What causes abdominal swelling after gallbladder surgery

Chat protocol: gallstone surgery

Status: 02/05/2020 2:12 p.m. | archive
The gastroenterologist Jürgen Pohl answered questions in the visit chat.

Gallstones sometimes also form directly in the bile ducts - an underestimated danger. Because if the gallbladder has already been removed, even doctors do not expect that the cause of abdominal pain and discomfort can be small stones in the passages. The build-up of bile fluid threatens complications such as fever, jaundice and severe inflammation.

On Tuesday, February 4th, 2020, the gastroenterologist Jürgen Pohl was a guest at Visite and then answered your questions in the chat. The protocol for reading.

Waldi: I have had a feeling of pressure in my right upper abdomen for a few months. I have had gallstones for ten years that I hadn't noticed before. Should I have the bile removed?

Prof. Jürgen Pohl: I would get an ultrasound. It is important whether the pressure discomfort is food-related.

KS: Is there a blood test from which one can conclude that gallstones are present, even without ultrasound?

Pohl: Gallstones in the gallbladder cannot be detected by blood tests. However, if gallstones lead to a build-up in the bile duct, the classic result is an increase in liver values.

Simba1: My husband's gall bladder has been removed and now he always has very strong coughing attacks at irregular intervals and then comes bile? How can you turn that off?

Pohl: Let the cough clear up. The symptoms described are not related to the removed gallbladder.

Gerd P .: My family doctor recommends having the gallbladder removed prophylactically, as I have gallstones, but so far they have not caused any problems. Do you generally agree here?

Pohl: No, I don't agree with that. If there are stones in the gallbladder that do not cause symptoms (discomfort), surgery should not be performed.

Nicole P .: In the last three months I have been to the hospital five times. The first time the gallbladder was removed. Two more times I was admitted to the hospital because of severe pain in the upper abdomen, all examinations without results. The third time an ERCP [endoscopic procedure] with two stones in the corridors. Three weeks later, he was admitted to the hospital again, ERCP again, another stone in the hallway. I've been home for two weeks now and I'm still in pain. A CTt, Endosono, MRCP, gastroscopy, colonoscopy, blood sample was done. Everything without any findings. However, the pain is still sometimes very strong. Pain medication only helps to a limited extent. Do you have any ideas or advice? I would love to go back to work pain-free. Acupuncture and a change in diet to a possible histamine intolerance were started.

Pohl: Unfortunately, with this complex medical history, I cannot give any good advice from afar. However, you can be certain that the clarification of the complaints was undertaken very conscientiously according to your descriptions.

Barbara: Are there any drugs that dissolve stones in the bile? If so, can they also be used if there is calcification of gallstones or if the stones cast shadows on the X-ray?

Pohl: There have been many attempts to dissolve gallstones with medication in the past. This form of therapy has been abandoned completely because its effectiveness is extremely limited.

BZ: I decided to have my gallbladder removed after several colic attacks. About a year and a half later, I had another bile duct stone that was destroyed by an ERCP procedure. Since then (2 years) I have been taking Ursofalk 500 on the recommendation of the doctor. Question: Is the drug suitable for long-term medication? Are there side effects to be feared?

Pohl: Ursofalk is very well tolerated. No long-term side effects should occur with this dosage. Nevertheless, I would advise you to attempt a discharge in consultation with your treating doctor.

tuttisoja: I have read repeatedly that to prevent gallstone formation again, you should drink a glass of water mixed with a teaspoon of apple cider vinegar and a little lemon juice. Is that correct?

Pohl: There is no evidence of such an effect.

Jana: Last September my gall bladder was removed. Am 42 and female. Now it stings again and again in the liver area. Am afraid of bile duct stones. Should I have a Sono done?

Pohl: An ultrasound examination (Sono) and a blood sample appear to be useful.

Vivien: Is it possible to remove a gallstone with a gastroscopy?

Pohl: Gallstones cannot be removed with a pure gastroscopy.

D. Mohoric: I have had problems with diarrhea since the biliary removal. Shouldn't that have slowly subsided after a year, or is there still too much bile acid?

Pohl: Physical adjustment disorders after removal of the gallbladder are seldom seen. If this complaint does not resolve itself, I recommend a more detailed investigation in order to rule out other causes.

eva: My gallstones are small (the largest is 0.2 mm). Nevertheless, the doctor only offers surgery. Why can't I take ursodeoxycholic acid? Due to recurrent Clostridium difficile, I cannot tolerate painkillers or antibiotics and therefore want to avoid surgery. Please tell me alternatives.

Pohl: The important thing is whether your gallstones are causing problems. If this is the case, only surgical removal of the gallbladder is the correct long-term route.

Peter: Is there any way to dissolve gallstones without surgery? Could they also dissolve on their own?

Pohl: Calcareous gallstones do not dissolve on their own. If only bile semolina (also known as bile sludge) has developed, these structures can regress if the gallbladder is functioning.

Ruth: I have sludge in and on the gallbladder and a cyst near the pancreas in the bile duct. Have no complaints. Radiologist recommends renovation. Do you advise having surgery to remove the gallbladder?

Pohl: From this description I cannot derive any indication for an operation.

