Could the pain in your abdomen be a gallbladder attack?
By Roberta Cannon, RN
We’ve all had some form of a stomachache or pain, either from eating spicy foods, constipation, or a stomach virus. We may grab a Tums or other antacid to relieve the discomfort, and often it just goes away on its own.
When the pain repeatedly returns and becomes bothersome, how do you know when it is something more serious?
One clue might be if you have a family history of gallstones.
“Gallstones tend to run in families and many times when we see patients with gall bladder issues, they have family members who have had their gallbladders removed,” said Mark Loewen, MD, FACS, a general surgeon with Cape Cod Healthcare General and Specialty Surgery.
Gallstones are hard, about the size of a pebble and consist of cholesterol or bilirubin, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
“Some people have pain on and off for years or some have it over a short period of time,” said Dr. Loewen. “When it lasts longer than an hour or two, people are pretty desperate to get to the emergency room.”
Symptoms and DiagnosisDr. Loewen listed some of the typical symptoms of a gallbladder attack:
A CT scan of the abdomen and/or an abdominal ultrasound are two tests used to diagnose gallstones, said Dr. Loewen. The tests may show mild thickening of the gall bladder wall, gall stones or both. The thickening suggests there may be some infection going on.
Both tests can sometimes miss visualizing the gallstones and, while blood tests such as elevated liver function blood tests can be an indicator of gallstones in the duct, there are other tests to help identify what is going on, said Dr. Loewen.
One test is called a magnetic resonance cholangiopancreatography (MRCP) which is a special MRI that looks at the pancreas, pancreatic duct, bile ducts, gallbladder and liver.
“If the liver function blood tests are high enough, then we get a gastroenterologist involved to see if they agree to do an Endoscopic Retrograde Cholangiopancreatography (ERCP),” said Dr. Loewen. “This is an upper endoscopy that can visualize the bile duct and sweep the gallstone or stones out so the ducts are nice and clear.”
Other Complications“If the liver function tests and MRCP are negative and we want to make certain there is no stone in the duct during the surgery, and finish with certainty, we can do a cholangiogram, an X-ray with contrast, to see the bile duct in real-time,” said Dr. Loewen. “If there are stones in the bile duct, we can sometime flush some contrast into the bile duct to clear the duct, and other time we may need to schedule an ERCP.”
The complications of a lodged gallstone in a biliary duct that is not removed include biliary cirrhosis, cholangitis, and pancreatitis, according to the National Library of Medicine.
“While 98 percent of gallbladder problems are related to gallstones, there is a subcategory called biliary dyskinesia,” said Dr. Loewen. “This is a category of patients having gallbladder problems without stones who present with gallbladder pain. Traditional imaging does not show any stones or abnormality. In this situation, we would do a specialized test called a hepatobiliary iminodiacetic acid (HIDA) scan to check the ejection fraction for gallbladder emptying. If the results are abnormal, then removal of the gallbladder is recommended.”
Surgery to remove the gallbladder is the usual course of treatment, and the majority is done with a laparoscopic approach, said Dr. Loewen.
“Half a percent of patients every two or three years need an open surgery to remove the gallbladder because it’s the worst-case gallbladder. The anatomy of the gallbladder can’t be identified because everything inside it is rock solid. With open surgery, we can identify the anatomy, which we wouldn’t be able to do with the laparoscope.”
about the expertMark Loewen, MD, FACSMark Loewen, MD, FACS is a general surgeon with Cape Cod Healthcare General and Specialty Surgery in Hyannis. Dr. Loewen attended Rush Medical College in Chicago, IL and did his general surgical residency at the Westchester Medical Center in Valhalla, NY. He completed a fellowship in laparoscopic surgery at Saint Francis Hospital in Hartford, CT. He is board certified by the American Board of Surgery. Dr. Loewen has been affiliated with Cape Cod Hospital since 2007. He is a member of Medical Affiliates of Cape Cod and Cape Cod Preferred Physicians. Dr. Loewen’s clinical interests include abdomen surgery, hernia repair, pediatric hernia repair, skin cancer, melanoma, soft tissues, lymph nodes, small bowel, colon surgery, laparoscopic colon surgery, liver disease, gallbladder, pilonidal hidradenitis, hemorrhoids, and port placement.
View Physician Profile
Originally published on Cape Health News December 12, 2023
When the pain repeatedly returns and becomes bothersome, how do you know when it is something more serious?
