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Suggest Treatment For Severe Pain Due To Gall Stones
Question: Dear sir
My sister is feeling severe pain below chest on right side of the body. She visited gynecologist for the pain she suggested her sonography found that multiple stone in gall bladder. She has prescribed her drotin;ranidom injection;pan d;coleptry. Iam only wandering because she was pregnant and had a delivery 3 months back at that time she had sonography 3 -4 times but why it was not detected at that time. Is we have to reconfirm the reports. As her delivery took place 3 months back we want to avoid operation as her child is too small. Pls suggest some medicine which can be taken during severe pain.
My sister is feeling severe pain below chest on right side of the body. She visited gynecologist for the pain she suggested her sonography found that multiple stone in gall bladder. She has prescribed her drotin;ranidom injection;pan d;coleptry. Iam only wandering because she was pregnant and had a delivery 3 months back at that time she had sonography 3 -4 times but why it was not detected at that time. Is we have to reconfirm the reports. As her delivery took place 3 months back we want to avoid operation as her child is too small. Pls suggest some medicine which can be taken during severe pain.
Brief Answer:
She can avoid operation for now
Detailed Answer:
Hi,
I have gone through your query. Your sister has been diagnosed with Cholelithiasis (Gall stones). Your concern is that ultrasonography done in pregnancy period didn't reveal Gall stones.
During Pregnancy ultrasound is advised for fetal well being only if there are no other associated symptoms. So, sonologist mainly focus on uterus and fetus and may use Doppler for fetal heart beat and blood flow. Later due to increasing size of fetus other organs are difficult to visualize. This is why gall stones may have been missed. Considering, she had been done ultrasound from reputed center, no repeat ultrasound is needed.
For Gall stones, only treatment is surgery. But for time being, if pain is not severe then it can be postponed upto 6 months or it may depend upon her condition later. Remember that if left for long time, it may lead to infection. In that case infection needs to be controlled before surgery.
I advise you to consult a surgeon for clinical examination and planning about surgery.
Regarding pain, Drotin either tab or injection will ease it that is why take it when needed. Rest of ongoing medications are good and can be continued.
Hope i have answered you. If you have any other query, I will be happy to help.
Regards
Dr. G.Katiyar
She can avoid operation for now
Detailed Answer:
Hi,
I have gone through your query. Your sister has been diagnosed with Cholelithiasis (Gall stones). Your concern is that ultrasonography done in pregnancy period didn't reveal Gall stones.
During Pregnancy ultrasound is advised for fetal well being only if there are no other associated symptoms. So, sonologist mainly focus on uterus and fetus and may use Doppler for fetal heart beat and blood flow. Later due to increasing size of fetus other organs are difficult to visualize. This is why gall stones may have been missed. Considering, she had been done ultrasound from reputed center, no repeat ultrasound is needed.
For Gall stones, only treatment is surgery. But for time being, if pain is not severe then it can be postponed upto 6 months or it may depend upon her condition later. Remember that if left for long time, it may lead to infection. In that case infection needs to be controlled before surgery.
I advise you to consult a surgeon for clinical examination and planning about surgery.
Regarding pain, Drotin either tab or injection will ease it that is why take it when needed. Rest of ongoing medications are good and can be continued.
Hope i have answered you. If you have any other query, I will be happy to help.
Regards
Dr. G.Katiyar
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear sir
Thanks for prompt reply. Few more things I wish to confirm
1. Which technique is best for treatment of this problem. Lithotripsy is good or laproscopy surgery?
2. She is not getting relief from the tablet some time so can you suggest some good pain killer.
3. Which doctor can be consulted.
4. What food to be avoided.
Thanks for prompt reply. Few more things I wish to confirm
1. Which technique is best for treatment of this problem. Lithotripsy is good or laproscopy surgery?
2. She is not getting relief from the tablet some time so can you suggest some good pain killer.
3. Which doctor can be consulted.
4. What food to be avoided.
Brief Answer:
Answers below
Detailed Answer:
Hi,
Thanks for the follow up. I will answer to your queries accordingly.
1) laparoscopic cholecystectomy is a better option. Lithotripsy is now a days not done for gallstones rather it is used for kidney stones. Moreover Lithotripsy is done when there is a single stone, but in your sister's case its multiple.