Sara: I am female (27) and have gallstones. I was advised to have my gallbladder removed. Frequent biliary colic, but since dieting, I haven't had colic. Does the bladder have to get out even if I no longer have colic after dieting?

Pohl:If you can make friends with the diet in the long term, there is no absolute indication (reason) for removal of the gallbladder.

Vera: I (female)currently have cholesterol stones in my liver. Getting out did not work. At 25 the removal of the gallbladder, further gallstones. Seven times in NMR [magnetic resonance imaging]. What to do?

Pohl: Do you have any complaints? In this case, stones in the liver could certainly be removed endoscopically. Otherwise, we recommend taking ursooxydeoxycholic acid. This can lead to a reduction in cholesterol stones. Often the tendency is genetically predisposed at a young age.

Thomas: Is it possible to loosen gallstones naturally and excrete them through the intestines?

Pohl: No.

Heike: Can I do intermittent fasting without a gallbladder if I have occasional stone pain in the bile duct?

Pohl: Intermittent fasting should not last longer than twelve hours, then there is nothing wrong with it. Are the stones in the bile duct really proven? Maybe you should investigate.

Beate M .: Gallstones and gallbladder were removed in April 2019. Drawing pain on the right side and slight pressure in the upper abdomen since December. Blood values ​​are okay except for the inflammation value, which is elevated. Examinations, ultrasound and other blood tests did not reveal anything. Can this be gallstones again?

Pohl: That doesn't sound like it. If the symptoms only occurred after the gallbladder was removed, a CT scan is recommended.

Gerda: Why do you have to remove all of the bile from gallstones?

Pohl: The entire biliary tract is not removed, only the gallbladder.

Conny: Can the pain go on for days and can it hurt the stomach area?

Pohl: In principle yes, but you should exclude other causes.

Doctor 50: Does the gallbladder necessarily have to be removed even if the gallstone is up to five centimeters in size? However, the single gallstone does not cause colic!

Pohl: Medical guideline is to consider removing the gallbladder from such a large stone. But it is not an absolute indication.

Nicole: My gallbladder was removed because of bile gravel in the passages. Can urticaria [hives] and general pruritus be related to bile semolina? There are no allergies.

Pohl: Urticaria no, itching can in principle be explained by an accumulation of bile.

Freund: 2012 biliary surgery. Colic-like pain again and again at intervals. An increased amount of bile was found during a gastroscopy. Could this be a cause of stones in the bile ducts?

Pohl: No.

Lutz: Gallstones caused pancreatitis over Christmas and the gallbladder was removed at the beginning of the year. How can I best prevent gallstones from forming again?

Pohl: Weight reduction, a balanced lifestyle with exercise and needs-based nutrition.

Freiberg: Can pain occur when lying down in the upper abdomen, right below the ribs of gallstone?

Pohl: Yes.

Regine: Can you remove a large gallstone without surgery, for example by smashing it? Can I take Buscopan if I have biliary colic? What else can help quickly to get rid of colic?

Pohl: A gallstone in the gallbladder cannot be removed without surgery. A gallstone in the biliary tract, however, does. Buscopan and Novalgin help with colic.

Chrissi: What are the symptoms of adhesions after gallbladder surgery or scar pain? Can you say something about the frequency?

Pohl: Adhesions are possible with every intervention in the abdominal cavity. However, if the gallbladder is removed without complications, such complaints are very rare.

hanne: An examination revealed that I have a porcelain gall bladder. I have problems with it about once a year. The doctor recommended that I have the gallbladder removed soon, although I hardly have any problems with it. Should I follow the recommendation or are there alternatives?

Pohl: Porcelain gallbladders should be removed because of the risk of tumor formation if the general condition of the person concerned allows surgery.

Karla: What does the blood count say about bile duct stones? Which doctor do I have to go to?

Pohl: Your family doctor will surely know. The values ​​GGT, ALP and bilirubin are interesting.

Hnigbiene: Can there be a connection between gallstones and irritable bowel syndrome?

Pohl: They can be confused with each other. There is no causal relationship.

Guen: I am currently in very intense, persistent pain from the gallstones that I have. What can I do about this pain now?

Pohl: If you are sure that the pain is related to gallstone, then you could use Novalgin and Buscopan tablets from your medicine cabinet. However, please seek medical support as soon as possible. Get well!

Andreas: Male, 64 years old. My three gallstones have enlarged from six millimeters to ten millimeters in the last two years, according to an ultrasound from my family doctor. Occasionally I have slight discomfort on the right side of my stomach. Should I have the stones removed? Is this even done "on request" if I haven't had any serious complaints?

Pohl: If the symptoms do not bother you, there is no urgent need for surgery.

Stephanie: If gallstones formed as a result of hormonal changes during pregnancy and the gallbladder was removed seven weeks after delivery, followed by ERCP, can you assume that more stones will form if you become pregnant again? Can ERCP be done during pregnancy if necessary?

Pohl: Stone formation in pregnant women is certainly not uncommon. After removing your gallbladder, the risk of stone formation again is certainly very low (less than ten percent).

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Visit | 02/04/2020 | 8:15 pm