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.

[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.

[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.

[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

[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

[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]

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 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.