2) Yes, I can suggest but try only after consulting your local doctor. She is given Drotin for pain by her OBGYN. This is because, she might be breastfeeding the baby and this medicine is safe during lactation. If pain is severe You can use injection Drotin. Another drug which is used for gall stone pain is Spasmo Proxyvon (Dicyclomine) but it is not given during lactation.
3) Surgeon with expertise in laparoscopic surgery can be consulted and soon.
4) Avoid Fatty and junk food. Taking these food will aggravates the pain. Continue all other nutritional food as her demand is more because of Lactation.
Hope i have answered you. You can close the discussion and rate the answer.
Regards
Dr. G.Katiyar
Answers below
Detailed Answer:
Hi,
Thanks for the follow up. I will answer to your queries accordingly.
1) laparoscopic cholecystectomy is a better option. Lithotripsy is now a days not done for gallstones rather it is used for kidney stones. Moreover Lithotripsy is done when there is a single stone, but in your sister's case its multiple.
2) Yes, I can suggest but try only after consulting your local doctor. She is given Drotin for pain by her OBGYN. This is because, she might be breastfeeding the baby and this medicine is safe during lactation. If pain is severe You can use injection Drotin. Another drug which is used for gall stone pain is Spasmo Proxyvon (Dicyclomine) but it is not given during lactation.
3) Surgeon with expertise in laparoscopic surgery can be consulted and soon.
4) Avoid Fatty and junk food. Taking these food will aggravates the pain. Continue all other nutritional food as her demand is more because of Lactation.
Hope i have answered you. You can close the discussion and rate the answer.
Regards
Dr. G.Katiyar
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear sir good morning
We consulted gastro surgeon yesterday; he re examined my sister and concluded that the gall stone is abstracting the bile duct and the gall is full of bile which is creating other issue such increase in SGPT and billirium. Doctor is now suggested to perform ERCV and remove the blockage.while at same time locating the stone.whether the step are ok and the stone can be removed by this technique if not what we can further talk to doctor pls advice.
We consulted gastro surgeon yesterday; he re examined my sister and concluded that the gall stone is abstracting the bile duct and the gall is full of bile which is creating other issue such increase in SGPT and billirium. Doctor is now suggested to perform ERCV and remove the blockage.while at same time locating the stone.whether the step are ok and the stone can be removed by this technique if not what we can further talk to doctor pls advice.
Brief Answer:
Bile duct obstruction.
Detailed Answer:
Hi XXXXXXX
Welcome back to HCM. I am glad for your quick visit to surgeon. From your query, it is obvious that there is stone in bile duct too leading to obstruction of bile flow. This in turn cause severe pain and deranged Liver Function Test values of SGPT and Bilirubin.
Her treating doctor has suggested ERCP (Endoscopic retrograde cholangiopancreatography) because of Presence of stone in bile duct.
Mainly, ERCP is a diagnostic procedure, where endoscope is inserted through the mouth and XXXXXXX (contrast) is injected in bile and pancreatic duct to see the location of stone or obstruction. Obstruction can be due to stone or stricture or other causes.
Now again ERCP is also used (Therapeutic use) for removal of stone, if possible or required, in the same sitting.
Laparoscopic surgery is not advised at present because location of stone in bile duct is not known and if gall bladder is removed stone will remain inside leading to pain.
Your treating doctor may be confident of removal of stone due to small size. You can consult him regarding the removal of other stones (may be larger in size) too since Ultrasound showed multiple stones.
Hope i have answered you. If you have any other query, I will be happy to help.
Regards
Dr. G.Katiyar
Bile duct obstruction.
Detailed Answer:
Hi XXXXXXX
Welcome back to HCM. I am glad for your quick visit to surgeon. From your query, it is obvious that there is stone in bile duct too leading to obstruction of bile flow. This in turn cause severe pain and deranged Liver Function Test values of SGPT and Bilirubin.
Her treating doctor has suggested ERCP (Endoscopic retrograde cholangiopancreatography) because of Presence of stone in bile duct.
Mainly, ERCP is a diagnostic procedure, where endoscope is inserted through the mouth and XXXXXXX (contrast) is injected in bile and pancreatic duct to see the location of stone or obstruction. Obstruction can be due to stone or stricture or other causes.
Now again ERCP is also used (Therapeutic use) for removal of stone, if possible or required, in the same sitting.
