An estimated 20 million Americans have gallstones (cholelithiasis), and about 30 percent of these patients will ultimately invent symptoms of their gallstone disease. The most tasteless symptoms specifically related to gallstone disease comprise upper abdominal pain (often, but not always, following a heavy or greasy meal), nausea, and vomiting. (The upper abdominal pain often radiates nearby towards the right side of the back or shoulder.)
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Patients with complications of untreated cholelithiasis may feel other symptoms as well, in expanding to an increased risk of severe illness, or even death. These complications of gallstone disease include:
- Severe inflammation or infection of the gallbladder (cholecystitis)
- Blockage of the main bile duct with gallstones (choledocholithiasis), which can cause jaundice or/and bile duct infection (cholangitis), as well as pancreatitis
More than 500,000 patients feel dismissal of their gallstones and gallbladders every year in the United States, making cholecystectomy one of the most generally performed major abdominal surgical operations. In 85 to 90 percent of cholecystectomies, the doing can be performed laparoscopically, using manifold small "band-aid" incisions instead of the former large (and more painful) upper abdominal incision.
For the vast majority of patients with cholelithiasis, cholecystectomy effectively relieves the symptoms of gallstones. In 10 to 15 percent of patients undergoing cholecystectomy, however, persistent or new abdominal or Gi symptoms may arise after gallbladder surgery. Although there are many private causes of persisting post-cholecystectomy abdominal or Gi symptoms, the nearnessy of such symptoms following gallbladder surgical operation are collectively referred to as "post-cholecystectomy" syndrome (Pcs) by many experts.
I routinely receive inquiries from patients who have previously undergone cholecystectomy, and who narrative troubling abdominal or Gi symptoms following their surgery. In many cases, these patients have already undergone rather ample evaluations, but without any specific findings. Understandably, such patients are troubled and frustrated, both by their persisting symptoms and the ongoing uncertainty as to the cause (or causes) of these symptoms.
The most tasteless symptoms attributed to Pcs comprise persisting abdominal pain, nausea, vomiting, bloating, inordinate intestinal gas, and diarrhea. Fever and jaundice, which most generally arise from complications of gallbladder surgery, are much less common, fortunately. While the exact cause, or causes, of Pcs symptoms can finally be identified in about 90 percent of patients following a thorough evaluation, even the most ample work-up can fail to recognize a specific ailment as the cause of symptoms in some patients. It is leading to stress that there is no universal consensus on the topic of Pcs among the experts, although most agree that there are manifold and diverse causes of persisting post-cholecystectomy symptoms. Thus, it can be very difficult to counsel the small minority of patients with persisting symptoms after surgical operation when a ample work-up fails to recognize specific causes for their suffering.
Because Pcs is, in effect, a non-specific clinical analysis assigned to patients with persisting symptoms following cholecystectomy, it is critically leading that an thorough work-up be performed in all cases of persisting Pcs, so that an exact analysis can be identified, and thorough treatment can be initiated. As the known causes of Pcs are numerous, however, physicians caring for such patients need to tailor their evaluations of patients with Pcs based upon clinical findings, as well as prudent laboratory, ultrasound, and radiographic screening exams. This logical clinical arrival to the estimation of Pcs symptoms will recognize or eliminate the most tasteless diagnoses related with Pcs in the majority of such patients, sparing them the need for further unnecessary and invasive testing.
In reviewing the etiologies of Pcs that have been described so far, both patients and physicians can gain a good insight of how involved this clinical qoute is:
- Irritable bowel syndrome (Ibs)
- Bile gastritis (inflammation of the stomach)
- Gastroesophageal reflux (Gerd)
- Hypersensitivity of the nervous ideas of the Gi tract
- Abnormal flow of bile into the Gi tract after dismissal of the gallbladder
- inordinate consumption of fatty and greasy foods
- Painful surgical scars or incisional (scar) hernias
- Adhesions (internal scars) following surgery
- Retained gallstones within the bile ducts or pancreatic duct
- Stricture (narrowing) of the bile ducts
- Bile leaks following surgery
- Injury to bile ducts during surgery
- Infection of the bile ducts (cholangitis), incisions, or abdomen
- Residual gallbladder or cystic duct remnant following surgery
- Fatty changes of the liver or other liver diseases
- persisting pancreatitis or pancreatic insufficiency
- Abnormal function or anatomy of the main bile duct sphincter muscle (the "Sphincter of Oddi")
- Peptic ulcer disease
- Diverticulitis
- Crohn's disease or ulcerative colitis
- Stress
- Psychiatric illnesses
- Tumors of the liver, bile ducts, pancreas, stomach, small intestine, colon, or rectum
In reviewing the ample list of inherent causes of Pcs, it is clear that some causes of Pcs are directly attributable to cholecystectomy, while many other etiologies are due to unrelated conditions that arise either prior to surgical operation or after surgery.
While it is impossible to predict which patients will go on to invent Pcs following cholecystectomy, there are some factors that are known to growth the risk of Pcs following surgery. These factors comprise cholecystectomy performed for causes other than confirmed gallstone disease, cholecystectomy performed on an urgent or emergent basis, patients with a long history of gallstone symptoms prior to undergoing surgery, patients with a prior history of irritable bowel syndrome or other persisting intestinal disorders, and patients with a history of obvious psychiatric illnesses.
In my own practice, the initial estimation of patients with Pcs must, of course, begin with a thorough and exact history and corporeal exam of the patient. If this initial estimation is with regard to for one of the many known corporeal causes of Pcs, then I will commonly ask the sick person feel some initial screening tests, which typically comprise blood tests to compare liver and pancreas function, a unblemished blood count, and an abdominal ultrasound. Based upon the results of these initial screening tests, some patients may then be advised to feel further and more sophisticated tests, together with endoscopic ultrasound (Eus), upper or/and lower Gi endoscopy (including, in some cases, Ercp, or endoscopic retrograde cholangiopancreatography), bile duct manometry, or Ct or Mri scans, for example. (The decision to order any of these more invasive and more high-priced tests must, of course, be dictated by each private patient's clinical scenario.)
Fortunately, as I indicated at the starting of this column, a thoughtful and logical arrival to each private patient's presentation will lead to a specific analysis in more than 90 percent of all cases of Pcs. Therefore, if you (or man you know) are experiencing symptoms consistent with Pcs, then referral to a physician with expertise in evaluating and treating the discrete causes of Pcs is valuable (such physicians can comprise family physicians, internists, Gi specialists, and surgeons). Once a specific cause for your Pcs symptoms is identified, then an thorough treatment plan can be initiated.
Disclaimer: As always, my guidance to readers is to seek the guidance of your physician before making any valuable changes in medications, diet, or level of corporeal activity.
Post-Cholecystectomy Syndrome (Symptoms After Gallbladder Surgery)
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