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Had gallbladder removal. Having pain and indigestion. Cure? - Online Doctor Chats

Date : 20-Sep-2013
User rating for this question
Very Good Posted in: Liver and Gall Bladder
Answered by

General & Family Physician
Practicing since : 2009
Answered : 983 Questions
User:Any doc online?
Doctor:How can I help you?
User:I have got my gall bladder removed last year and since then I am having various stomach related problems continuously
Doctor:Please explain.
User:1. Indigestion
User:2. Abdominal pain - mainly in upper abdomin
User:3. Bowl irritation all the time
User:4. Lack of sleep
User:5. Heaviness in stomach most of the time
User:6. Loose stool while in stress
Doctor:Have you seen your doctor for these problems?
User:I was taking a homeopathic treatment as could not bear the alopathic medicines
User:It worked for couple of month but has revealed again\
User:Sometimes I have nosia too
Doctor:You mentioned the symptoms started a year ago, may I know over the last one year how have these symptoms progressed. Is it improved or worsened now?
User:Almost worsened
User:Improvement seen only during homeopathic medication
Doctor:May I know the reason why you underwent gall bladder removal?
User:as soon as the medication is over, the problems come back
User:I developed stones in the gall bladder during pregnancy and they had tendency to come out from the gall bladder and block the duct between gall bladder and pencias
User:I had undergone ERCP once before the lap colei
User:and frequent hospitalizations due to severe pain attacks
Doctor:I was just going through your details.
Doctor:Before I proceed to explain further, may I know if you have any other medical illness such as diabetes, high blood pressure, thyroid problems?
User:No, doc.
Doctor:Have you had similar complaints before surgery (in milder forms)
Doctor:Are you there?
User:I always had a problem of hyper acidity even before I concieved and during the pregnancy period which got aggravated during pregnancy and after the child birth
Doctor:Let me brief you.
Doctor:You have set of complex symptoms.
Doctor:Most of the abdominal and digestion complaints can be related to gall bladder surgery.
User:I missed out to mention a complication
User:that happened during my surgery
Doctor:Please add that.
User:laringeal edema
User:and my voice box got damaged
User:I had to be on ventilator for couple of days
User:Right now I do not have any major problem due to it but my voice has got vhanged a bit
Doctor:This one is not related to the current symptom.
Doctor:Let me explain.
Doctor:I was about to tell you that, Post gall bladder removal, most individual have a fairly normal life. However a small group of individual say one in 5/7 individuals face some set of symptoms similar to yours.
Doctor:This is referred to as post cholecystectomy syndrome.
Doctor:In most case of post cholecystectomy sydrome, symptoms gradually resolve over the course of time. Generally they settle down in 6-7 months period.
Doctor:However rarely symptoms can be persistent.
Doctor:Persistent cases are managed either conservatively or by interventional techniques.
Doctor:Among conservative treatment, we recommend patients to modify the type of food you take. A high volume diet containing plenty of fats can make these symptoms worse.
Doctor:You should avoid any fatty diet and preferably take small and frequent meals.
User:Yes I do
User:And also have developed a food pattern
User:That I can digest
Doctor:This symptoms are generally more pronounced in sedentary individuals. Exercising and keeping your weight under check is also recommended.
User:But that is not helping much as I travel a lot due to my job profile and I cant maintain the diet pattern during travel
Doctor:Besides that, if you consume alcohol, then you need to avoid that.
User:I dont
User:I never consumed alcohol!!
Doctor:If you have to eat outside at a restaurant, ask for low fatty diet. All junk food and fizzy drink need to be avoided.
User:yes, I do. Most of the time I have juicies or fruit dishes or salads or icecream
Doctor:Apart from this life style changes, there is a drug known as cholestyramine. This can be very helpful in this situation.
User:and sandwitches
Doctor:It is a prescription based medication, very often used by gastroenterologist.
Doctor:Yes. This is a bile binding medication that has been used in this condition.
Doctor:If you haven't tried this yet, you can check with your gastroenterologist about it.
User:I gastroenterologist ever prescribed this even after my surgery
Doctor:In addition to this specific medication, your doctor can also start you on medicines for hyperacidity like pantoprazole.
Doctor:It can be used in combination with cholestyramine to control the symptoms.
User:pantoprazole...I had been taking for quite a long time after surgery
User:okay.....shall I continue it now?
Doctor:And as I said earlier, post cholecystectomy syndrome rarely persists for long time in some cases.
Doctor:You can continue with pantoprazole. If you are not feeling better with it, the next option would be to add cholestyramine.
Doctor:But if you feel the symptoms are not controlled with it or if they recur after stopping medicine, then the next step would be to opt for interventional procedure.
Doctor:Your doctor need to perform a simple ERCP procedure known as splincterotomy or a bypass procedure.
Doctor:That should resolve most of these cases.
User:Okay. So excatly till what time I have to take pantoprazole and observe?
User:and how many doses a day?
Doctor:To be precise, pantoprazole can be used as long as you wish too. It would be difficult to predict for how long your symptoms going to last.
Doctor:I suggest 40mg once a day before food schedule to my patient.
Doctor:If symptoms don't feel better or if you develop any side effects, you can get back to your doctor for change of treatment. ifI start pantoprazole from do I decide when to start cholestyramine?
Doctor:Other drugs or ERCP guided splincterotomy/bypass procedure can be performed as needed.
Doctor:This is going to be a step by step process. The change to next step will depend on how you perform with the previous step. If you don't feel better or if you are not able to tolerate the previous one better
Doctor:you can opt for the next one.
User:Got it
Doctor:In simple words, I would prefer to keep my patients on pantoprazole alone if they are tolerating well and if symptoms are well controlled.
Doctor:Add the next step if they don't tolerate or the symptoms do not improve.
User:Cleared now
Doctor:You can work this step by step approach with regular follow ups with a gastroenterologist.
User:Can I follow up with you after a week's time?
Doctor:In addition to this, I also recommend you check your blood sugar and thyroid hormones if they haven't been tested recently.
User:I have got a full body check up in Jun '13
User:No detection of blood sugar or thyroid
Doctor:You can contact me any time; but I wouldn't be able to replace your gastroenterologist who has known your condition since the beginning.
User:yes yes
Doctor:He can be able to tell you precisely when the change is needed and whether we can try the previous management for a bit more.
User:Would I be able to refer to the chat again once I close it?
Doctor:Without a clinical examination, I wouldn't be able to do that very well as he would do.
Doctor:You should be able to see that in your history.
Doctor:You can contact the customer care if you find problems.
Doctor:Do you have any more questions?
User:Thanks a ton, doc.
User:nope..not as of now
Doctor:Before we close this discussion,
User:Will try with your medicaiton
Doctor:I would like you to know that I saw your question that you had posted.
Doctor:As I was about to answer that, you came on chat.
User:I posted two queries
Doctor:I would want to know that if your question is answered here; do you want answers to those questions again on that page.
User:So, its okay, if you dont want to post the answer for the second one
Doctor:I can post the same reply there.
User:Yes, that will do.
Doctor:Thanks for consulting me.
Doctor:Bye for now.
User:Really nice talking to you.
User:and thanks.
User:Have a good day.
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