Laparoscopic surgery is not advised at present because location of stone in bile duct is not known and if gall bladder is removed stone will remain inside leading to pain.
Your treating doctor may be confident of removal of stone due to small size. You can consult him regarding the removal of other stones (may be larger in size) too since Ultrasound showed multiple stones.
Hope i have answered you. If you have any other query, I will be happy to help.
Regards
Dr. G.Katiyar
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Dear sir
Thanks for prompt reply today before ERCP doctor tested pancreas function and found elevated values w.rt to reference values (pancreatitis).whether there is any major problem or after ERCP it will become ok.how much time time is required for curing of this pancreas issue.what medicines are recommended for this.
Thanks for prompt reply today before ERCP doctor tested pancreas function and found elevated values w.rt to reference values (pancreatitis).whether there is any major problem or after ERCP it will become ok.how much time time is required for curing of this pancreas issue.what medicines are recommended for this.
Brief Answer:
Complication of gall stone.
Detailed Answer:
Hi,
Thanks for the follow up again.
Acute pancreatitis may be the first sign of gallstones. Gallstones can block the pancreatic duct, which causes acute pancreatitis. Level of pancreatic enzyme amylase and lipase is increased in it.
This is not a major problem. After the gallstones are removed and the inflammation goes away, the pancreas usually returns to normal. Time will depend upon the level of inflammation.
The point is that ERCP is contraindicated in pancreatits unless there is obstruction resulting in high level of bilirubin. So the decision of ERCP will be of your treating doctor. Focus of treatment will be on removal of gall stones only.
Medicines except pain killers are usually not required in acute case of pancreatitis but pancreatic enzymes can be given. Avoid fatty diet.
You can upload her complete reports till now for better assessment of the condition.
Hope i have answered you. If you have any other query, I will be happy to help.
Regards
Dr. G.Katiyar
Complication of gall stone.
Detailed Answer:
Hi,
Thanks for the follow up again.
Acute pancreatitis may be the first sign of gallstones. Gallstones can block the pancreatic duct, which causes acute pancreatitis. Level of pancreatic enzyme amylase and lipase is increased in it.
This is not a major problem. After the gallstones are removed and the inflammation goes away, the pancreas usually returns to normal. Time will depend upon the level of inflammation.
The point is that ERCP is contraindicated in pancreatits unless there is obstruction resulting in high level of bilirubin. So the decision of ERCP will be of your treating doctor. Focus of treatment will be on removal of gall stones only.
Medicines except pain killers are usually not required in acute case of pancreatitis but pancreatic enzymes can be given. Avoid fatty diet.
You can upload her complete reports till now for better assessment of the condition.
Hope i have answered you. If you have any other query, I will be happy to help.
Regards
Dr. G.Katiyar
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear Sir
Good Evening
I again need your guidance.
My sister was discharged from hospital on 24.07.14 after ERCP & Removal of bile juice & sone in bile duct, her gall stone was not removed as it was told by doctor to first allow the liver & pancreas to be at normal state (Acute pancreatitis) . She was feeling mild pain in abdomen & back side of chest after that ,but today she had very high pain, she is now again admitted to hospital doctor perform sonography and confirmed that no bile duct stone is there but gall bladder is swallow that is reason of high pain. Now what i should do whether i need to visit to another big hospital (Some other city). pls advice.
Suppose laparoscopy is not possible due to acute pancreatitis for removing gall stone whether open surgery can be possible. what will be risk. Pls suggest any other gastroenterologist in your knowledge whom we can refer.
Good Evening
I again need your guidance.
My sister was discharged from hospital on 24.07.14 after ERCP & Removal of bile juice & sone in bile duct, her gall stone was not removed as it was told by doctor to first allow the liver & pancreas to be at normal state (Acute pancreatitis) . She was feeling mild pain in abdomen & back side of chest after that ,but today she had very high pain, she is now again admitted to hospital doctor perform sonography and confirmed that no bile duct stone is there but gall bladder is swallow that is reason of high pain. Now what i should do whether i need to visit to another big hospital (Some other city). pls advice.
Suppose laparoscopy is not possible due to acute pancreatitis for removing gall stone whether open surgery can be possible. what will be risk. Pls suggest any other gastroenterologist in your knowledge whom we can refer.
