Gall bladder and hepatitis

[mike716]

Hi, Medhelpers! I'm in Buenos Aires and we are having a heat wave. Man, is it hot! Whew!!!

I got to see the head hepatologist at one of the big public hospitals here last week. Very nice and knowledgable guy, quite different from the screwballs at my own hospital. Many people here have told me that the public hospitals are better than the private ones, and I am beginning to believe it.

This head honcho, Dr. Frider, told me among other things that I ought to have my gall bladder removed as I have stones. He says that the gall bladder is a danger for hepatitics because once you've got cirrhosis the operation to remove it can cause decompensation. So he says I should have it removed now rather than later, when it might be too late. He also said I can have another liver biopsy done at the same time.

This seems to make sense to me, but I wanted to check with people here in the forum about it. Anyone have knowledge or experience with gall bladder problems, or preventative gall bladder surgery?

Any helpful comments will be greatly appreciated.

Cheers!

Mike

[desrt]

Makes sense to me to have it done now along with the biopsy. It's my understanding that this type of bx can give a much more accurate picture of what's going on with your liver.
I had a stone get caught in my common bile duct shortly after my original HCV dx ('92) and aside from being excruciatingly painful, it also caused a flare up of pancreatitis. Chose to have it removed and have never missed it.

[merryBe]

yep, if he says it needs doing better to do it probably.

I had mine done...it was stoneless, but had torn loose from my liver numerous times, (due to my long history of dieting without much success (no pituitary function) )

the tearing caused infection....the stones can too. If it gets bad enough, the thing can burst. Also, if a stone does get caught beneath the common duct it will back up the bile into your pancreas and digest it....rare...but not good.

you have to weigh the risk of that versus the risk of surgery though. Since you are stage 4 you should not have any surgeries that are not needful.
But a needful one is best done sooner rather than later.

I'm facing the same issue, only with my female parts. One must weigh the risks and it may help to talk to an anesthesiologist and find out what is most likely to clear to liver quickly, amongst the many drugs. Anything that circumvents the liver and rely's more on the kidneys would be preferable.

let me know what you decide to do. I'm curious.

[orphanedhawk]

I know there's a drug called ursidiol prescribed to dissolve stones.
Some doctors now prefer to put you on that rather than doing the operation.

[desrt]

http://www.drugs.com/pro/ursodiol.html

[meakea]

Mike, I had my gallbladder removed about 9 years ago.  It was a fairly unremarkable surgery.  Home the next day.  It's usually done laparoscopically.  I wouldn't discourage anyone from having it done because I didn't have any adverse effects and there was no life style changes for me after the normal recovery period.

If you have stones, it would seem to me to be just a matter of time before symptoms pop up and those symptoms are not fun.

[robo229]

Mike,
Some thoughts on your GB.  Many people have asymptomatic stones and go for years with no problem.  I documented my GB stones in 2001 and had no symptoms until April of '09.  As my surgeon said "better to deal with it now on a semi emergent basis and get the first string team than wait for an acute problem and have it removed by the backup squad".

Acute cholecystitis is painful and makes surgery slightly more difficult than elective cholecysyectomy.  If you liver disease progresses you can develop pericholecystic varicies that make laproscopic removal my difficult.

Liver biopsy during lap cholecystectomy is easily done, if you haven't had one.

I understand your apprehension.  Many consider lap chole to be a minor procedure, but a "minor procedure" by definition is a procedure on somebody else.  I did not have mine out without much trepidation.   Spent 1 night in hospital due to coexisting medical problems, but quick recovery.

Best of luck,
Robo

[copyman]

I would NOT have the gall bladder removed.  For every person that doesn't have any problems after removing it there are many more that do have problems. Do yourself a favor and research this real good before jumping to a decision.

Like one of the others said many people live with stones without any problems, including me. If it isn't bothering you leave it alone!

[_Matt_]

Hasn't anyone heard of Apples and Apple juice dissolving Gall Stones? Did you know that Apples or Apple juice actually dissolves Kidney Stones too?

[his3707]

I thought they determined you to be a stage 2.  Is there anything else going on with the gb other than the asymptomatic stones?  I like the idea of dissolving than removing.  Did the hep doc say you could do any treatment for the HCV?

