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

[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

[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

[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

[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.

[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.