Do you know about - Post-Cholecystectomy Syndrome (Symptoms After Gallbladder Surgery)
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An estimated 20 million Americans have gallstones (cholelithiasis), and about 30 percent of these patients will ultimately build symptoms of their gallstone disease. The most base symptoms specifically linked 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 palpate other symptoms as well, in increasing 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 undergo extraction of their gallstones and gallbladders every year in the United States, production cholecystectomy one of the most generally performed major abdominal surgical operations. In 85 to 90 percent of cholecystectomies, the execution can be performed laparoscopically, using many small "band-aid" incisions instead of the traditional 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 personel causes of lasting post-cholecystectomy abdominal or Gi symptoms, the nearnessy of such symptoms following gallbladder surgery 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 article troubling abdominal or Gi symptoms following their surgery. In many cases, these patients have already undergone rather allinclusive evaluations, but without any specific findings. Understandably, such patients are troubled and frustrated, both by their lasting symptoms and the ongoing uncertainty as to the cause (or causes) of these symptoms.
The most base symptoms attributed to Pcs comprise lasting 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 eventually be identified in about 90 percent of patients following a acceptable evaluation, even the most allinclusive work-up can fail to identify 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 many and diverse causes of lasting post-cholecystectomy symptoms. Thus, it can be very difficult to counsel the small minority of patients with lasting symptoms after surgery when a allinclusive work-up fails to identify specific causes for their suffering.
Because Pcs is, in effect, a non-specific clinical determination assigned to patients with lasting symptoms following cholecystectomy, it is critically leading that an acceptable work-up be performed in all cases of lasting Pcs, so that an exact determination can be identified, and acceptable medicine 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 thrifty laboratory, ultrasound, and radiographic screening exams. This logical clinical advent to the evaluation of Pcs symptoms will identify or eliminate the most base diagnoses linked with Pcs in the majority of such patients, sparing them the need for additional unnecessary and invasive testing.
In reviewing the etiologies of Pcs that have been described so far, both patients and physicians can gain a best understanding of how involved this clinical qoute is:
- Irritable bowel syndrome (Ibs)
- Bile gastritis (inflammation of the stomach)
- Gastroesophageal reflux (Gerd)
- Hypersensitivity of the nervous principles of the Gi tract
- Abnormal flow of bile into the Gi tract after extraction 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
- lasting 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 allinclusive list of potential causes of Pcs, it is evident that some causes of Pcs are directly attributable to cholecystectomy, while many other etiologies are due to unrelated conditions that arise whether prior to surgery or after surgery.
While it is impossible to predict which patients will go on to build 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 lasting intestinal disorders, and patients with a history of obvious psychiatric illnesses.
In my own practice, the preliminary evaluation of patients with Pcs must, of course, begin with a acceptable and exact history and corporeal test of the patient. If this preliminary evaluation is with regard to for one of the many known corporeal causes of Pcs, then I will normally ask the patient undergo several preliminary screening tests, which typically comprise blood tests to assess liver and pancreas function, a complete blood count, and an abdominal ultrasound. Based upon the results of these preliminary screening tests, some patients may then be advised to undergo additional and more sophisticated tests, along 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 costly tests must, of course, be dictated by each personel patient's clinical scenario.)
Fortunately, as I indicated at the starting of this column, a thoughtful and logical advent to each personel patient's presentation will lead to a specific determination 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 assorted causes of Pcs is requisite (such physicians can comprise house physicians, internists, Gi specialists, and surgeons). Once a specific cause for your Pcs symptoms is identified, then an acceptable medicine plan can be initiated.
Disclaimer: As always, my advice to readers is to seek the advice of your physician before production any requisite changes in medications, diet, or level of corporeal activity.
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