One clue might be if you have a family history of gallstones.
“Gallstones tend to run in families and many times when we see patients with gall bladder issues, they have family members who have had their gallbladders removed,” said Mark Loewen, MD, FACS, a general surgeon with Cape Cod Healthcare General and Specialty Surgery.
Gallstones are hard, about the size of a pebble and consist of cholesterol or bilirubin, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
“Some people have pain on and off for years or some have it over a short period of time,” said Dr. Loewen. “When it lasts longer than an hour or two, people are pretty desperate to get to the emergency room.”
Symptoms and DiagnosisDr. Loewen listed some of the typical symptoms of a gallbladder attack:
- Intermittent or acute pain in the upper abdomen, especially on the right side.
- The pain can occur after a meal or sometimes at night.
- Sometimes, the pain radiates to the right upper back.
- The pain can occur after a meal or sometimes at night.
- Fever and/or vomiting with the pain can be an indication the gall bladder is infected.
- The development of jaundice, a yellow color of the skin, if a gallstone is lodged in the bile duct for long enough.
A CT scan of the abdomen and/or an abdominal ultrasound are two tests used to diagnose gallstones, said Dr. Loewen. The tests may show mild thickening of the gall bladder wall, gall stones or both. The thickening suggests there may be some infection going on.
Both tests can sometimes miss visualizing the gallstones and, while blood tests such as elevated liver function blood tests can be an indicator of gallstones in the duct, there are other tests to help identify what is going on, said Dr. Loewen.
One test is called a magnetic resonance cholangiopancreatography (MRCP) which is a special MRI that looks at the pancreas, pancreatic duct, bile ducts, gallbladder and liver.
“If the liver function blood tests are high enough, then we get a gastroenterologist involved to see if they agree to do an Endoscopic Retrograde Cholangiopancreatography (ERCP),” said Dr. Loewen. “This is an upper endoscopy that can visualize the bile duct and sweep the gallstone or stones out so the ducts are nice and clear.”
Other Complications“If the liver function tests and MRCP are negative and we want to make certain there is no stone in the duct during the surgery, and finish with certainty, we can do a cholangiogram, an X-ray with contrast, to see the bile duct in real-time,” said Dr. Loewen. “If there are stones in the bile duct, we can sometime flush some contrast into the bile duct to clear the duct, and other time we may need to schedule an ERCP.”
The complications of a lodged gallstone in a biliary duct that is not removed include biliary cirrhosis, cholangitis, and pancreatitis, according to the National Library of Medicine.
“While 98 percent of gallbladder problems are related to gallstones, there is a subcategory called biliary dyskinesia,” said Dr. Loewen. “This is a category of patients having gallbladder problems without stones who present with gallbladder pain. Traditional imaging does not show any stones or abnormality. In this situation, we would do a specialized test called a hepatobiliary iminodiacetic acid (HIDA) scan to check the ejection fraction for gallbladder emptying. If the results are abnormal, then removal of the gallbladder is recommended.”
Surgery to remove the gallbladder is the usual course of treatment, and the majority is done with a laparoscopic approach, said Dr. Loewen.
“Half a percent of patients every two or three years need an open surgery to remove the gallbladder because it’s the worst-case gallbladder. The anatomy of the gallbladder can’t be identified because everything inside it is rock solid. With open surgery, we can identify the anatomy, which we wouldn’t be able to do with the laparoscope.”
about the expertMark Loewen, MD, FACSMark Loewen, MD, FACS is a general surgeon with Cape Cod Healthcare General and Specialty Surgery in Hyannis. Dr. Loewen attended Rush Medical College in Chicago, IL and did his general surgical residency at the Westchester Medical Center in Valhalla, NY. He completed a fellowship in laparoscopic surgery at Saint Francis Hospital in Hartford, CT. He is board certified by the American Board of Surgery. Dr. Loewen has been affiliated with Cape Cod Hospital since 2007. He is a member of Medical Affiliates of Cape Cod and Cape Cod Preferred Physicians. Dr. Loewen’s clinical interests include abdomen surgery, hernia repair, pediatric hernia repair, skin cancer, melanoma, soft tissues, lymph nodes, small bowel, colon surgery, laparoscopic colon surgery, liver disease, gallbladder, pilonidal hidradenitis, hemorrhoids, and port placement.
View Physician Profile
Originally published on Cape Health News December 12, 2023