I have never understood the ignorance of some well meaning physicians. They leave patients with the idea that the likelihood of their symptoms coming from their gallbladder is somehow proportional to the number or size of the stones present. Although you may develop a life threatening complication from a stone either blocking the neck of the gallbladder, or passing into the common bile duct with subsequent blockage or the most lethal complication, gallstone pancreatitis the evidence would argue that the day to day symptoms that patients with gallstones experience isn't actually from the stones at all. You must realize that approximately 15-20% of folks walking around the mall at any given time would be shown to have gallstones if they were ultrasounded. Only 20% of these people will ever have symptoms from their gallbladders. If the symptoms actually came from the stones why wouldn't they all have problems? As it turns out, studies have suggested that the pain and other symptoms are actually related to gallbladder dyskinesia or "malfunction" of the gallbladder. Most patients with gallstones have been shown to have relatively normal function of their gallbladders while those with symptoms typically have ineffective gallbladder contractions. To get back to your situation, you have typical biliary symptoms. All you are looking for with the ultraound is some evident of an abnormal gallbladder. Even one small stone is sufficient. If your ultrasound had been normal (no stones) you would have been given a functional test of your gallbladder (HIDA with CCK stimulation) because your history is so consistent with biliary pain. Only if that were normal and did not elicit your typical pain would further workup be undertaken. There is absolutely no indication for another ultrasound - you already have an abnormal one. There is nothing that another one would show that would change the recommendations. If there were more stones present the gallbladder should be removed. If the one stone was no longer there then the delay from the physicin not responding to the abnormal study allowed for a serious complication to occur as the only path out of the gallbladder is down the common bile duct with the potential for very bad complications as noted above. People with biliary dyskinesia have the option of deciding on surgery depending on their level of symptoms. People with proven gallstones and typical biliary symptoms - any biliary symptoms - fall into a high risk category where they have a 35% chance of landing in the ER with a serious complication. When we are forced to deal with these patients in the face of a complication, some studies have shown a 100 fold increase in their mortality rate. That is why we recommend cholecystectomy to patients with gallstones and biliary symptoms. I am, as a surgeon, less of a threat to their longevity than their gallbladder is. As for the people with gallstones and no biliary symptoms, only 1-3% will develop symptoms annually and it is unusual to initially present with a sevee complication. In this group, observation is recommended with the understanding that they will return should they develop symptoms. This is the standard of practice. It was developed in a National Institutes of Health Concensus Committee in 1992. These are developed with experts from multiple specialties based on available data to standardize patient care and facilitate the highest level of care no matter what specialty your physician belongs to. When the question is whether or not surgery would be indicated, the only opinion that counts is from a surgeon. We are trained to know the indications and contra-indications better than anyone else. You wouldn't expect the carpenter to be able to tell you what's wrong with your air conditioner would you? Why would surgical recommedations come from a primary care provider?
Thank you so much for your quick and helpful response. I have felt strongly from what I have read over the last month that my gallbladder is what is causing me the trouble. Maybe I'm not crazy after all?!
I should have mentioned that I do have an appointment with a surgeon, but not for 2 months and that's just for the consultation. I went to the ER this week and was sent home before even being admitted because the triage nurse said my pain wasn't severe. I have been doubting myself, and trying to ignore how terrible I feel.
Your information has now given me the info now to walk back in there with confidence.
I will look to your site for help in the future. Thank you so much.
The patient I saw today is getting his gallbladder out tomorrow. He called yesterday for an appointment. You can always come to North Carolina!