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Doctors' Answers to "Frequently Asked Questions" - Gallbladder

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Problems After Gall Bladder Surgery [posted 12/04/98]
Question: I underwent surgery for removal of my gall bladder about two months ago (Lap). In the last few weeks I seem to be having gall bladder attacks again. I get nauseous, bloating, and chest pains. What could be the problem? Thank you.

Answer: Well, there is a syndrome called post-cholecystectomy syndrome where patients develop similar symptoms after the gall bladder is removed. However, you should have an ultrasound of the common duct to ensure you don't have a retained stone. Sometimes an ERCP is necessary to ensure that you don't have stenois of the Ampulla of Vater (the opening to the small intestine).

  Problems After Cholecystectomy (Gall Bladder Removal) [posted 11/19/98]
Question:  Six weeks ago I underwent a laparoscopic cholecystectomy. I continued to have problems with abdominal pain & nausea and sometimes loose stools. As a result, my doctor thought I may be suffering from Post-Cholecystectomy Syndrome. She prescribed a drug called Questran, and I've been using it daily for the past four weeks. The problem is that it really constipates me and causes GI gas and severe bloating. My questions are: 1) Will I have to use the drug Questran the rest of my life or will this Post-Cholecystectomy Syndrome go away with time? 2) Is there another drug I can use which will NOT cause bloating and constipation? 3) Could you please provide me with names of alternative drugs? Thank you very much!

Answer:  Does it work? Usually, we use a calcium channel blocker;but, women with this problem generally have life long problems.

Could These be Gall Bladder Symptoms [posted 11/3/98]
Question: I am an 18 year old male in perfect health. After eating I expierence stomache pains, and a pain below my right ribs. This usually happens 4-5 times a week. There is a history of gallbladder problems in my family, and my father had his removed when he was in his 30's. From what I have read is that most gallbladder problems occur in people over 40 and mostly women. I rarely drink milk or take in anything that contains large amounts of calcium, so I don't think it's gallstones. Being only 18 could this be a gallbladder problem, or a problem with what I'm eating.

Answer: Certainly could, also occasional ulcers symptoms felt like this. Lastly, occasionally colon spasms occur in the turn by the liver and is called hepatic flexure syndrome. But, you will need to be seen and evaluated, possible gall bladder testing depending on the findings. Gall stones are very frequently familial, the calcium intake has little to do with it. Fat intake usually is a better predictor.

What to Do About Gall Bladder Symptoms [posted 10/23/98]
Question: My 17 yr. old daughter got unbearable pain in her side. Couldn't stand up. Went to ER, but they found nothing. They took a blood test, but no x-rays. They suggested a gall bladder attack and said they would get increasingly worse, but did not suggest treatment. She's had 4 attacks, 15 minutes each in the last month. We don't want to just sit & wait. Isn't there anything we can do? She's a normal HT. & WT., active child.

Answer: Get a HIDA scan of the gall bladder. This is a functional test, also, an ultrasound may answer the question.

Gall Bladder Symptoms [posted 10/23/98]
Question: Is a feeling that my ribs are poking my right side a symptom of gallstones? Other than this, and a pressure in my back about 3 inches above my waist on my right side, lots of gas and occasional nausea, I don't think I have any symptoms. I have been advised by a surgeon to have my gallbladder removed however he did not see the ultrasound that showed multiple stones, does not know how many stones or what size. He knows my liver enzymes were all elevated (except bilirubin) in Feb, but are all back within normal range except alkaline phospahase ( 143, up from 132 in Feb.)Do you suggest a second opinion?

Answer: I suggest getting your gall bladder out.

Gall Bladder or Acid Reflux [posted 10/1/98]
Question: This week, i went to the e.r. with what i thought were chest pains. I am 36, the er dr. indicated it could be gall bladder. ekg, sonogram, and bloodwork were normal. my friend, a gastro, brought me prevacid and instructed me to take each day. I have suffered from IBS for about 5 years. Could this be gall bladder? what's next? i hate to bother my friend with what i think is indegestion.. have a presciption for librax which i take before mexican food. I HATE getting old, and i am NOT a whiner! What do i do now?

