Managing Gallstone Pain: When to Seek Emergency Care and Treatment Options

Issues with Pain Relief Injections for Gallstones

Hello Dr.
Chen,
In July of this year, I underwent an abdominal ultrasound at the hospital and discovered that I have a gallstone approximately 1 cm in size.
My symptoms typically begin with nausea, followed by intermittent severe pain in the upper abdomen that can disrupt my daily activities and work.
I have had to visit the emergency department multiple times, and after receiving pain relief injections, I can usually go home and rest within about half an hour, as the pain subsides.

From July to now, in October, I have visited the emergency department around 7 to 8 times, each time receiving pain relief and then returning home to rest.
I have assessed that I may experience an episode every 8 to 10 days, requiring another emergency visit for pain relief.

I have consulted with several doctors regarding the potential complications of laparoscopic cholecystectomy.
Some doctors have mentioned that there is a chance of experiencing pain post-surgery, while others have said that it is unlikely.
I am unsure how to make a decision on this matter.

I would greatly appreciate it if you could share your experience on this issue.
Thank you very much for taking the time to respond amidst your busy schedule.

SKY ku nao zhong, 30~39 year old female. Ask Date: 2016/10/21

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir.
It's better to undergo surgery as soon as possible to avoid recurrent inflammation and adhesions, which can complicate the procedure.
Changhua Hospital cares about your health.
Best regards, Chen Shidian.

Reply Date: 2016/10/21

More Info

Managing gallstone pain can be a complex issue, especially when it involves recurrent episodes that significantly impact daily life. Based on your description, it seems you have been experiencing episodes of severe abdominal pain, likely related to your gallstones, which have prompted multiple visits to the emergency room for pain management.
Gallstones can cause symptoms when they obstruct the bile ducts, leading to conditions such as biliary colic, acute cholecystitis, or pancreatitis. The pain you describe, starting with nausea and escalating to severe abdominal pain, is characteristic of gallbladder-related issues. Given that you have a 1 cm gallstone and have experienced recurrent episodes, it is essential to evaluate your treatment options carefully.

When to Seek Emergency Care
You should seek emergency care if you experience any of the following:
1. Severe abdominal pain that does not subside with over-the-counter medications.

2. Fever or chills, which may indicate an infection or inflammation.

3. Jaundice (yellowing of the skin or eyes), which suggests a blockage in the bile duct.

4. Persistent vomiting that prevents you from keeping food or fluids down.

5. Changes in bowel movements, such as clay-colored stools, which can indicate a bile duct obstruction.

Treatment Options
1. Pain Management: As you have experienced, pain relief is often the first step in managing gallstone attacks. Intravenous pain medications can provide rapid relief during acute episodes.

2. Supportive Care: After pain management, supportive care may include hydration and monitoring for any signs of complications.

3. Surgical Intervention: Given your recurrent symptoms, laparoscopic cholecystectomy (gallbladder removal) is often recommended. This procedure is minimally invasive and typically has a shorter recovery time compared to open surgery. While some patients report post-operative pain or complications, the majority experience significant relief from gallstone-related symptoms after surgery. The risk of complications from leaving gallstones untreated, such as acute cholecystitis or pancreatitis, often outweighs the risks associated with surgery.

4. Observation: In some cases, if the gallstones are asymptomatic (not causing pain or complications), doctors may recommend a watchful waiting approach. However, given your recurrent pain episodes, this may not be the best option for you.

Addressing Concerns About Surgery
It’s understandable to have concerns about potential complications from surgery. While some patients report ongoing discomfort post-surgery, many find that their quality of life improves significantly after gallbladder removal. It is essential to discuss these concerns with your surgeon, who can provide insights based on your specific case and medical history.

Conclusion
In summary, given your recurrent episodes of pain and the impact on your daily life, it may be time to consider surgical options seriously. Consulting with a surgeon who specializes in gallbladder surgery can provide you with a clearer understanding of the risks and benefits involved. Additionally, if you continue to experience frequent pain episodes, it is crucial to have a plan in place for managing these attacks, including when to seek emergency care. Your health and well-being should be the priority, and addressing the underlying issue of gallstones through appropriate medical intervention can lead to a significant improvement in your quality of life.

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