. I still have discomfort but has improved . The discomfort was much worse during the severe nausea. I have been having mild nausea since the episode 10 days ago. I don't eat fatty foods. I have been a  vegetarian for 20 years. I have been taking Excedrin for 10 years due to an injury. I have stopped taking that for the last 10 days.  I am 48 years old. Do you think I need  my gall bladder out or do think my symptoms could be another problem?

[Kevin Pho, MD]

Hello - thanks for asking your question.  

You are describing upper abdominal discomfort and gallstones diagnosed by ultrasound.  It is likely that the gallstones are contributing to your abdominal pain.  

There are three approaches to gallstones: 1) do nothing and wait, 2) surgery (cholecystectomy), 3) non-surgical options.  

The standard treatment for symptomatic patients who suffer from gallstones has been to have the gallbladder removed surgically along with its contained stones. Removing the gallbladder may have little or no effect on digestion.

Non-surgical approaches include an oral bile-acid pill that dissolves the gallstones, percutaneous endoscopic laser or electrohydraulic lithotripsy which breaks up the gallstones, or extracorporeal shock wave lithotripsy which also breaks up the gallstones.  

The approach depends on the size and location of the gallstones and whether the patient can tolerate surgery.  

I would discuss these options with your physician.  It is likely that your symptoms are from the gallstones.  Another (less likely) consideration would be dyspepsia (i.e. peptic ulcer disease, GERD, gastritis/esophagitis) that could be evaluated with an upper endoscopy.  

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.

[tina123]

Would I be at risk for a painful gall bladder attack if I wait to have surgery?

Thanks!

[surgeon]

people who get gallbladder attacks tend to get more of them. However, it's not possible to predict when or how many. Some have them practically daily, some once a year or less. Some can minimize them by avoiding certain foods, especially fatty foods. Most attacks are pain only; sometimes infection can develop, or bile duct blockage, or pancreatitis, which are all more serious than a pain attack alone. Non surgical means, such as pills, lithotripsy, etc, nearly always lead to stones coming back again: people who form stones, do so as long as they have a gallbladder, unless there's a specific reason why it may have happened. So the bottom line is this: no one can predict if, when, and how serious future attacks might be. If you don't like the idea of surgery (which is very safe and even an outpatient procedure in many cases), you can choose to wait and see. The odds are you will have more attacks. The odds are also that they won't get you seriously ill. But there's no way to know for sure.

[tina123]

hello again,
I don't get severe pain. Most of the day I feel like I have something stuck  under my right ribs. It increases at night.  Lately I get some nausea daily.  The nausea was only very severe for those few days.

[tessa0825]

I'am wondering if a positive gallbladder surgery experience could help if you are struggling with what you should do if you, in fact, do have GB disease....I had mine removed three wks. ago today....I had heard terror stories of people having a hard time with complications following this surgery and I was apprehensive....My main concern was that I didnt want to have to miss much work....Im an area supervisor for a retail/grocery chain and this was not a good time for me to be off work....I also have a demanding boss who has little to no patience for illnesses...However, I was suffering with terrible attackes that would wake me up and have me vomitting sometimes for three hrs....I decided I would take a weeks vacation and have my surgery and if I had complications, I would deal with them after the fact....I had my surgery on Monday and believe me, as far as surgeries goes, this was a breeze.....I spent the night and came home the next afternoon...I had very little pain and was off the vicodin by Wednesday (two days post surgery) by Friday I felt back to normal and went to our office for a few hrs on Sat and sun. to do paperwork. I returned to work full time after one week, I felt far better and had more energy than what I had been having before surgery....There are a minority of Pts. that do have complications, I thank God I was in the MAJORITY that dont....I also was able to go back with no restrictions and my job has many duties....I do alot of physical work as well as other non-physical work...I reset coolers and move full end-caps, help unload trucks many days, and noone even suspected I had just had surgery....anyway, I have no way of knowing why you might not want to have surgery if you need it but I thought this might help......Good Luck...............Tessa

[lemonhead]

I've also got a positive gallbladder surgery story. I had mine taken out in 1998 and had no problems in my recovery from my surgery. I had it done as a lap chole (i.e. laproscopically) and although it was meant to be an outpt procedure (i.e. home the same day) that didn't work for me. I was just far too nauseous and sick to even move that day. Just went home the next day and everything was fine. Took about a week to recover, but I was back at work half-days in about three days post-surgery. However, like I said, no problems associated with it.

If your doc says you need it, I'd have it done.  But that's my two cents.
lemonhead

[tina123]

Thank you all for the information. I just want to make sure that my problem is my gall bladder since my symptoms are nausea and discomfort not pain. Thanks again!

[bufurd]

I recently had a HIDA scan with CCK. During the CCK, I experienced extreme nausea and pain in my right upper side. I have been having these symptoms for 6 months now and the pain is just not going away. They say my test was negative. Does any body have their gall bladder removed if the test was negative. Are you supposed to experience the severe pain and nausea during the CCK? Is this normal?

[MacyMaid]

Dear Surgeon,

I hope you are still in there.  

I am a 60 year old who had her gallabladder removed 30 years ago.  I had Sphincture of Odie pain since this surgery but only when I take certain meds, i.e. codeine, vicodin, fentynal and all opiod derivatives.  I learned the hard way to avoid all these meds.

One year ago, I started having chest pains/upper abdominal and right sided mid area pain that would go to the right back and up the shoulder blades and under the right rib cage.   I also have burning pain and my stomach is distended and at times get nauseated.  I have seen 2 doctors plus a pulmonologist.  Upper GI Barium showed a sliding hiatal hernia and a possible stricture.  Had Endoscopy and revelaed Grade 2 Esophagitis.  Nexium 40mg x 2 a day.  No help.  CT scan showed a possible dilation in the Intra and Extra hepatic ducts.  MRCP ordered and this was normal.  This did show a 7mm left sided kidney stone in the ureter/pelvic junction which I had no idea I had. Had that removed 6 months ago.  Serum Gastrim normal.  Serum Amylase below normal. Alt...slightly elevated.  (15 pts above)

Had another CT scan in February.  This one confused the radiolgist and did not really know what to make of a distened/swollen/edemous Tranverse colon and flexure region.  Saw a new GI doc and he did a colonoscopy with normal biopsy findings.  He ordered blood work and again the Serum Amylase was 10  (normal range 30 to 90).

I do not know where to go from here.  The pains are horrendous at times.   Laying down I do much better.  

Could there be a stone lurking even though there still is not a gallbladder.  Is having below normal amylase readings mean anything?

I live in Houston so we do have access to many physicians but have no idea where to go from here.  MY GP works in a clinic that goes to a small hospital of which I will not go to.

Thank You if you can comment.  

Lauren