[babycham18]

Hi there. I 2 am in stage 4 Hep-c w/gall stones. I seen my internal med. dr 1 st sent me 4 x-rays & a sonar gram. She then mentioned a Hyderscan which I never heard of. So I met w/a surgeon. She said I had plenty of stones, didn`t need to have my gall bladder or the stones removed & also said I needed a hyderscan ASAP.
A friend went w/me 2 write notes w/my memory scan being the size of a gnat since my brain sugery...So I called my GI dr to set an appt for the hydercan only to be told by my dr.s nure that they have a place for people like me up in the mountains w/rubberwalls.
I was abit confused, but she told me she thought I had a problem wanting to have a hyderscan done & that I was a hyperchondriac.
Excuse me, but prior to 2 of my drs telling me I needed to have 1 done (ASAP) I had never heard of it & still don`t know what it is!
From what I`ve researched re:gall stones w/Hep-C ttends to increase your viral load. I was scheduled in 2005 whille I was living in DE that it needed to be removed then & that a cathera would be inserted btwn both my liver & gall bladder as to ensure the bile duct wasn`t cut w/my liver being distended @ the time.
I`ve been having problems w/my gb since 1984 & feel that if it needs to come out, I`d rather it happen now then down the road & just be done w/it. I can cause bilary tract infections as well, which are difficult to pick up on a scan if you are taking pain meds. Well, they actually don`t allow you to take them for 6 hrs prior to the scan to be able to see whether there`s any spasms going on that are undetectable on meds as that area is relaxed.
I`m sorry, but I`m probably not helping you much, just sharing the little bit of info I have. I would like to start Infterferon soon. It`s been nearly 7 yrs since I was diagnosed. However until now I couldn`t find any1 to treat me. Prior to DE I lived in NJ & prior to that I lived in NY where I was born..
I still in shock that I finally found a dr who wants to treat me. Genotype 1A. I don`t know if it has anything to do w/treatments changing as I never bothered looking into them since I couldn`t find any1 willing 2 help me. Iwas told my chances were only 40%. I`ll take that!...Plus I`ve gotten pretty tight with The Big guy upstairs (heard we can`t really talk about religion in here).
Good luck to you & don`t be afraid to seek out a 2nd & even 3rd opinion. No disrespect 2 any1, but some of them aren`t called Quacks for no reason, lol!

[babycham18]

Hey again,
I just remembered reading in a medical book a friend gave me & I was suprised to read that 2,000 mgs. of vitamin c daily can eliminate gallstones...I had doubled up to that dose a few days b4 reading about it.
I guess the only way I`d know if it worked or not is 2 ask for the dreaded hyderscan. .Asking couldn`t hurt,  however in my case, I was told I would go on that  much needed "vacation" in the mountains the dr mentioned!...NOT!...lol
Pls. let me know how it goes for you.

[copyman]

i think what you are talking about with a scan to evaluate the gall bladder function is a
"HIDA scan" not Hyderscan. good luck

[sldb]

Stage 3-4, geno1a, svr for almost 4yrs.. I had one stone in my gallbladder,removed in may of 2009, iam 54 yrs old,surgeron said it had to go, gallbladder was very inflamed. It took 45min  for him to do the surgery, and i went home 2hrs. later.  I have felt so much better since the surgery....Good Luck to you...Leah

[merryBe]

the reports of people with probs after GB removal are greatly exaggerated. It's less than 10% of folks that have issues and there's a reason that they do.
Namely, they eat too much crud. Fat to be precise is the usual culprit.
Fat is harder to digest, requires more bile, bile concentration is reduced my GB removal.
However, if you eat healthy you shouldn't have any issues.
I dip my bread in olive oil, and eat some rich dishes and have no issues.
(well except at Holidays and thats just too many calories)

The only people I know personally who have had issues after GB removal were those who binged on a pound of M & M's and such. Obviously one can't eat a pound of fat at a sitting and not have some issues.

Here's the issue, yes, you could use ubsodiol, and it's not liver toxic so it may seem like a good alternative, but you have to weigh what may happen.

What I mean is, stones are not all created equal. Some are small, mostly fatty, and will dissolve with the drug, some are harder, denser, contain minerals not just fat, and don't dissolve well.
If you have one large stone, as many do, it can block the bile duct on a regular basis, causing inflammation as stored bile becomes more and more concentrated while it cannot be released due to the blockage and eventually enough infection to burst the gall bladder.
A burst is life threatening, sepsis and so on, peritonitis can follow. also, dissolving the stone can, not will but can, cause them to be expressed.
Meaning as they become smaller they can escape the GB, head down the duct, and if they pass into the intestines you are fine but if they get caught in the common bile duct or at the sphincter of oddi (where bile enters the intestines) then you will have a back up and trouble.
This is why removal is still the preffered SOC.

