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Is Difficult Breathing After Gall Bladder Removal A Serious Condition?

Posted on Fri, 9 May 2014

Question: Hello Doctor, My father aged 61 years is diagonised with acute pancreatitis .after MRCP it was found that he had gall stones and went through a laproscopic surgery to remove his gall bladder yesterday and was kept under post surgical ICU for 24 hrs and today he was complaining of breathing difficulty and the oxygen saturation level was droping ,so now the doctor adviced to shift him to medical ICU and have put him on few medication, a tube in both of his nostrils and i guess some tube on his stomach to reduce the stomach detention (Not sure).Kindly advice if this condition can be handled and will not lead to any complications?

Answered by Dr. Ashish Verma (1 hour later)

Brief Answer: its a little serious situation Detailed Answer: Hi XXXXXXX The condition of your dad is a little serious. At this age the lungs are not 100% fit. And now they are failing in their work. The tubes in both the nostrils are most likely for oxygen delivery. The other one is called Ryles tube, to decompress the stomach. The next 24-48 hours are critical for him. And during this period nothing much can be said. But the good thing is that he is not on ventilator, so chances of recovery are more in his case. So relax and don't take much tension. Be patient and have faith in your doctors, i am sure they are trying their best to bring him out of this situation. Hope, i havs been helpful. Regards Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ashish Verma (7 hours later)

Thanks for your quick response.i am here in the icu and he conditions seems to be ok after 12 hrs per duty doc and what is the ptentional cause for this.would this now lead any further complications ?

Answered by Dr. Ashish Verma (1 hour later)

Brief Answer: its postoperative stress Detailed Answer: Hi XXXXXXX This happens due to the postoperative stress hormones and inflammatory mediators released into the circulation following the surgery. If now he is ok, then he should recover completely, with mostly no complications later. All you need to do now is to improve his nutrition and general health by mobilization, and he should be back to normal. Regards Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ashish Verma (44 minutes later)

Thank you once again doctor.his blood and urine reports look normal and pulse and oxygen saturation level reading seems normal as well with oxygen mask and he could sleep in the night and I was wrong in my first query where i had mentioned abt tubes .there is only one tube through one nostrial to discharge some kind of waste liquid and no tubes inserted in his stomach .so with this do u think he can recover soon and get back to normal

Answered by Dr. Ashish Verma (38 minutes later)

Brief Answer: yes he should recover fast Detailed Answer: Hi XXXXXXX He is doing well, and should recover fast. Don't worry so much. That tube in one nostril which is discharging liquid is Ryles tube only and its other end is in your dads stomach only. Its a routine procedure to decompress the stomach. He is slowly improving with normal blood and urine parameters, and should be fine in a few days. Once he starts maintaining oxygen saturation without support, he will be discharged. Regards. Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ashish Verma (9 hours later)

Hello doctor he was looking till noon and Infact soc told tomorrow they would like to shift him to ward but now again in the evening his saturation is dropping may be due to coz they started him on clear liquid diet in the noon .the suitation looks same as last evening now they are again tiring to use the rayles tube to discharge and stop the liquids. Why is this condition recurring . Do u think itz getting complicated or it is just matter of time for him to recover ?

Answered by Dr. Ashish Verma (2 hours later)

Brief Answer: his intestinal motility has not returned yet. Detailed Answer: Hi, His intestinal motility has not returned yet. Thats why on starting oral fluids his stomach is getting distended, causing compression of the lungs leading to fall in saturation. This motility will take some time. This gets delayed following surgery and bed ridden condition and sometimes due to electrolyte imbalance. Try to make him sit on the bed for 2-5 mins every 2-3 hours and XXXXXXX his back, this will help to clear his lungs and also stimulate his bowels, thus helping in recovery. Also make sure that whenever anything is given to him orally, he must be in sitting or semi-sitting position and continues to be so for 2 hours after that. This is to prevent aspiration. Its not a very major problem, he should recover in a matter of time. Regards Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Ashish Verma (13 hours later)

Thank you once again .today doctor said he is stable but the recovery is slow and says the pancreatitis is still playing on him and he still needs to be in ICU .Do you think this condition will improve without any complications and he will recover with time ? The only problem he is complaining is about breathing difficulty and some congestion which doctors are controlling through oxygen mask and medication some steam inhalation breathing exercise with this his PaO2 level is around 80+

Answered by Dr. Ashish Verma (9 minutes later)

Brief Answer: this is all expected Detailed Answer: Hi, Pancreatitis is know to get flared up post surgery due to surgical stress. It will take time to settle down. His oxygen saturation is still low. But since he is improving, then nothing to worry about. Continue with the respiratory exercises and he will improve. These things take a little time. Maintain his nutrition, as lots of energy is needed to heal. Also keep moving his limbs to prevent deep vein thrombosis. Regards Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Ashish Verma (22 hours later)

Today doctors says his condition is stable however he is not improved significantly from yesterday he still needs bpap for oxygen support .he was also Mentioning about lung injury due to pancreatitis .my anxiety levels are going up itz been 3 days post operation .kindly advice if this condition will recover with time and he would get back to normal

Answered by Dr. Ashish Verma (5 hours later)

Brief Answer: he is on ventilator? Detailed Answer: Hi XXXXXXX I guess your dad is on ventilator support. His oxygen mask is attached to a machine? In that case, his condition is serious. But if your doctors are saying that he is stable, then he should recover, but that will take time. He may take a few more days to be weaned off the ventilator, if his condition remains stable. Actually this stage is a sort of midway between the two sides, no one can predict which side he may turn. It all depends on the degree of lung injury and the conditions of rest of the vital organs. Age is also on the higher side. So all you can do is pray, at this stage. Regards Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ashish Verma (3 hours later)

He just now got shifted to ward but with oxygen mask and they did an ultra sound here is the impression Post choleccystectomy status with Mild gall bladder fossa collection Known case of pancreatitis Shows bulk pancreas and Minimal as cities ,peripancreatic echo genie fat Fatty changes in liver Kibdly advice

Answered by Dr. Ashish Verma (1 hour later)

Brief Answer: that's great news!! Detailed Answer: Hi XXXXXXX That's a really great news. He is off ventilator and shifted out of icu, means he is recovering fast. The usg report is OK for him. That much is very much acceptable. Now all you have to do is to provide him good nutrition and physiotherapy. He should recover fast with that. At least now you relax, else you will develop stress gastritis. Regards Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ashish Verma (13 hours later)

Thanks a lot doctor for all your advice and support. The infection seems to be still there for which there giving him higher antibiotics his TLC of blood report is howering around 14000-20000.todays itz around 20000 .he has swelling mostly on his legs hands and near his urinal area where the tubes for discharge of urine is put .with these higher antibiotics you think the TLC should come down . And he also has started with all the physiotherapy and taking some clear fluids orally .kindly advice

Answered by Dr. Ashish Verma (1 hour later)

Brief Answer: it should reduce Detailed Answer: Hi XXXXXXX With higher antibiotics, the infection should reduce. The swelling in legs and genital area are due to hypoproteinemia (low protein levels). When he starts taking thicker fluids give him milk with protein powder (3-4 heaped tabel spoons) twice daily, also give him boiled egg whites (2 eggs, 3 times a day). These are over and above the regular food he takes. You can feed him every 4th hourly, but in sitting position and let him sit for 1-1.5 hours after the meal. If possible, make him sit on a chair with arm support for as long as possible, as no one likes to be lying down all day. As i had said earlier, now its all on nutrition and physiotherapy. The better they are, the faster will be the recovery. Regards Dr. Ashish Verma

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj