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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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hi doctor my dad had done a laproscopic surgery for

Answered by
Dr.
Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 17747 Questions

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Posted on Fri, 8 Mar 2019 in General Health
Question: hi doctor my dad had done a laproscopic surgery for gall bladder removal 2 weeks back. However, he is still getting some pain in abdomen . Also he is losing weight.
He is 69 years old patient of Hyper tension and Has been on blood thinners for 10 years.

We had gone to hospital for severe stomach pain , which on diagnosis came out to be big gall bladder stone stuck on the neck . We had to wait for 3 days to stop blood thinners and on third day he also got fever and WBC count was 14000
We performed the surgery next day .However, the surgeon who performed the surgery was very rude and was not very open to answering our questions due to some personal Ego issues casued by some mis understanding.

Post surgery , he kept telling us of 10% chances of Septis , Blood clotting , infection etc saying there are chances of same. My Dad was eating Antibiotics from day one and continued it for another 8 days after surgery .

We are not sure of how to take this condition as the doctor while discharging was not willing to do blood tests etc .

We have got the blood tests done a week back on our own and we note that ESR has gone up to 86
SGOT/SGPT levels have increased from 33 / 35 to 56/70 levels.
However WBC count has come down to 9000

We are worried for the increase in ESR and SGPT /SGOT levels. DO you think we should take this seriously and investigate further
Can you please help us understand if something needs to be done as doctor is not co-operative and we dont know what is the way forward.

We understand the post this surgery the complications can be quite bad for septis and infection etc and hence want to know more
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Follow up: Dr. T Chandrakant 0 minute later
hi doctor my dad had done a laproscopic surgery for gall bladder removal 2 weeks back. However, he is still getting some pain in abdomen . Also he is losing weight.
He is 69 years old patient of Hyper tension and Has been on blood thinners for 10 years.

We had gone to hospital for severe stomach pain , which on diagnosis came out to be big gall bladder stone stuck on the neck . We had to wait for 3 days to stop blood thinners and on third day he also got fever and WBC count was 14000
We performed the surgery next day .However, the surgeon who performed the surgery was very rude and was not very open to answering our questions due to some personal Ego issues casued by some mis understanding.

Post surgery , he kept telling us of 10% chances of Septis , Blood clotting , infection etc saying there are chances of same. My Dad was eating Antibiotics from day one and continued it for another 8 days after surgery .

We are not sure of how to take this condition as the doctor while discharging was not willing to do blood tests etc .

We have got the blood tests done a week back on our own and we note that ESR has gone up to 86
SGOT/SGPT levels have increased from 33 / 35 to 56/70 levels.
However WBC count has come down to 9000

We are worried for the increase in ESR and SGPT /SGOT levels. DO you think we should take this seriously and investigate further
Can you please help us understand if something needs to be done as doctor is not co-operative and we dont know what is the way forward.

We understand the post this surgery the complications can be quite bad for septis and infection etc and hence want to know more
doctor
Answered by Dr. T Chandrakant 39 minutes later
Brief Answer:
Please give details and post actual reports.

Detailed Answer:
Hi.
Thanks for your query.
Noted the history related to your 69 year old Father and understood the concerns.

I can understand all your points well.
Please give additional information for me to assist you better:
Where exactly is the pain?
Type of pain? Throbbing, twisting, burning or so on..
What is the color of urine and stool?
Any bloating, nausea or vomiting?
Any changes in bowel or bladder habits?
Any referred pain to should or back?
Please post the reports as they are?
Any X-ray or Ultrasonography of abdomen done recently?
Any fever or chills?

Any other information please.
Awaiting for your detailed feedback.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. T Chandrakant 0 minute later
Brief Answer:
Please give details and post actual reports.

Detailed Answer:
Hi.
Thanks for your query.
Noted the history related to your 69 year old Father and understood the concerns.

I can understand all your points well.
Please give additional information for me to assist you better:
Where exactly is the pain?
Type of pain? Throbbing, twisting, burning or so on..
What is the color of urine and stool?
Any bloating, nausea or vomiting?
Any changes in bowel or bladder habits?
Any referred pain to should or back?
Please post the reports as they are?
Any X-ray or Ultrasonography of abdomen done recently?
Any fever or chills?

