Thursday, 13 November 2008

After cholecystectomy

Anonymous said...
1)uncomfortable feeling in my upper abdomen, across the top of my ribs and radiates down just above my belly button. pain also goes through to my upper back around my rib cage. colic pains and feeling very full rather than out and out pain. Also having twinges and pain spasms below my belly button to the left.

2)only get the uncomfortable feelings after eating in upper abdomen, lower pain below button is constant.

3)every time i eat, and constant pain below belly button

4) always in same 3 places, lower left side belly button, upper abdomen and back.

5)can't work at the moment due to constantly feeling sick when i eat, not sleeping and i can't sleep on my side, skin itching.

6)had keyhole gallbladder removal surgery 3 weeks ago, i think it is still associated with that.

7) gallstones, havent had follow up since surgery.

8) same as 7

9) no further treatment planned since surgery

10)february 2008

11) ibs, me, glandular fever

12) cut out alcohol and fatty foods since being diagnosed, although since surgery eating normally but having the pains all the time, whereas before it was only when i ate fatty foods. bowels opening every other day.

13) self employed no problems at work except not working at the moment.



Thanks for this - as you say it is likely to be related to your recent surgery to your gallbladder. Even though you had keyhole surgery, this is still a major disruption to your abdomen. It is a lot of trauma, the gallbladder is a large organ, between two and three inches across. It sits under the lower surface of the liver and has to be taken off from the liver. Again, the operation is done under a general anaesthetic, which also takes its toll on the body.

The gallbladder is part of the "gastro intestinal tract", which from a practical perspective extends from the mouth to the anus. It is run by the "autonomic nervous system" which are the nerves that do the housekeeping for the body, making sure food gets sorted, digested and converted into waste. The autonomic nervous system looks after all the bits that we are generally not conscious of - so that the conscious part of the brain can get on with earning a living. 

The autonomic nervous system gets affected by stress, by a poor diet,  physically damaged by straining or pushing - either to have your bowels open, or during difficult deliveries and childbirth. 

Eating, from the moment you even think about food, starts the digestive process. Remember the mouth watering cakes from childhood?, even thinking about them starts a person salivating!

The digestive process is continuous and coordinated. Food is chewed in the mouth, releasing saliva, this is swallowed, goes into the stomach where it is churned and separated into its various components. 

The stomach produces acid and enzymes to help the digestive process, squirts some of the meal into the next part of the gut, where the guts adds bile and enzymes from the pancreas. The churning and mixing continues until the food gets digested, passed along the gut until it finally gets expelled. 

Ideally bowel movements, and this is the part people don't often talk about should be large, bulky and soft, be passed easily in the morning and again perhaps midday. Burkitt did a lot of work photographing african stools and comparing them to Western stools, drawing the links between what diseases were common and the patterns of stools. This led to a lot of people recommending fibre in the diet. However almost certainly the link was not just the size and weight of the stools, but the ease with which they were passed. 

Western lifestyles do not lend themselves to the easy passage of stools!, from the sit up and beg toilet ware, as opposed to the african squat, to the time pressures to get on with life and work, as opposed to relaxing and letting nature do her work.

I am sure that this is already more than you wanted to know!! and from your position at the moment, it is likely that you are still nauseous because the surgery has upset your gastrointestinal tract and it is taking its time to settle down. 

However, several points in your history worry me. Firstly that you took the time to find this site and post your question. In other words, this is not something trivial that just needs reassurance. Secondly that you are getting pain when you lie in a particular position only, which may suggest that there is some fluid in your abdomen that is moving around. This may indicate that there has been a little bit of bleeding or even a slight infection and thirdly that you describe "itching". Itching can be an early sign of jaundice which may mean that the liver is upset in some way, and that it is not draining bile as it should be. 

And finally, you are not getting better - the body heals, if everything is going according to plan the body gets better from day to day. You are not getting better and it sounds as though you may even be getting worse. 

What to do:

I believe you need to see your GP as soon as possible, certainly within the next two days. If you were my patient, I would arrange an ultrasound scan of your abdomen and for you to be seen urgently by the surgical team. It may be that your GP will be reassured by examining your abdomen that nothing serious is going on, but obviously over the Internet, it is not possible to do that (yet!). I would also arrange some blood tests to check whether there is an infection and to check on the state of your liver.  

In the longer term, you will benefit from keeping to a healthy diet, avoiding processed food, chewing your food well to help digestion, exercise as that also helps the gut function. Aiming to have your bowels open easily and daily!

Many thanks for such a clear history

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