Monday, June 18, 2012

Biliary Colic?


I would truly appreciate your help. I have had persistent throbbing pain at a point specifically between the umbilicus and xiphoid process. The frequency of pain began as once every 6 months, and over the course of two years has increased in frequency to once or twice a week. When the pain comes on, it always starts in the evening and lasts for 3 to 5 hours (it's important to note that it comes on while I am sitting up or standing - in other words, not when I'm lying down). Last month I adopted a vegetable + fruit + dairy diet, but then eating wheat bread triggered it. I believe the density of certain foods can trigger it, as may sugary foods (such as apple pie). I have been able to eat creamy foods and not feel pain. I began blending fruits and vegetables and this helped. Sometimes I also have an achy anterio-lateral right sided pain (like at the far edge of my body), which is where my liver is (wouldn't gallbladder pain be between the midline and lateral side?). I was a veg etarian (but ate salmon and shrimp) between the ages 14 and 32. At 32 I began to eat poultry. I'm 39 now.

I had an ultrasound done that showed 7 gallstones. I had an endoscopic exam of the esophagus, stomach, and intestines that came back negative for h.pylori, gluten intolerance, but positive for mild acid reflux on the esophagus. I had a functional CT scan of my upper and lower abdominal quadrants that was negative (stones could not be seen on this scan - I was told because they were not calcified). EKG was negative. Liver enzymes were normal.

Last night I had an attack after eating a piece of pie, and felt feverish, throbbing pain, and vomited for a few hours (did not vomit bile - only pie). I've only had vomiting with the pain once before. Usually I do not feel feverish or vomit with the pain. Thanks so much!!!

Gender: Female
How tall are you (feet and inches)?: 5 foot 6 inches
What is your weight in pounds?: 120
How old are you?: 39
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing: Abdominal Pain
Please list any medication allergies that you have : : None.
When was your last menstrual cycle?: Now
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Rarely


Top three questions...
1. Could this throbbing pain be my pancreas?
2. Could the achy pain be my liver?
3. What could be wrong? What tests would you recommend for a differential diagnosis?

The doctors suggested I have my gall-bladder removed, but I've read that sometimes it's not the gall-bladder. I don't want to have something removed and then still have pain and now even more issues (like having to take digestive enzymes for the remainder of my life).


Okay, a quick answer from me. This is, in all likelihood, your gall bladder. It is not your pancreas, as pancreatitis is typically of acute onset and not recurrent with meals. It is true that pancreatitis can be caused by gallstones, but the way you describe your pain and with the testing that has been done you most certainly have BILIARY COLIC. If you click on the blue lettered link you will be taken to a pretty thorough explanation of why you almost certainly have pain from your gall bladder. 

You gall bladder sits with in the liver which is on the right side of your abdomen and just under the ribs. The fact that you have had attacks that now seem to be associated with meals makes this more certain. 

And as to what you have heard about problems after gall bladder removal I am amazed at all the bad information that is out there. The fact is that with the ability to remove the gall bladder laparascopically (without an open incision) that the recovery time and the results of ROUTINE gall bladder surgery today are almost always excellent.

There does seem to be, in a small number of patients, problems with post gall balder pain. Mostly these patients have small stones retained in the bile ducts and a simple endoscopic procedure fixes this problem. In an even smaller group of patients some persistent symptoms of gall bladder pain can occur for months after the procedure. 

However, consider this, since we know you have stones in your gall bladder you would be well advised to have removed at a time of your choosing for two main reasons.....

1. your pain attacks will keep happening and become more frequent and you will find yourself in the ER eventually, and maybe many times. A few ER visits and you have already spent more money than you would in an elective surgery. 


2. If you keep waiting the chances of your gall bladder becoming infected become higher and higher, and when this happens 'acute cholecystitis' it is called, the surgery no longer is elective, it is an emergency surgery and it is life saving surgery. In this way the gall bladder with stones is much like the appendix. In short, you run a much greater health risk by waiting than by having this done as soon as you can and on an elective baasis. 

So, in summary, I would bring your concerns to your surgeon and ask about post-cholecystectomy syndrome and how frequent it is. Your concerns are valid, your surgeon will answer your questions and will be happy to hear them. If he is not then you may have the wrong surgeon.

Please feel free to ask questions in the comment section below. Good luck and thanks for your question.

1 comment:

space doc said...

I agree with MEDSTAT ER DOC 1. The symptoms are almost certainly related to the gall stones.

The gallstones can cause some irritation in both the pancreas and some gastro=esophageal reflux and esophagitis. Also the liver often can show some abnormalities from bile associated with stones.

I is interesring that you have been able to tolerate creamy foods because any foods with a high fatty content are often associated with the presence of gallstones and biliary colic.

I agree that removal of the gall bladder sooner rather than later is wise to avoid acute cholecytitis

There are some thorough articles on post cholecytectomy syndrome. You can google "post cholecytectomy syndrome" and there are a number of articles . The e-med Medscape article is a bit technical but with the apparent sophistication of your description of your condition I think it wouldn't be too hard to grasp.

There is some disagreement as to the frequency of post cholecystectomy problems--many studies seem to indicate atound 15-30%. Many of these have been associated with some residual small stones or sludge in the gall bladder ducts or some problem with the little band of muscle where the common bile duct and the pancreatic duct empty into the small intestine (called the sphincter of Oddi)

Your surgeon or gastro-enterologist can go over all of this with you--but I think the gall bladder needs to be removed. It is good that you had the endocscopic exam and the CT scan--they will have ruled out the things other than the gallstones that could give you similar symptoms.

Best of Luck!! Would love to hear all this turns out.

Sincerely, Space Doc.