Any other information please.
Awaiting for your detailed feedback.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. T Chandrakant 46 hours later
Hi doctor ,

the pain is mild ,
We have not done USG or CT scan post the operation and only have done blood test report. I am attaching the blood test report in this mail.

Stool is paste like not solid. While Urine isnt full yellow in color but is mild yellow in color.

However there is weight loss and weakness , which isnt going.

Do you think we should do a USG or CT scan to check for more details or is it not required as of now. We are more worried for weakness and the increase in ESR and SGOT/SGPT levels
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Follow up: Dr. T Chandrakant 0 minute later
Hi doctor ,

the pain is mild ,
We have not done USG or CT scan post the operation and only have done blood test report. I am attaching the blood test report in this mail.

Stool is paste like not solid. While Urine isnt full yellow in color but is mild yellow in color.

However there is weight loss and weakness , which isnt going.

Do you think we should do a USG or CT scan to check for more details or is it not required as of now. We are more worried for weakness and the increase in ESR and SGOT/SGPT levels
doctor
Answered by Dr. T Chandrakant 26 minutes later
Brief Answer:
As detailed below.

Detailed Answer:
Thanks for your partial feedback.
Your concern is for the weakness and weight loss as well as the raised levels of some investigations.
To Elucidate more:
Raised ESR is not a diagnostic test, please read the footnote of the report.
The Bilirubin level is normal and most importantly the Alkaline Phos level and also there are no bile salts and pigments in Urine hence there appears to be no complications related to Gallbladder surgery.
You may please repeat the tests of liver functions and ESR.
USG or CT is not required as per the symptoms and reports, you may please wait and get these done if the symptoms persist or increase.

Since the bile now flows continuously in intestine as there is no storage organ called gallbladder the intestines and the food digestion can take some time to get adjusted to the change.
This can reduce the willingness to eat and particularly the oily, tasty foods. Which in turn can cause weakness and weight loss.
Please check for the food he is taking, he wants but not yet started. Certainly oily foods can cause problems hence not to be given.

I hope this answers your query and helps in decision making.

Dr T Chandrakant.
General Surgeon.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. T Chandrakant 0 minute later
Brief Answer:
As detailed below.

Detailed Answer:
Thanks for your partial feedback.
Your concern is for the weakness and weight loss as well as the raised levels of some investigations.
To Elucidate more:
Raised ESR is not a diagnostic test, please read the footnote of the report.
The Bilirubin level is normal and most importantly the Alkaline Phos level and also there are no bile salts and pigments in Urine hence there appears to be no complications related to Gallbladder surgery.
You may please repeat the tests of liver functions and ESR.
USG or CT is not required as per the symptoms and reports, you may please wait and get these done if the symptoms persist or increase.

Since the bile now flows continuously in intestine as there is no storage organ called gallbladder the intestines and the food digestion can take some time to get adjusted to the change.
This can reduce the willingness to eat and particularly the oily, tasty foods. Which in turn can cause weakness and weight loss.
Please check for the food he is taking, he wants but not yet started. Certainly oily foods can cause problems hence not to be given.

I hope this answers your query and helps in decision making.

Dr T Chandrakant.
General Surgeon.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 48 hours later
Hi Doctor ,

Many thanks for the reply . I am answering few of your questions that you asked before and symptoms which i feel needs to be shared with you so please do let us know on what needs to be done on same.

Where exactly is the pain?
Pain is for a short period of time either in the centre upper abdomen or at times on the extreme right lower abdomen. But it is for a short period. It is like normal pain which comes and goes after sometime

Type of pain? Throbbing, twisting, burning or so on..
Normal Pain

What is the color of urine and stool?
Urine is pale yellow and stool is yellow too

Any bloating, nausea or vomiting?
No , infact the stool gets passed everyday morning so it feels light and no bloating. But the stool is in form of paste or liquid eversince the operation was done

Any changes in bowel or bladder habits?
The quantity of stool passed has increased and it feels quite empty every day after passing stool. It usually comes in morning and at times afterwards too once or twice. Also some gas is being passed during the day after stools

Any referred pain to should or back?
No pain in the back but after sitting for a while the back starts to hurt. So he has to walk and too much walking causes weakness

New Symptoms which i feel like sharing

Burning sensation since last 2-3 days like its a buildup to piles
Also the stiches have moved up a bit like a inch upwards so it covers the rib cage. We feel there is a change in structure as the Ribcage has moved down. Is this because of the Gas CO2 which is injected for operation . is this normal as now we see stiches on the right side which were below the rib cage are now ahead of the rib cage. this change we have observed in last 4-5 days only.

