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Having abdominal pain. Scan showed gall stones. Should I go for surgery?

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Dr. Mayank Bhargava

Internal Medicine Specialist

Practicing since :2003

Answered : 1658 Questions

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Posted on Wed, 26 Dec 2012 in Abdominal Pain
Question: My wife is having pain in abdomin for a long time. And recently ultasound sonography done and found some gall stones of maximum size 20mm. What do you suggest? whether to go for surgery? if yes, is emergency? We wanted to have the surgery done in the month of March 2013.
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Answered by Dr. Mayank Bhargava 39 minutes later
Hi XXXXXXX
Welcome to XXXXXXX Forum.
Let me know the associated symptoms along with the abdominal pain.
Does she has fever/ vomiting or nausea/ constipation/ diarrhea/ yellow discoloration of eyes and urine/ acidic belching?
What is the type of abdominal pain?
Is there any aggravating or relieving factor for abdominal pain?

My answer can be tweaked with the above details. However with the available information I suggest the following:

Presence of gall stones (irrespective of the size) doesn't mean need of surgery.
Gall stones may be remain silently for years without any symptoms.
Presence of gall stones may cause cholecystitis (inflammation of gall bladder wall) by impacting in duct of gall bladder.
Gall bladder wall thickness >4 mm suggest gall bladder wall inflammation (cholecystitis).
I have gone through the attached ultrasound imaging report and it showed normal gall bladder wall thickness.
Cholecystitis is clinically diagnosed by presence of abdominal pain in right upper abdomen, vomiting, fever and yellow discoloration of eyes & urine.
In case of active cholecystitis, surgery is never advised and interval cholecystectomy (surgical removal of gall bladder) is advised after 6 weeks.
Gall stones can be treated by medical therapy also.
Gall stones size is decreased with the pace of 0.6mm/ month with the use of medicines.
This should be observed for 6 months and if the size is decreasing then medicines should be continued otherwise there is no role of medical therapy.
You should consult with XXXXXXX medicine specialist/ gastroenterologist and should go for relevant investigations such as complete blood count, liver function test, serum amylase (to rule out pancreatitis).
You should also take proper treatment on written prescription.
Hope that helps.
Let me know if I can address any more concerns.
Take care,
Dr. Mayank Bhargava
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mayank Bhargava 42 hours later
Sir,

Thanks your prompt reply to my question.

She use to get pain below the ribs on right hand side and continues towards back. This normally happens whenever she takes heavy food like biryani and other XXXXXXX fried items. For the last one year she has been taking acidity medicines as per the local doctors prescription whenever she gets pain. She doesn't have any other symtoms like fever, naucea, vomiting, diarrhea etc.

Regards,

XXXXXXX
doctor
Answered by Dr. Mayank Bhargava 1 hour later
Hi XXXXXXX
History described by you suggest involvement of gall bladder.
Gall bladder gets activated after oily foods thats why low fat diet is generally prescribed to patients with history of gall bladder removal.
She should also go for endoscopy for clarification of upper gastrointestinal tract.
There is high chances of developing chronic cholecystitis as recurrent pain may cause thickening of gall bladder wall.
She should take medicines for the coming months and observe on the size of gall stones.
If endoscopy is normal, and recurrent abdominal pain is the major distressing symptom then she could go for cholecystectomy (removal of gall bladder).
Put your queries if you have.
Best regards,
Dr. Mayank Bhargava
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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