Post-Cholecystectomy: Persistent Nausea and Appetite Loss in Elderly Patients

After gallbladder stone surgery, experiencing loss of appetite and nausea for several days?

The grandmother had a loss of appetite, nausea, and constipation for 19 days prior to her examination, which revealed choledocholithiasis.
She underwent a cholecystectomy on July 2, 2018, and was discharged with a drainage tube in place.
Three days post-discharge, her appetite returned to normal without any vomiting.
However, on the fourth day, she began to experience persistent nausea and a strong aversion to food, to the point where even drinking water would trigger the urge to vomit.
She described her stomach as feeling "twisted" and "cold," and she experienced ongoing constipation, feeling unable to have a bowel movement.
Her medical history includes asthma, hypertension, a previous surgery on the fifth lumbar vertebra, Parkinson's disease, and mild dementia.

Mr. Huang, 20~29 year old female. Ask Date: 2018/07/07

Dr. Chen Jiaming reply Surgery

Elderly patients who undergo major surgery are at an increased risk of developing stress-induced gastritis or ulcers.
It is recommended to consult a clinical physician for prescriptions related to reducing gastric acid, minimizing vomiting, and enhancing gastric emptying and intestinal motility.
Additionally, some analgesics that contain opioid components (which provide effective pain relief without the side effects of other analgesics that increase gastric acid secretion) can lead to nausea, loss of appetite, and constipation with prolonged use.
It is advisable to reduce the dosage of such medications as pain subsides.
In summary, it is recommended to bring the patient back for a follow-up appointment as soon as possible.

Reply Date: 2018/07/07

More Info

Post-cholecystectomy syndrome (PCS) is a condition that can occur after gallbladder removal, and it can manifest as persistent nausea, appetite loss, and other gastrointestinal symptoms. In elderly patients, such as your grandmother, these symptoms can be particularly concerning due to their potential impact on overall health and recovery.

After gallbladder surgery, the body undergoes several changes in how it processes bile, which is essential for fat digestion. The gallbladder's primary function is to store bile produced by the liver until it is needed for digestion. Once the gallbladder is removed, bile flows directly from the liver into the small intestine, which can lead to various digestive issues, including nausea and changes in appetite.

In your grandmother's case, her symptoms of persistent nausea and appetite loss starting four days post-surgery could be attributed to several factors:
1. Bile Salt Diarrhea: After gallbladder removal, some patients experience diarrhea due to the continuous flow of bile into the intestines, which can irritate the bowel. This can lead to discomfort and a feeling of nausea.

2. Dietary Changes: Post-surgery, patients are often advised to modify their diet. If your grandmother has not adjusted her diet appropriately, she may experience gastrointestinal distress. A low-fat diet is typically recommended initially to ease digestion.

3. Medication Side Effects: If your grandmother is on medications for her other health conditions (as you mentioned she has asthma, hypertension, Parkinson's disease, and mild dementia), some of these medications can cause gastrointestinal side effects, including nausea and loss of appetite.

4. Underlying Health Conditions: Given her age and existing health issues, her body may be more sensitive to changes, including those caused by surgery. Conditions like Parkinson's disease can also affect gastrointestinal motility, leading to symptoms like constipation and nausea.

5. Psychological Factors: Post-operative patients, especially the elderly, may experience anxiety or depression, which can manifest as a loss of appetite and nausea.

Recommendations:
1. Consultation with Healthcare Providers: It is crucial to follow up with her healthcare team, including her surgeon and primary care physician. They can assess whether her symptoms are related to the surgery or if there are other underlying issues that need to be addressed.

2. Dietary Adjustments: A dietitian can help create a meal plan that accommodates her new digestive needs. Starting with small, frequent meals that are low in fat may help ease her symptoms.

3. Hydration: Ensuring she stays hydrated is essential, especially if she is experiencing nausea and is reluctant to drink water. Sipping on clear fluids or electrolyte solutions may help.

4. Medications: If her nausea persists, her doctor may consider prescribing anti-nausea medications. Additionally, reviewing her current medications for potential side effects is advisable.

5. Monitoring Symptoms: Keeping a log of her symptoms, including when they occur and their severity, can provide valuable information to her healthcare providers.

6. Physical Activity: Gentle physical activity, as tolerated, can help stimulate digestion and alleviate constipation.

7. Psychological Support: If there are signs of anxiety or depression, involving a mental health professional may be beneficial.

In summary, persistent nausea and appetite loss after cholecystectomy in elderly patients can stem from various factors, including changes in bile flow, dietary adjustments, medication side effects, and underlying health conditions. Close monitoring and collaboration with healthcare providers are essential to manage these symptoms effectively and ensure a smooth recovery.

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