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What Casues Abdominal Pain After Insertion Of Stent Post Gall Bladder Surgery?
Question: Hi! My mother 70 yrs old has been suffering from jaundice from long back used to carry S bilirubin from 3 to 7 and she was getting treatment from local medicine doctor.Suddenly last month it was observed her S billirubin increased to 18.5 and admitted to local hospital for 7 days.After getting MRCP it was found 1 stone in GB pipe as her GB already operated in the year 1996.At last we decided to do ERCP and on 22nd july doctor tried to do the ERCP but after entering into the OT room he put one stent for by passing that one and suggested us to test the Bilirubin after 10 days and to intimate them and after testing the bilirunin raised to 35 and she got admitted to Nursing home and on 6.8.2014 doctor executed ERCP and extracted the stone from the pipe.And doctor put another stent on the opposite bile duct as it was not visible from MRCP.
Now the outside portion of the lower abdomen from outside observed like bludder and some pain and she became very weak even she can not stand properly.As directed by the doctor she has been admitted at Internatinational Hospital XXXXXXX for Gastro doctor and from 13th to till date she is in Hospital.Doctor could not find the proper cause .All the latest report attached here with.Pl guide me what to do and the root cause.
Now the outside portion of the lower abdomen from outside observed like bludder and some pain and she became very weak even she can not stand properly.As directed by the doctor she has been admitted at Internatinational Hospital XXXXXXX for Gastro doctor and from 13th to till date she is in Hospital.Doctor could not find the proper cause .All the latest report attached here with.Pl guide me what to do and the root cause.
Brief Answer:
Possibly infection in background of Fatty liver
Detailed Answer:
Hello Mr XXXXXXX
How are you? Thanks for writing to HCM. my name is Dr Suresh Raghavaiah. I am a liver transplant surgeon and I will attempt to answer your question today.
First of all I am sorry to about your mother's condition.
I have just read all the reports you have attached with the query. By the look of it, your mother was suffering from fatty liver (suggested by the imaging) and mild cholestasis (suggested by the bilirubin of 3-5). This unfortunately has been complicated by obstruction of the bile duct leading due to the stone. This led to the increase in the bilirubin to 18. I also feel due to the obstruction, there was also infection associated as evidenced by the increased white cell count, increased CRP and the increased ferritin levels. Although the cultures have been negative (Bile culture report not attached), I suspect your mother had received antibiotics before the culture was taken and that is the reason why the blood cultures are negative. That is why a bile culture report will be very helpful.
When there is an infection, the liver usually suffers and might not excrete the bile properly into the intestine. This is called as cholestasis (Also evidenced by raised alkaline phosphatase). This usually takes a while to resolve and the rest of your mother's liver is working fine (normal SGOT and SGPT). So as long as the stents are functioning well and there is no suspicion of obstruction of the stent, I would continue on conservative management and antibiotics. If there is suspicion of blockage of the stents then obviously the stents will need to be replaced.
Hope this helps and hope your mother feels better soon.
Please let me know if you need any clarifications
Have a great day
Dr Suresh Raghavaiah
Possibly infection in background of Fatty liver
Detailed Answer:
Hello Mr XXXXXXX
How are you? Thanks for writing to HCM. my name is Dr Suresh Raghavaiah. I am a liver transplant surgeon and I will attempt to answer your question today.
First of all I am sorry to about your mother's condition.
I have just read all the reports you have attached with the query. By the look of it, your mother was suffering from fatty liver (suggested by the imaging) and mild cholestasis (suggested by the bilirubin of 3-5). This unfortunately has been complicated by obstruction of the bile duct leading due to the stone. This led to the increase in the bilirubin to 18. I also feel due to the obstruction, there was also infection associated as evidenced by the increased white cell count, increased CRP and the increased ferritin levels. Although the cultures have been negative (Bile culture report not attached), I suspect your mother had received antibiotics before the culture was taken and that is the reason why the blood cultures are negative. That is why a bile culture report will be very helpful.
When there is an infection, the liver usually suffers and might not excrete the bile properly into the intestine. This is called as cholestasis (Also evidenced by raised alkaline phosphatase). This usually takes a while to resolve and the rest of your mother's liver is working fine (normal SGOT and SGPT). So as long as the stents are functioning well and there is no suspicion of obstruction of the stent, I would continue on conservative management and antibiotics. If there is suspicion of blockage of the stents then obviously the stents will need to be replaced.
Hope this helps and hope your mother feels better soon.
Please let me know if you need any clarifications
Have a great day
Dr Suresh Raghavaiah
Above answer was peer-reviewed by :
Dr. Prasad
Hi, I have provided some attachments. Please review them.
Brief Answer:
Already Reviewed
Detailed Answer:
Hello Mr XXXXXXX
Thanks for getting back to me.
I had already reviewed the reports before writing back to you.
My advice is still the same
Please do keep me updated regarding your mother's progress.
Dr Suresh Raghavaiah
Already Reviewed
Detailed Answer:
Hello Mr XXXXXXX
Thanks for getting back to me.
I had already reviewed the reports before writing back to you.
My advice is still the same
Please do keep me updated regarding your mother's progress.
Dr Suresh Raghavaiah
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
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