Answer: Yeah, I hate getting old too;but, as a patient once told me-Beats the alternative. Anyway, I would get some studies to find the cause of this problem. An additional test for the gall bladder would be a HIDA scan with ejection fraction. This looks at the function of the gall bladder ( not whether stones are present) and a decrease ej fraction can be a reason to take out the gall bladder-given the right clinical situation. If your pain is due to reflux disease, this can turn out to be important. Prevention of reflux is necessary to prevent long term scarring of your esophagus. If you hate bothering your friend, see a colleague-don't sell your health short due to guilt.

Gall Stones [posted 8/11/98]
Question: What are the symptoms of gall stones? What can you eat to avoid attacks?

Answer: Post prandial nausea and pain. Usually about 30-45 minutes post prandially. Fatty foods are usually worse. Apples and cabbages are also offenders. Occasionally the pain can be felt in the chest, left jaw or left arm. Generally, a feeling of nausea and right upper abdominal discomfort. Jaundice can result if stones obstruct the common duct. There will be marked pain in this situation. Food should be as low fat as possible. Avoid apples and cabbages. However, no diet will completely fix the problem, surgery is the only effective answer.

Gall Bladder Pain?
Question: What is the treatment for pain in the right side of my chest about 10 minutes after a meal. There doesn't seem to be any indigestion symptoms. Just a burning type pain for about a half hour. Liquids don't bother me at all. Could it be an irritated gall bladder and if so what would help or should be prescribed?

Answer: Hard to know if this is gall bladder or not. You would need an ultrasound, or a functional test of the gallbladder to know. Gallbladder typically is 30-40 minutes post prandially and worse with fatty foods. Occasionally an ulcer or just spasm could give similar symptoms. If it is your gallbladder, only surgical removal will alleviate the problem. Low fat meals will buy you time, but, not fix the problem.

Gall Stones
Question: If I had been diagnosed with gall stones, is there a danger in waiting to have surgery? Can the stone pass without surgery?

Answer: In a study of predominantly male silent gallstone patients, it was suggested that the cumulative risk for the development of symptoms or complications requiring surgery is relatively low. Decision analysis has suggested that the cumulative risk of death while on expectant management is small and prophylactic chlolecystectomy is not warranted. Complications requiring the surgery are much more common in patients who have symptoms.

Question: If a patient was informed that the gallbladder is not emptying efficiently, is there anything besides surgery that can eliminate the recurrent pain? What are the negative effects of living without a gallbladder.

Answer: If you are experiencing pain from your gallbladder and poor emptying (a low ejection fraction) you would be best advised to get your gallbladder removed. There are oral drugs which will dissolve stones (a possible cause of your problem), but they'll just come back over time if the gall bladder is left intact. There seem to be few side effects post cholecystectomy. Some patients continue to experience discomfort (especially after fatty meals) and this is called the post-cholecystectomy syndrome. Most patients don't notice any difference.

Gallbladder & Food Poisioning
Question:What are the symptoms of food poisoning or gall bladder attack?

Answer: There are two basic kinds of food poisoning. First is the food is contaminated with bacteria. These bacteria will multiply in your gut causing diarrhea, fever, etc. Since it takes time for them to multiply it will take 7-14 days before symptoms occur. Second it a toxin produced by bacteria which is present on the food. This will cause nausea, vomiting, diarrhea within several hours of eating the food. It will not cause fever or an elevated white count(suggestive of infection not poisoning). Gall bladder attacks occur when the gall bladder is either inflamed, contracting poorly, or blocked(usually by a stone). Classically, it occurs with fatty foods, apples, cabbages, etc. It is usually about 30-45 minutes after a meal and is worse with fatty meals. Pain is usually in the area under your right ribs and occasionally with pain between the shoulder blades or neck.
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