I keep receiving emails from anxious patients with gall bladder related or other problems, and I try to reply to each one as informatively as I can. Since many of the questions I get asked are not covered by my "FAQs" on this web site, I thought it might be a good idea to put up the questions and answers as an alternative FAQ. The names and email addresses of course, have been deleted. The questions are marked Q.and my replies are marked A.
Why am I having surgery, you ask. I presume that you have had a lot of pain and symptoms related to the gall bladder, and possibly your doctor, having found no stones on an ultrasound scan decided to check you further with a HIDA scan. An inflamed gall bladder can cause further trouble, and should be treated. Currently, the best possible permanent solution for an inflamed gall bladder is surgery.
Any overweight person is at increased risk from surgery. The general problems that overweight people tend to suffer from include diabetes, high blood pressure and heart trouble. Diabetes needs to be suitably controlled, and the heart and blood pressure need to be carefully monitored and controlled during and after surgery as the drugs used can affect them.
Operating on the abdomen (stomach area) of an overweight person leads to an increased risk of of chest infections after operation, although the risk is much smaller after laparoscopic surgery, since only punctures are made and pain is minimal. But in those occasional instances when a laparoscopic operation is not possible, a large open incision has to be made and there is a definite risk of chest infection. This will need to be countered by chest and breathing exercises before surgery, to be continued after surgery.
The operation itself tends to be a little bit more difficult for a surgeon, though the difficulty may not be so noticeable in a laparoscopic operation.
Finally, overweight people have an increased risk of developing clots in the veins of their legs, which could migrate to the heart. Suitable precautions against this would include special stockings or compression of the legs during surgery, anti-clotting drugs to suppress clotting in the legs, and ensuring early mobilization of the patient after surgery.
People can have gallstones with absolutely no symptoms at all - but you obviously do not fall into this category, because you do have some symptoms, and it is a question of making a judgement decision as to whether your symptoms are related to your gallstones or not.
Large or small, if gallstones are not causing any symptoms at all, they may be left alone. If symptoms are present, and they can reasonably be attributed to the gallstones, then some form of treatment is essential - and this usually means surgery to remove the gall bladder and gallstones.
On the face of it, these symptoms do not seem to have any connection with your gall bladder at all, although I have a fair number of patients who have similar symptoms and also have had gallstones.
The usual causes of symptoms such as those you complain of include bowel infections (probably unlikely in your case), "malabsorption", and Irritable Bowel Syndrome. (IBS)
I always like to rule out malabsorption and food allergies/intolerance in my patients who have loose stools as well as gallstones, since impaired digestion caused by malabsorption can lead to the formation of gallstones in some people.
A lot of people are intolerant to milk sugar (lactose intolerance) and some to wheat products (sprue). Avoidance of these is helpful in such people.
All in all you appear to have a problem that may require some specialist gastroenterological opinion to help you sort it out - though you may be able to find lots of information about the conditions I have mentioned on the Net.
If it isn't your gall bladder, appendix or an ectopic pregnancy - it is highly unlikely that you will require surgery, although it is difficult to make dogmatic statements without actually examining someone.
I normally advise my patients to avoid strenuous physical activity for 4 weeks, though some doctors allow such activity after 2 weeks.
It is in fact quite difficult to even think of any remote connection between the two, so we are really looking at some other cause for the change in your periods.
In theory, any eating can aggravate gall bladder pain, and a low-fat diet merely holds back fat, which is among the more potent stimulants of gall bladder related pain.
You are nearly in your 3rd trimester of pregnancy - so perhaps it is best for you to try and pull along with some safe pain-killers (take your doctor's advice regarding this) and your diet until your baby is born, after which you can have your gall bladder sorted out.
Gall bladder operations have been done and can be done in pregnancy - but the 2nd trimester is probably the optimum time to operate on a pregnant woman if such surgery is absolutely mandatory. Personally, I prefer not to interfere with the gall bladder during a pregnancy if that is possible.
I have read articles about ways to get rid of stones, you can visit one
at www.hps-online.com/hliver.htm. It suggests a potion that pushes bile
out (olive oil) and something to open the ducts so you get no pain
(epsom salts). I've heard about olive oil and I think Ayurveda talks
about the use of it for liver problems.
I have read that after surgery your colon is subject to more bile and
your chances of cancer increase. I have heard some poeple complain
about bloating after surgery (8 days after) and they never had bloating
before.
Right now my upper-right abdomen is somewhat sensitive to touch and I
know the gall bladder is full of something. It's probably stagnating or
maybe it's infected? How can you tell? (No fever).
Is there danger in trying to flush out the stones?
Cholesterol, bile pigments and bile salts which are constituents of bile are really terrible substances that hardly dissolve in anything, and nature does a fine job of keeping them dissolved in bile. But once stones have formed, the mechanism for keeping them dissolved is upset and almost nothing will dissolve the stones or get rid of them easily without leading to complications or the possibility of recurring stones.
The possibility of a small increase in the incidence of colon cancer has been reported but I don't think there is unequivocal evidence to prove that people who have their gall bladders removed are at a significantly higher risk than others to develop colon cancer. The problem is that there are many other things that colon cancer has been linked to, including beef eating and constipation. I would say that the theoretical risk of a colon cancer linked to gall bladder removal is far less than the risk to life from infection of the gall bladder or from bile duct blockage by stones. Sticking to the topic of cancer and gallstones - it has been noted that most people with cancer of the gall bladder (which, unlike colon cancer, is practically incurable currently) also have gall stones, but it has not been conclusively proved that gallstones lead to gall bladder cancer. One is at risk from something or the other whichever way you look at it, and one needs to look at priorities and relative risk factors.
Most people remain well, comfortable and symptom free after they have their gall bladders removed. Bloating is a very general symptom that cannot be blamed on removal of the gall bladder alone, and eight days after surgery should be considered as the "early postoperative period" at which time many people can have some symptoms.
Unlike kidney stones. it is difficult or impossible to "flush out" gallstones, because the drainage pipe is narrow and may get blocked and may necessitate urgent surgery. You may have been lucky in having passed a small stone or perhaps sludge.
Chronic infection is an ever-present possibility in symptomatic gallstones, and some authorities have cited infection as the possible cause of the formation of gallstones in the first place. Infection may be present without fever.
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