Brief Answer:
Complication
Detailed Answer:
Hi,
Welcome back to HCM. I am glad to hear that your sister has been discharged following ERCP with removal of stone in bile duct.
From the present condition of her it is clear that she is experiencing complication of the procedure. Usually in one sitting all stones need to be removed but your treating doctor might have faced unfavorable condition like cholangitis during the procedure, that is why he decided keep GB stones as it is.
As far as complications like cholecystitis or pancreatitis are concerned, preoperative managements are useless to some extent. So surgeon or procedure is not responsible for it.
At present she is having inflamed GB and pancreatitis. Both are very painful conditions and need to be managed well. She will require potent analgesics and antibiotics along with fluids. I hope that you have given the history of Lactation. When both of these condition subsides then only removal of Gall bladder can be done. Usually 6 weeks of time is needed which may vary according to individual's condition.
As per my opinion There is no need to visit another hospital (But as per your wish you can consult another surgeon for opinion). Neither open nor laparoscopic surgery can be done at present. If done without reducing the inflammation, severe complications may arise.
Hope I have answered you. If you have any other query, feel free to ask.
Regards
Dr. G.Katiyar
Complication
Detailed Answer:
Hi,
Welcome back to HCM. I am glad to hear that your sister has been discharged following ERCP with removal of stone in bile duct.
From the present condition of her it is clear that she is experiencing complication of the procedure. Usually in one sitting all stones need to be removed but your treating doctor might have faced unfavorable condition like cholangitis during the procedure, that is why he decided keep GB stones as it is.
As far as complications like cholecystitis or pancreatitis are concerned, preoperative managements are useless to some extent. So surgeon or procedure is not responsible for it.
At present she is having inflamed GB and pancreatitis. Both are very painful conditions and need to be managed well. She will require potent analgesics and antibiotics along with fluids. I hope that you have given the history of Lactation. When both of these condition subsides then only removal of Gall bladder can be done. Usually 6 weeks of time is needed which may vary according to individual's condition.
As per my opinion There is no need to visit another hospital (But as per your wish you can consult another surgeon for opinion). Neither open nor laparoscopic surgery can be done at present. If done without reducing the inflammation, severe complications may arise.
Hope I have answered you. If you have any other query, feel free to ask.
Regards
Dr. G.Katiyar
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear sir
This is what my consulting doctor has confirmed, but I wanted to know whether there is no medicine for reducing the inflation because she is felling some time sevre pain and medicine given by doctor is only for minimizing gas and some antibiotic?.
Doctor also told us that this problem may come again at any point of time again, until her gall stone is removed( which may take,2-3 months) but looking to her condition I feel very bad. Is visting to Asian institute of gastroenterology XXXXXXX can help for better recovery of inflation or it will be recover by time only ( no medicine). Pls advice for further planning
This is what my consulting doctor has confirmed, but I wanted to know whether there is no medicine for reducing the inflation because she is felling some time sevre pain and medicine given by doctor is only for minimizing gas and some antibiotic?.
Doctor also told us that this problem may come again at any point of time again, until her gall stone is removed( which may take,2-3 months) but looking to her condition I feel very bad. Is visting to Asian institute of gastroenterology XXXXXXX can help for better recovery of inflation or it will be recover by time only ( no medicine). Pls advice for further planning
Brief Answer:
She need injectables
Detailed Answer:
Hi,
Thanks for the follow up.
I understand your concern for her sufferings. As i already mentioned that severe pain is due inflammation of GB and Pancreas. There are two situations, Home or hospital.
When at home, I am suggesting you intensives measures which i do in my patients.
1) take medicines prescribed by your doctor.
2) Creon 10000 (expensive) can be added to it thrice daily. It will help reducing pain by giving rest to pancreas. Cheaper alternative is Pankreoflat tablets, thrice daily.
3) Tramadol can be taken for pain. If pain increases, Inj. Ketonov should be given by doctor.
4) Avoid fatty diet completely, otherwise episodes of pain recur.
All these steps will help her in reducing pain and subsiding inflammation.
Now at Hospital, all these measures will be taken, injections will be given. If pain recurs it will be easily managed and still she will be operated after minimum of 6 weeks.
As this is very common problem, it can be managed anywhere with good setup.
But, If you need second opinion, you can consults doctors at AIG, XXXXXXX It is better to have second opinion before taking any decision, and at AIG they can find if anything is missing or not.
