GALLSTONES
Gallstones are something 85-90% of people will never experience.
However, because the other 10-15% of people do get the totally
unforgettable opportunity to be in pain described as worse than
childbirth, it's a good idea to learn all we can about it now.
Gallstones are solid deposits that form in the gallbladder and block the
passage of bile. Attacks are often triggered by eating a fatty meal.
For most patients, the pain is constant. Other symptoms include
jaundice, gray or gray-white stools, nausea, and vomiting. (I had none
of those other symptoms.) In a grid-down situation if you're not sure
the patient's pain is due to gallstones, have the patient eat some fatty
foods. That will generally make the pain worse.
The pain is generally in the upper right quadrant of the abdomen.
Classic onset of gallstone pain occurs over 30-60 minutes, lasts several
hours, and then slowly dissipates. While the patient is in pain, s/he
can't get comfortable in any way and often paces the floor.
The classic risk factors for gallstones are the four F's:
- fat
- fertile (has had children)
- female
- forty (over the age of forty)
Unfortunately, the only sure treatment is surgical removal of the gallbladder, which requires a functioning society. Herbal remedies may prevent future attacks. These include:
- apple cider vinegar
- peppermint
- turmeric
- ginger
- dandelion root
- beet, carrot, lemon, and grape juices
CHOLECYSTITIS
Gallstones may trigger an infection or inflammation called cholecystitis. The symptoms are pain in the right upper quadrant of the abdomen and fever, and sometimes nausea, vomiting, and jaundice. Treatment in challenging circumstances is as per other abdominal infections, to wit:
- fluids
- pain relievers and fever reducers
- Augmentin, intravenous (preferred)
However, intravenous Augmentin may be hard to come by. Dr. Koelker
suggests an alternative that may work would be to administer an
anti-nausea drug such as meclizine (OTC) or ondansetron (prescription)
to help the patient keep down oral antibiotics, such as Augmentin,
cephalexin, ciprofloxacin, or TMP-SMX plus metronidazole.
CHOLANGITIS
This condition results from a stone lodged in the bile duct and is
difficult to differentiate from cholecystitis without a functioning
laboratory as the symptoms are basically the same. Cholangitis is a
medical emergency. The gallbladder needs to be removed, but it is
beyond the scope of care in an austere environment. A doctor will
administer pain relievers, fluids, and high doses of the antibiotics,
but these are unlikely to be effective.
For further reading:
Armageddon Medicine
Survival and Austere Medicine, 3rd Edition, pp 166
The Survival Medicine Handbook, pp 400-402
25 march 2020
Pro Tip RE: Gallstones. Frequently after a gallstone episode it will be recommended that the gall bladded be removed. If performed by modern Western medical practitioners, it will almost certainly be done laparoscopically, meaning 2-4 small abdominal incisions allowing instruments access into the abdomen instead of one large incision for the surgeon's hands and instruments. Laparoscopic surgery is frequently performed on a same-day outpatient basis and allows for much faster patient recovery.
ReplyDeleteThe gallbladder connects to the Common Bile Duct, sharing it with the liver, and the Common Bile Duct connects to the duodenum at the bottom of the stomach. If you have been passing gallstones (you'll know because the pain is excruciating) they have been going into and, hopefully, completely through, the Common Bile Duct.
I strongly suggest conferring with your doctor and requesting an ultrasound study of the Common Bile Duct post-surgery; how long after surgical removal of the gall bladder is a matter of medical opinion best answered by your doctor, but it is worthwhile to determine if an unnoticed gallstone, a stone that did not make it completely through the Common Bile Duct to the duodenum, was left in the Common Bile Duct, part of which is cut and sealed when removing the gallbladder. From what I've learned it doesn't happen often but a simple ultrasound can provide your doctor with the information.
I recently experienced what happens when a Common Bile Duct obstruction occurs; the duct becomes blocked with what is called a "retained stone" (several months later in my case) when a gallstone that did not pass all the way through gets into a position where it can block the common bile duct rather than passing through, the duct becomes inflamed, liver output is blocked, and an infection can occur which spreads into the liver. The liver has a great deal of blood circulating through it so any infection there quickly becomes sepsis. Sepsis is fatal if not treated quickly, and so is liver failure which can occur. I was lucky because the problem was discovered quickly, corrected quickly (see below), the sepsis overcome with several days of massive doses of IV antibiotics and my liver is slowly recovering.
Should a retained stone be discovered through an ultrasound, in the Common Bile Duct post gall bladder surgery, and judged by your doctor to potentially be a problem, removal is pretty simple, performed through an endoscopic procedure under brief full sedation.
Interesting. That sounds like the cholangitis described above. And it also seems like something that a physician and/or surgeon should routinely check for when the gallbladder is removed.
DeleteI’ve seen a few people with reoccurrence of gallstones post gallbladder removal, treatment like described above. After removal, the eventually duct forms a pseudo bladder to let bile pool again.
DeleteI believe but don’t have sources that fasting can sometimes trigger attacks.
In healthcare gallbladder disease generally presents as cholecystitis....an inflamed gall bladder. If it is severe enough it can include the hepatic biliary system. Gallbladder disease is often called the "great pretender" because it's presentation can be so varied from person that it is extremely difficult to diagnose without lab results and most importantly imaging ....either an ultrasound or a CT scan. Only after a correct diagnosis can intervention occur. An the only viable treatment is surgery. Holistic approaches may help but are generally ineffective once the disease is symptomatic.
ReplyDelete