[copyman]

my GI at Univ of Penn told me it was more like 30% who have some sort of problem after removing GB. not all serious but something none the less. my point is if it isn't bothering you leave it alone. there is that possibility you could feel worse after. I know one person that can't even go out to eat because as soon as they finish eating they have to run to the bathroom. very embarassing.

[smaug48]

I'm "at least" stage 3, far enough along for my doctor to want me to get the liver cancer screening annually.  Last summer my doctor (a gastro) said she found gallstones with the ultrasound, and said don't worry about them now.

I think I might try a gallbladder cleanse sometime before the next screening to see if it works.  There is no clinical evidence that it does anything.  

However, there are a number of people who absolutely believe it works.  And as far as I know, no harm done if it doesn't work.  

Just google "gall bladder cleanse," you will get a lot of relevant hits.  There are different cleanse recipes out there, I have no idea which one is best.  Maybe someone with experience can chime in.  

IMHO, I don't think organs should be removed unless they absolutely have to.

smaug

[mike716]

Hi, Merry! Thanks for the insights. Re my stage F3/F4 Fibroscan, that has now been superceded by a later F1/F2 scan, so I'm probably not even F3 yet. It's hard to tell, though, since all my fibrosis tests are in disagreement.

Thanks VERY much for reminding me that, if I do have the gall bladder surgery, I need to make sure the anesthetist knows I've got hepatitis C. You're right, it's important that they use the least-harmful drugs.

I'll keep you in touch.

Mike

[mike716]

Hi! Thanks for posting. I was wondering: what is the normal recovery period? How long will I have to stop doing gym and sports?

Thanks.

M.

[mike716]

Thanks for the insights, Robo. Your reasoning sounds good and it's more or less what Dr. Frider said: take it out while it's easy. And it'd be nice to have a really good liver biopsy instead of the bad one done in 2008. So I'll probably go for it, that is, if I can convince my hospital to do it.

Mike

[mike716]

It's always interesting to hear dissenting opinions like yours. What are the problems that people have after removing it?

It's true that I've had no problems with it so far, and my philosophy has always been "If it isn't broken, don't fix it", but Dr. Frider (and some of the other posts here) have me pretty well convinced to remove it. My fibrosis is advancing. I haven't done Tx yet, but seeing as I am geno 1b there's not much chance of it working. So, when my liver becomes cirrhotic, if I still have the gall bladder I'm in trouble. Isn't it better to get rid of the darn thing now?

Once again, though, I'd like very much to hear what the bad consequences of the gall bladder operation could be.

Thanks.

Mike

[mike716]

Hiya. You wrote:

} I thought they determined you to be a stage 2.  

Yeah, more or less. At least, that's the agreement between the biopsy and the last Fibroscan. But it's all kinda inaccurate.

} Is there anything else going on with the gb other than the asymptomatic stones?

Nope.

} I like the idea of dissolving than removing.

That's the first thing I'm gonna bring up when I see him again in March.

} Did the hep doc say you could do any treatment for the HCV?

Tx for me is a long and confused story. This Dr. Frider who brought up the gall bladder isn't my regular hep MD. He's the chief hepatologist at a big public hospital, and I just had a consult with him. My hep MD at my health plan hospital wants me to do SO, and I am resisting.

M.

[mike716]

Hi, babycham! Real sorry to hear about all your troubles with doctors, but frankly nothing about "the medical profession" surprises me any longer.

What the heck is a Hyderscan? Never heard of it. (Which doesn't mean much, as I have never heard of a lot of things.)

If you are F4 you probably don't want to wait for approval of the new meds and ought to try SOC, if your new MD is willing and your insurance covers it. That's my understanding of the situation, anyway. Even if Tx doesn't clear the virus, it will get your viral load down, slow down the fibrosis, give you a year of relief. That's nothing to sniff at.

My situation is somewhat different as I am probably not even F3 yet, and where I live (Argentina) the care on Tx is not so good as in the States. So I am not in any hurry to do it. If I can, I want to wait for beetter drugs.

But it's all a game of roulette. Especially for us gt 1s.

Good luck!

Mike

[mike716]

You had the stone removed, not the whole gall bladder?

And they did the surgery because the stone was causing trouble, not because you have hepatitis?

M.

[mike716]

Thanks for the biology and reasoning on removal vs dissolving. Sounds right. I am thin and am very careful what I eat (zero fat), so there shouldn't be any problem on that score.

Maybe I can talk my hospital into doing an ultrasound scan to see how hard those stones are. Maybe they can tell whether they are dissolvable or not.

I have long-time Irritable Bowel Syndrome and often have intestinal pain after eating, even after eating diet foods. I wonder how removing the gall bladder will affect my IBS?

Mike