Please do guide us if something needs to be done like investigation etc. You have already said there is no need for USG or CT scan but now with new symptoms if its required do let us know on same or any other reports that your suggestion

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Follow up: Dr. T Chandrakant 0 minute later
Hi Doctor ,

Many thanks for the reply . I am answering few of your questions that you asked before and symptoms which i feel needs to be shared with you so please do let us know on what needs to be done on same.

Where exactly is the pain?
Pain is for a short period of time either in the centre upper abdomen or at times on the extreme right lower abdomen. But it is for a short period. It is like normal pain which comes and goes after sometime

Type of pain? Throbbing, twisting, burning or so on..
Normal Pain

What is the color of urine and stool?
Urine is pale yellow and stool is yellow too

Any bloating, nausea or vomiting?
No , infact the stool gets passed everyday morning so it feels light and no bloating. But the stool is in form of paste or liquid eversince the operation was done

Any changes in bowel or bladder habits?
The quantity of stool passed has increased and it feels quite empty every day after passing stool. It usually comes in morning and at times afterwards too once or twice. Also some gas is being passed during the day after stools

Any referred pain to should or back?
No pain in the back but after sitting for a while the back starts to hurt. So he has to walk and too much walking causes weakness

New Symptoms which i feel like sharing

Burning sensation since last 2-3 days like its a buildup to piles
Also the stiches have moved up a bit like a inch upwards so it covers the rib cage. We feel there is a change in structure as the Ribcage has moved down. Is this because of the Gas CO2 which is injected for operation . is this normal as now we see stiches on the right side which were below the rib cage are now ahead of the rib cage. this change we have observed in last 4-5 days only.

Please do guide us if something needs to be done like investigation etc. You have already said there is no need for USG or CT scan but now with new symptoms if its required do let us know on same or any other reports that your suggestion

doctor
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
Stool tests and an ultrasonography to rule-out any problem.

Detailed Answer:
Thanks for your detailed feedback and additional information.
As for the type, severity and location of pain along with now burning sensation like build up to piles may indicate intestinal infection of some sort or loss of normal bacterial flora. As discussed above it may take some time for intestines to get adjusted to the changes.
I would advise him the following in such a situation:
Take pre and probiotics.
Foods as discussed above.
Boiled for 20 minutes and cooled water.
Send stool sample for lab tests with history of gallbladder removal.
Ultrasonography of abdomen is a simple investigation that helps to rule out an collection or so.
Please post the reports once done.

Scars can show upward movements as you have noticed as the trocars and cannulae during the operation are placed on inflation of gas that balloons up the abdominal wall. I do not think this to be of any clinical significance unless they are causing any symptoms.

Backache may resolve with local application of rubefacient liniment that warms up the area.

I hope this answer helps you further.
Feel free to communicate further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. T Chandrakant 0 minute later
Brief Answer:
Stool tests and an ultrasonography to rule-out any problem.

Detailed Answer:
Thanks for your detailed feedback and additional information.
As for the type, severity and location of pain along with now burning sensation like build up to piles may indicate intestinal infection of some sort or loss of normal bacterial flora. As discussed above it may take some time for intestines to get adjusted to the changes.
I would advise him the following in such a situation:
Take pre and probiotics.
Foods as discussed above.
Boiled for 20 minutes and cooled water.
Send stool sample for lab tests with history of gallbladder removal.
Ultrasonography of abdomen is a simple investigation that helps to rule out an collection or so.
Please post the reports once done.

Scars can show upward movements as you have noticed as the trocars and cannulae during the operation are placed on inflation of gas that balloons up the abdominal wall. I do not think this to be of any clinical significance unless they are causing any symptoms.

Backache may resolve with local application of rubefacient liniment that warms up the area.

I hope this answer helps you further.
Feel free to communicate further.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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