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Gastroenterology  (Expert Forum)
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Gallbladder with thickened wall
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Gallbladder with thickened wall

by Richyp, Mar 25, 2003 12:00AM
While in Florida I had a very painful attack and went to the emergency ward of our local hospital.  When my home physician read the tests he said gallbladder.  I have seen the tests and they say clear gallbladder but thickened wall.  The ejection fraction was 8%.  I have all the symptoms and have had subsequent attacks when I'm a bad boy.  I can stand the pain, though it is as bad as a kick in the you know whats, and have learned to monitor my food intake.  I'm loosing weight and think I should wait to see if it gets worse since there are no stones found in an ultrasound.  I'm also 62 years old and mega fat.  240lbs at 5ft 3inches tall.  I sort of welcome this situation since it causes me to watch what I eat and I'm loosing weight.  I want to lose weight and have laproscopic surgery IF I have to have ANY surgery.  I have a consult with a surgeon in a little over a week.  I spend a lot of social time with MD's and health care people and I don't trust them to always operate at the "A" level so I don't like the idea of going to any hospital unless it is absolutely necessary.  In Florida during my first attack I stopped a Dr. from giving me a transfusion that was meant for the guy in the bed next to me.  Good thing I wasn't still sedated.  So you see that I have cause to worry about going to a hospital again.

My questions are.

1. What is the risk of waiting?

2. How can I find a surgeon that won't kill me?

3. I saw on the web some guy who had laproscopic surgery and had a drain and a bag for over a week. Is this normal with laproscopic surgery?

4. Does pain always accompany further complication, so I will be warned when it is not good to wait any longer for surgery?

5. I travel a good bit so my strategy for dealing with an attack on the road is to tough it out and maybe take a pain pill.  Is that stupid?

6. I'm lucky enough to be in the "cost is not an issue" category.  I also can be away from work as often and as long as I want.  What would you suggest if there were no limit on cost or time away to treat this condition?

I live in the Cleveland, Ohio area.



Thanks.

Richyp
Doctor's Answer

by Kevin Pho, MD, Mar 25, 2003 12:00AM
Hello - thanks for asking your question.



Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.



1) With such a low gallbladder ejection fraction (normal 35-75%), you are prone to further gallbladder attacks.  As surgeon mentioned, the risk of delay will be continued gallbladder attacks.  Studies have shown that cholecystecomy improves the symptoms of acalculous (non-stone) biliary pain (characterized by a lower gallbladder ejection fraction) 90% of the time.



2) You may want to try the American College of Surgeons website for surgeons near you:

http://www.facs.org/index.html



3) Typically, drains are not needed after laparoscopy cholecystectomy.  A surgical complication may be an explaination of why a drain was used in the case you described.



4) There is what is known as post-cholecystectomy syndrome where patients have recurrent right upper quadrant pain after surgery.  This may be related to dysfunction of the Sphincter of Oddi and if this is present a procedure called an ERCP may need to be performed.  



5) Again, with a gallbladder ejection fraction that low, you will continue to be prone to gallbladder pain.  While you can take a pain pill, a surgical opinion for possible removal of the gallbladder is suggested.



6) A referral for cholecystectomy would be my suggestion.  The literature suggests about 90% of patients with acalculous gallbladder pain (i.e. suggested by a low gallbladder ejection fraction) improve after surgery.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (7)

by tessa0825, Mar 25, 2003 12:00AM
Well, I have no idea where you are finding your Drs. at but I can tell you in my 50 yrs. I have never had one that I thought was trying to kill me...I am very recent post gallbladder surgery...I had mine out last Monday and I am so much better than I was prior to this lap surgery....I came home on Tues. afternoon and I was able to stop the Vicodin on Wed....I started just taking extra strength tylenol and by Fri I was spending all day up and doing things around the house...Saturday I started driving and on Sunday I went to the office and did some paperwork...Today I return to see the surgeon and I will return to work full-time tomorrow....I cant imagine wanting to live with the pain of gallbladder attackes for the sake of losing weight.....I don't even think that could possibly be healthy, but I am no Dr....Hope you get some good advise here.....I would think that most People have rapid relief of symptoms following surgery.....Good luck......Tessa

by surgeon, Mar 25, 2003 12:00AM
there are plenty of excellent surgeons in Cleveland. No surgery is entirely predictable but having a bag for drainage after gallbladder surgery is very uncommon. Most people who have symptoms like yours are delighted with having their gallbladder gone. There are rarely any side effects: you should be able to eat normally afterwards. The risk of delay is having more attacks. Most attacks, like yours, subside. Occasionally they are more severe and require emergency surgery which is a bit more risky. No crystal ball, unfortunately.

by surgeon, Mar 25, 2003 12:00AM
there are plenty of excellent surgeons in Cleveland. No surgery is entirely predictable but having a bag for drainage after gallbladder surgery is very uncommon. Most people who have symptoms like yours are delighted with having their gallbladder gone. There are rarely any side effects: you should be able to eat normally afterwards. The risk of delay is having more attacks. Most attacks, like yours, subside. Occasionally they are more severe and require emergency surgery which is a bit more risky. No crystal ball, unfortunately.

by surgeon, Mar 25, 2003 12:00AM
there are plenty of excellent surgeons in Cleveland. No surgery is entirely predictable but having a bag for drainage after gallbladder surgery is very uncommon. Most people who have symptoms like yours are delighted with having their gallbladder gone. There are rarely any side effects: you should be able to eat normally afterwards. The risk of delay is having more attacks. Most attacks, like yours, subside. Occasionally they are more severe and require emergency surgery which is a bit more risky. No crystal ball, unfortunately.

by tessa0825, Mar 25, 2003 12:00AM
Also, I did have a drain following surgery, I think they called it (a jackman pratt sp) drain....Long plastic tube with a clear bulb on the end...They took (pulled) it out right before I came home on Tues...It was no big deal having it other than it hurt like heck while they pulled it out...If you go ahead with surgery and do have a drain, here is a hint:..At the exact time they start pulling it out you start taking a big deep breathe in and keep taking that breathe until they are finished, makes the pain of it alot less, anyway it worked for me.....Tessa

by schaeff, Mar 26, 2003 12:00AM
I had the lap procedure done in a community hospital on a Saturday nearly 4 years ago at age 47. I was awake on the table at 8:30 a.m. before the anesthesia. I was back in a one-day surgery recovery room by 10:30 or 11 and back at home watching a baseball game by 2:30 p.m. with nothing but dressings over the 3 small holes used for the camera and instruments.  I was on tylenol with codeine Saturday and Sunday, had breakfast at IHOP Sunday morning, plain tylenol Monday and Tuesday, saw the surgeon Weds. to look at the holes, and jogged two (slow) miles Wednesday afternoon.



That said, since I never had typical gall bladder symptoms (only some reflux and mild RUQ bloating after meals), the finding of gall stones on ultrasound was probably incidental, and, after three gastroenterologists,the last at Columbia in NY, and countless scope, CT, MRCP and blood