Post-Cholecystectomy Syndrome (Symptoms After Gallbladder Surgery)
An estimated 20 million Americans have gallstones (cholelithiasis), and about 30 percent of these patients will ultimately fabricate symptoms of their gallstone disease. The most tasteless symptoms specifically connected to gallstone disease consist of 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.)
Post-Cholecystectomy Syndrome (Symptoms After Gallbladder Surgery)
Patients with complications of untreated cholelithiasis may palpate 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 undergo discharge of their gallstones and gallbladders every year in the United States, production cholecystectomy one of the most ordinarily performed major abdominal surgical operations. In 85 to 90 percent of cholecystectomies, the execution can be performed laparoscopically, using multiple 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 personel causes of persisting post-cholecystectomy abdominal or Gi symptoms, the proximity 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 record troubling abdominal or Gi symptoms following their surgery. In many cases, these patients have already undergone rather uncut evaluations, but without any exact 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 consist of persisting abdominal pain, nausea, vomiting, bloating, inordinate intestinal gas, and diarrhea. Fever and jaundice, which most ordinarily arise from complications of gallbladder surgery, are much less common, fortunately. While the strict cause, or causes, of Pcs symptoms can finally be identified in about 90 percent of patients following a suitable evaluation, even the most uncut work-up can fail to recognize a exact 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 multiple 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 uncut work-up fails to recognize exact causes for their suffering.
Because Pcs is, in effect, a non-specific clinical determination assigned to patients with persisting symptoms following cholecystectomy, it is critically leading that an suitable work-up be performed in all cases of persisting Pcs, so that an strict determination can be identified, and suitable 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 frugal laboratory, ultrasound, and radiographic screening exams. This logical clinical advent to the assessment of Pcs symptoms will recognize or eliminate the most tasteless diagnoses connected with Pcs in the majority of such patients, sparing them the need for added unnecessary and invasive testing.
In reviewing the etiologies of Pcs that have been described so far, both patients and physicians can gain a better understanding of how complex this clinical problem 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 discharge 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 uncut list of potential 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 whether prior to surgical operation or after surgery.
While it is impossible to predict which patients will go on to fabricate Pcs following cholecystectomy, there are some factors that are known to increase the risk of Pcs following surgery. These factors consist of 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 clear psychiatric illnesses.
In my own practice, the introductory assessment of patients with Pcs must, of course, begin with a suitable and strict history and physical examination of the patient. If this introductory assessment is concerning for one of the many known physical causes of Pcs, then I will regularly ask the inpatient undergo several introductory screening tests, which typically consist of blood tests to assess liver and pancreas function, a unblemished blood count, and an abdominal ultrasound. Based upon the results of these introductory screening tests, some patients may then be advised to undergo added and more sophisticated tests, including 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 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 exact 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 doctor with expertise in evaluating and treating the varied causes of Pcs is important (such physicians can consist of house physicians, internists, Gi specialists, and surgeons). Once a exact cause for your Pcs symptoms is identified, then an suitable treatment plan can be initiated.
Disclaimer: As always, my guidance to readers is to seek the guidance of your doctor before production any important changes in medications, diet, or level of physical activity.
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