Hope i have answered you.
Regards
Dr. G.Katiyar
She need injectables
Detailed Answer:
Hi,
Thanks for the follow up.
I understand your concern for her sufferings. As i already mentioned that severe pain is due inflammation of GB and Pancreas. There are two situations, Home or hospital.
When at home, I am suggesting you intensives measures which i do in my patients.
1) take medicines prescribed by your doctor.
2) Creon 10000 (expensive) can be added to it thrice daily. It will help reducing pain by giving rest to pancreas. Cheaper alternative is Pankreoflat tablets, thrice daily.
3) Tramadol can be taken for pain. If pain increases, Inj. Ketonov should be given by doctor.
4) Avoid fatty diet completely, otherwise episodes of pain recur.
All these steps will help her in reducing pain and subsiding inflammation.
Now at Hospital, all these measures will be taken, injections will be given. If pain recurs it will be easily managed and still she will be operated after minimum of 6 weeks.
As this is very common problem, it can be managed anywhere with good setup.
But, If you need second opinion, you can consults doctors at AIG, XXXXXXX It is better to have second opinion before taking any decision, and at AIG they can find if anything is missing or not.
Hope i have answered you.
Regards
Dr. G.Katiyar
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Dear sir
As pain is ok during medicine intake but again it pop up after that doctor is suggesting that this pain is of gall stone. He is now advising laparoscopy surgery to remove whether this is ok only 3 weeks is passed ( inflation had cured?) value of amalyse is 350. Pls suggest what can be done because two days back doctor was suggesting still inflation is there now he is telling surgery can be done.
As pain is ok during medicine intake but again it pop up after that doctor is suggesting that this pain is of gall stone. He is now advising laparoscopy surgery to remove whether this is ok only 3 weeks is passed ( inflation had cured?) value of amalyse is 350. Pls suggest what can be done because two days back doctor was suggesting still inflation is there now he is telling surgery can be done.
Brief Answer:
Wait for surgery
Detailed Answer:
Hi,
Thanks again for the follow -up.
I have gone through her report and i will advise to wait for the surgery. Ultrasound showed that there is inflammation in GB and pancreas resulting in inflammation around them. It cannot subside in 2 days of time. Don't stop antibiotics. If laparoscopic cholecystectomy is done now then there is high chance of adhesion and it may lead to opening of abdomen (open surgery).
Moreover stent is also put during ERCP. If plastic stent was used then it would have caused more local reaction. And plastic stent has to be removed after 4 weeks of ERCP.
What i have seen in my patients, we use to do cholecystectomy (lap) after a minimum of 4 weeks from first episode pain and if stent is there, we use to remove it in one sitting(both Lap. Chole. and ERCP), minimizing subsequent procedure and money.
So i suggest you to consult your doctor about stent removal and wait for operation at least for one to two more weeks. If your doctor wants to remove stent in next sitting then also wait for one to two weeks.
Level of amylase is in border line suggesting that inflammation of pancreas is reducing.
Hope i have answered you.
Regards
Dr. G.Katiyar
http://bit.ly/DrGaurav
Wait for surgery
Detailed Answer:
Hi,
Thanks again for the follow -up.
I have gone through her report and i will advise to wait for the surgery. Ultrasound showed that there is inflammation in GB and pancreas resulting in inflammation around them. It cannot subside in 2 days of time. Don't stop antibiotics. If laparoscopic cholecystectomy is done now then there is high chance of adhesion and it may lead to opening of abdomen (open surgery).
Moreover stent is also put during ERCP. If plastic stent was used then it would have caused more local reaction. And plastic stent has to be removed after 4 weeks of ERCP.
What i have seen in my patients, we use to do cholecystectomy (lap) after a minimum of 4 weeks from first episode pain and if stent is there, we use to remove it in one sitting(both Lap. Chole. and ERCP), minimizing subsequent procedure and money.
So i suggest you to consult your doctor about stent removal and wait for operation at least for one to two more weeks. If your doctor wants to remove stent in next sitting then also wait for one to two weeks.
Level of amylase is in border line suggesting that inflammation of pancreas is reducing.
Hope i have answered you.
Regards
Dr. G.Katiyar
http://bit.ly/DrGaurav
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Above answer was peer-reviewed by :
Dr. Raju A.T
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