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Gall stones, gall bladder wall thickening, cholecystitis with cholelithiasis, surgical removal

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General & Family Physician
Practicing since : 2004
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I had an ultrasound yesterday showing a gall stone and slight gall bladder wall thickening. I was taken to the surgeon's office and she said that because the pain that I have experienced twice now, upper abdominal over the stomache and left of midline that radiates to my back with nausea and very acidic emesis is not textbook for cholecystitis, she was 70-75% that it was gall bladder pain, but scheduled me for surgery a few weeks out anyways. Now that I have read up, I am questioning having the surgery. I am seeing that some people have chronic diarrhea, indigestion, etc. as well as weight gain. What are my options and what is your opinion - physicians only please. Thanks
Posted Mon, 7 May 2012 in Liver and Gall Bladder
Answered by Dr. Chakravarthy Mazumdar 46 minutes later

Thank for the query.

I have read through the details of it. All the symptoms and tests are pointing towards the diagnosis of Cholecystitis with cholelithiasis along with mild GB wall thickening. The abdominal pain on the left of mid line is not usual, though it can occur in few cases. The GB pain can radiate on to the back.

A two time history of similar pain suggests that the inflammation is on going and the gall bladder wall thickening on U/S scan is congruent with it. Remember that Ultrasonography and nuclear medicine studies are the best imaging studies for the diagnosis of both cholecystitis and cholelithiasis. Ultrasonography is usually favored as the initial test, whereas hepatobiliary scintigraphy(nuclear scan) is usually reserved for the 20% of patients in whom the diagnosis is unclear after ultrasonography has been performed. In your case it is confirmed by U/S scan.

After diagnosis is made, I would get few tests done especially WBC, if they are quite elevated more than 0000 / ml and ESR then I would cool the gall bladder off with conservative management like antibiotics, appropriate pain killers and Gall bladder stone dissolvers as an Outpatient. I shall follow up closely with U/S scans for sometime to check the size of stones and frequency of symptoms. Since there is no jaundice and there are no other co morbid conditions (diabetes ) I would not hospitalize.

Next question, should you go for operation or not? Perhaps the most definitive management of Cholelithiasis is Laparoscopic Cholecystectomy (Removal of Gall bladder) and you should go for it sooner or later. It is safe as there are no major post operative complications observed.

When to go for the surgery? Although controversy is around the use of cholecystectomy versus medical management for acute cholecystitis, the morbidity and mortality rates have been the same in patients receiving early surgery as in those in whom surgery was delayed more than 48 hours for stabilization of inflammation. However, because symptoms continued in 24% of patients in whom surgery was delayed, if surgery is the goal of treatment, no advantage to delaying surgery is perceived by some surgeons.

I hope my perspective is clear. Your doctor wants to treat the inflammation first (as I do)before going for a elective surgery.

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