WHAT ARE THE SIGNS SOMETHING IS WRONG?
If a gallstone becomes trapped in a duct (opening) inside the gallbladder it can trigger a sudden intense abdominal pain that usually lasts between one and five hours. This type of abdominal pain is known as biliary colic. The medical term for symptoms and complications related to gallstones is gallstone disease or cholelithiasis. Gallstone disease can also cause inflammation of the gallbladder (cholecystitis). This can cause persistent pain and a high temperature with abdominal tenderness. In some cases a gallstone can move into the pancreas, causing it to become irritated and inflamed. This is known as acute pancreatitis and causes severe abdominal pain that gets progressively worse. It is often associated with vomiting and feeling unwell. Sometimes a gallstone can block the main bile duct and cause jaundice which is yellowing of the skin and urine.
CAN I LIVE WITHOUT MY GALLBLADDER?
Yes – absolutely. The gallbladder, especially when diseased and causing symptoms, is a non-essential organ and complete removal of the gallbladder causes patients very few problems. Some patients do notice some change in bowel habit or slight indigestion after cholecystectomy, but fortunately in the majority of patients this is short lived and settles down after several months. Instead of the bile getting stored in the gallbladder, it just continuously flows in to the small intestines to aid in the digestion of food and nutrients.
HOW TO MANAGE A GALLBLADDER CONDITION
If you have gallstones, it is important to see an expert who commonly treats gallstones. Also it is important that you get high quality imaging tests performed to assess the gallstones and the bile duct system – the Gallbladder Clinic can provide this level of expertise. One thing that you can do at home to self-manage pain from the gallbladder is to avoid eating trigger foods. Often these are high in fat, such as chocolate, crisps, chips or greasy or fried foods.
PATIENT CONSENT FORM
WHAT HAPPENS WHEN I COME TO THE GALLBLADDER CLINIC?
You will be seen by a specialist consultant. The consultant will take a full history, especially a review of your symptoms, their nature and severity. We will also need to know about your past medical history including any previous operations, anaesthetics or other serious illness. You should bring a full list of all your medications with you when you come to the appointment and report any known allergies. The clinical examination includes a full examination of the abdomen. You will need blood tests in the clinic to assess how the liver is functioning, unless these have already been performed recently by your own GP. If you have not had an up-to-date scan of your gallbladder, liver and bile ducts, this needs to be arranged. Some patients require more advanced scans of their gallbladder such as a MRI scan of the bile duct system (MRCP test). Once the examination is complete, your consultant will discuss the treatment options with you. This will include outcomes as well as any potential risks or complications for a procedure. The surgeon may complete a consent form with you in the clinic. You will normally be able to arrange a date for surgery at the initial consultation if required. Alternatively, you may wish to book a date for surgery via our clinic secretary.
BEFORE ADMISSION TO THE HOSPITAL
All the details regarding the admission will be sent out by post to you by the hospital. This will tell you when and where to come. You will receive instructions about when to stop eating and drinking. If you have any other medical conditions such as heart or lung disease or diabetes, you may be asked to attend a pre-assessment clinic in the week before surgery. You may have blood tests taken and an ECG. You will also be given advice about any medications that you take. It is very important for us to know about any anticoagulant drugs, including aspirin, that you might be taking.
COMING TO THE HOSPITAL
Remember you will be having an operation and a general anaesthetic. You will need someone to bring you up to the hospital as you will not be able to drive yourself home. If you live alone, you can still go home on the same day as the operation but you should either arrange for someone to come and stay with you for 24hrs or go and stay with a relative or friend. Most gallbladder operations are performed as a day case or with a short overnight stay. So it is best to be prepared and bring in things for an overnight stay. A dressing gown and slippers are useful as we often walk patients to the theatre. Remember to bring clothes that are easy to get on and off. They shouldn't be too tight as this may be uncomfortable after an operation. Clothing with an elasticated waist band is ideal if you have it. Once you arrive at the hospital the reception staff will confirm all your details. You will be shown to the ward. On the ward you will be seen by a nurse who will complete the admission process and you will also be seen by your surgeon and anaesthetist. If you haven’t already completed a consent form this will be done before you leave the ward.
IN HOSPITAL AFTER THE OPERATION
After the surgery the nursing staff on the ward will try to get you up and moving around as quickly as possible. Often after laparoscopic surgery, because gas is blown in to the abdomen to make space to carry out the surgery, patients notice some shoulder and back discomfort due to the residual gas. This can be alleviated by walking around the ward. We want to make sure that you have had something to eat and drink before you go home. Your wound will be checked before you go to make sure there isn’t any excessive blood on the dressing or undue swelling.
AFTER YOU HAVE GONE HOME
Once you are at home it is important to stay active with short regular walks building up the time and distance each day. After the operation we recommend showering rather than bathing as patients will be uncomfortable and it could be quite difficult getting into and out of a bath. You can normally take a shower after 24hrs. Don’t worry about getting the dressing or the wound wet, simply remove the wet dressing. Dab the area dry with a towel and put a clean dry dressing on. The main reason for using a dressing is to stop your clothes from rubbing the scar directly. If there is any discharge a dressing will also protect your clothes. If you have skin stitches we would normally arrange for these to be removed between 10 and 14 days after surgery, but most of the time the skin stitches will dissolve and do not need to be removed. There are no hard and fast rules about dressings. Most people will be able to stop using a dressing within 2 weeks of the operation.
As already mentioned, we encourage all patients to stay active following surgery. Walking regularly is the most useful exercise after the operation. You should avoid heavy lifting for 4-6 weeks after the operation. After about 4 weeks you should be able to increase your exercise activities. Starting with gentle rhythmic exercises such as cycling or cross-training and gradually building up to your normal exercise regimen. Provided there are no wound problems, swimming can also be good at this stage. You should be able to return to work within one or two weeks but if your job involves any strenuous activities you may need to be off work for longer or carry out only light duties. Patients can usually drive again after one to two weeks, but your surgeon will give you specific instructions regarding this. It is often best to ensure you can do an emergency stop and that your car insurance company is happy for you to drive. We aim to see patients back in clinic after about 6 weeks but we can always see patients sooner if there is a problem.
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