April 17, 2009
Aches and Pains, Other
Question from Chicago, Illinois, USA:
About a month ago, I had a really awful stomachache that lasted for a week, at which time it became a mild stomach ache, which I still have. It has been in both the upper left and upper right parts of my stomach, just under my rib cage, originally more in the right side but currently more in the left. I called my endocrinologist and made an appointment to see him. By the time I got to the appointment, the ache was pretty mild. He ordered an ultrasound. The ultrasound showed a wall echo shadow complex, which I understand means that I have gallstones, and also an inflammation of the gallbladder. So, the endocrinologist referred me to a surgeon. I met with the surgeon and I’m scheduled for surgery in two weeks, with a pre-op exam scheduled for next week.
I got a copy of the radiologist’s report as I was leaving the surgeon’s office. Under impressions and liver it says “Slight increase in periportal echogenicity, suggestive of mild periportal edema. These findings can be seen with hepatitis, and correlation with liver function tests and hepatitis serologies can be performed if clinically indicated.” My liver enzymes were last tested in January, three months ago, and were fine at that time; I am vaccinated against some hepatitis and have never been sexually active. I don’t drink. Neither the surgeon nor the endocrinologist mentioned the liver in their conversations with me.
My endocrinologist and surgeon both have told me that mine is not a clear cut case of cholecystitits, and that my pain might have another cause, but that my gallbladder still needs to come out.
So, I have three questions:
What will the absence of the gallbladder do to my blood sugars after meals and through the day?
Did diabetes cause this? I am a skinny vegan (diet has NO cholesterol), a 20 year old male with no family history of gallstones, with three years of type 1 diabetes under my belt. My endocrinologist says my control is good. The surgeon says diabetes makes gallbladder disease worse and that means I have to have it out symptoms or not, but he doesn’t know if it causes gallbladder disease (or at least, he didn’t say).
Should I be satisfied that taking out the gallbladder will cure my stomach problems?
Answer:
Upon completion of your recovery, you should not have difficulty in the absence of your gallbladder. The gallbladder is an organ that stores up bile and releases it in the presence of a fatty meal. Your gut can function normally without your gallbladder. Patients with gallstones, and who also have diabetes, have shown a tendency to need to come to surgery for infection of the gallbladder more often than if they did not have diabetes. Several years ago, it was almost reflexive that surgeons would remove gallbladders with any hint of problems in people with diabetes. Now, fortunately, it is a bit more cerebral and surgery is more evidence-based. Therefore, I think your physician is giving you reasonable advice. I cannot say whether the removal of the gallbladder will be the answer to all your symptoms. It is not unreasonable to start that way. However, you might want to speak to your physicians and ask about alternative possibilities for the pain. I think you are entitled to this, even if you go ahead with the surgery.
As far as the periportal edema, it would be a good idea to have your serologies measured. If no findings were abnormal, you might want to repeat the ultrasound in a year or so. This would also be an area to discuss more in depth with your physicians.
JTL
