Re: Frequent biliary colic (severe pain without fever or vomit)


"Fabian" <newspost@xxxxxxxxxxx> wrote in message
news:1117544639.349207.256960@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
> Hi all there,
>
> My sister (41) has been diagnosed with Cholelithiasis. It gives her
> severe pain for each "fatty" meal or even sugary drinks (for example,
> even drinking half a red Fanta bottle can give her colics (just severe
> pain, no fever, no vomit).
>
> Blood and urine tests result with no alterations, but ulstrasound scan
> shows she has "lots of small stones" (sand) of cholesterol.
>
> She refuses surgery (removal of colecystis): first of all because we
> have a relative who died of colon cancer (and constant leaking of gall
> in the intestin slightly increase colon cancer probability) at a
> relatively young age, then we heard not positive feedbacks from
> different women that underwent the same surgery: they have become
> unable to have a "heavy" meal because of severe head aches and
> unbearable gastic reflux.
>
> She is keen to take tables for dissolve stones.
>
> I red in emedicine.com the following:
> ---
> Dissolution agents are employed infrequently.
> The most widely used oral bile salt compound is ursodeoxycholate, which
> is effective only for small, pure-cholesterol stones located in a
> functioning gallbladder.
> Despite maintenance therapy, recurrence rates are high, averaging
> 50-60% in most published series.
> ----
>
> This is exactly her case and she is willing to take the risk of the
> recurrence. 50% is always a good chance to get rid of the stones
> definitively.
>
> However, the doctor still discourages the drug: his opinion is that:
> "ursodeoxycholate gives metter results with big stones than with many
> small" (exactly the opposite of what the website states !!!).
>
> I wonder:
>
> * What are the side effect (if any) of taking "ursodeoxycholate"? The
> doctor was unable to inform her and I have not found anything online.
> * Are there specific exams that can show whether colecystis works
> properly or not (besides the presence of stones)?
>
> The main argomentation of the doctor is that it is useless to let the
> colecystis there because colecystis does not work (by the moment
> produces stones). On the contrary, in another website, I also red that
> the drug for stone dissolution is indicated if the colecystis works ok,
> otherwise better surgery.
>


There is little doubt that removing the gallbladder is the way to go in your
sister's case. It's a 20 minute operation and she would likely be able to go
home the same day. The risk of complications and death is higher with her
symptomatic gallstones than it is with the operation. Granted , I don't know
how things are done where you live, but that would certainly be the norm
around here.

However, if she refuses the gallbladder operation, the next best thing is
the use of dissolving agents, ursodeoxycholic acid or chenodeoxycolic acid.
Note that she will likely continue to have the biliary colic, and she may
have episodes of severe abdominal pain if the stones get small enough to
pass through the duct system. Additionally, these drugs tend to cause
nausea, so she may have that to contend with that in addition to the colic
and occasional pain. And, the stones will return in 50-75% of cases. Even
so, if that's the only alternative, that's what her doctor should do.

HMc





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