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My close friend is 95 with recurrent bouts of gallstones

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Gastroenterologist
Practicing since : 1986
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Question
My close friend is 95 with recurrent bouts of gallstones and has a chole tube in place. Now she immediately regurgitates even one spoonful of food. She can usually keep Ensure down (not always) but no food at all. Sometimes just having food in her mouth makes her regurgitate. All I can think of is a hiatal hernia. She has no other symptoms and no test results to upload.
Posted Thu, 23 Nov 2017 in Digestion and Bowels
 
 
Answered by Dr. Ramesh Kumar 49 minutes later
Brief Answer:
Please provide some more details.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone very carefully through your query.
My dear attendant while putting cholecystectomy tube in place carbondioxide gas is used.In some case due to incomplete absorption of this gas post procedure nausea and vomiting is observed for few days.This is a common complication and will settle down in 3 to 5 days.
As per your query regarding hiatel hernia is concerned i would say that for diagnosis an endoscopy has to be done.Symptoms of hiatel hernia develops over months and donot present suddenly.
Was an endoscopy ever done on your friend?
Dies she ever had reflux disorder or acid peptic problem?
From how long is she having emesis and nausea?
When was the tube inserted into her?
Nausea started after tube insertion?
Was she prescribed any antiemetic?

As of now i would suggest her to take Zofran 4 mg as and when required to control emesis.
Some times electrolyte and fluid disturbance post procedure can also result in nausea and vomiting.
Suggestion-
Serum Electrolyte test should be done.

Rx
Tab Zofran4 mg as and when required should be given(Over the counter)

Please revert back with answers so that i can provide you with further professional advice.

Regards!
Above answer was peer-reviewed by
 
Follow-up: My close friend is 95 with recurrent bouts of gallstones 10 hours later
She originally had a chole tube placed in July of 2016 after a huge stone blocked the common bile duct. It came out twice and was reinserted. The third time they left it out for several months until three weeks ago when she had severe pain again, and it was reinserted. This severe regurgitation started then and has not stopped. She is a very poor surgical risk but still has a gallbladder full of stones.

She has had reflux for many years and has been treated. I don't know if she has ever been scoped or not. She has received anti-emetics in the past.

Is it possible for the carbon dioxide to still be causing this?
 
 
Answered by Dr. Ramesh Kumar 14 minutes later
Brief Answer:
follow up.

Detailed Answer:
Hello again my dear attendant,
Regurgitation of food means that there are reverse peristaltic moments in gut(which is not natural).
When ever a external thing is inserted into our body it acts as a potential source of infection,Same principle applies with Lap chole tube.Most likely the tube has caused severe inflammation along her hepatobilliary tract.Emesis and nausea on taking food is suugestive of presence of infection in body.If she is having recurrent stone then its better to go for a planned endoscopic removal of gallblader.
Why is she a poor candidate for surgery?
Laproscopic cholecystectomy is a very safe operation and has high safety index.Despite of keeping a drainage tube inside her body(Source of infection) planned removal should be done.

I don’t feel that carbondioxide can cause problem after so many months.

Few tests sugested are-
Fecal calproctin-To rule out level of inflammation in gut.
Total and differencial leucocyte count-to see if infection is acute or chronic.

For the time being she could be given anti emetics for symptomatic relief.

Thanks!
Above answer was peer-reviewed by
 
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