Medical Health Encyclopedia

The slight risk of developing gallbladder cancer might encourage young adults who are asymptomatic to have their gallbladders removed.

Gallstones and Severe Abdominal Pain

Gallstones are the most common cause for hospital admissions of patients with severe abdominal pain. Diagnostic tests are performed and, depending on results, the approach may be as follows.

Normal Test Results and No Severe Pain or Complications. If the patient has no fever or underlying serious medical problems and shows no signs of severe pain or complications, and if laboratory tests are normal, then the patients may be discharged with oral antibiotics and pain relievers.

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Gallstones and Presence of Pain (Biliary Colic) but No Infection. Patients with pain and tests that indicate gallstones but who do not show signs of inflammation or infection have the following options:

• Intravenous pain killers are administered for severe pain. Such drugs include meperidine (Demerol) or the potent NSAID ketorolac (Acular, Toradol). Ketorolac should not be used for patients who are likely to need surgery. They can cause nausea, vomiting, and drowsiness. Opioids, such as morphine, may have fewer adverse effects, but some doctors avoid them for gallbladder disease.
• They may electively choose to have the gallbladder removed (called cholecystectomy) at their convenience.
• A minority of such patients may be candidates for a stone-breaking technique called lithotripsy (The treatment works best on solitary stones that are less than two centimeters in diameter.)
• Drug therapy for gallstones is available for some patients who are unwilling to undergo surgery or who have serious medical problems that increase the risks of surgery. Recurrence rates are high with non-surgical options. The introduction of laparoscopic cholecystectomy has greatly reduced the use of non-surgical therapies. Note: Drugs treatments are generally inappropriate for patients who have acute gallbladder inflammation or common bile duct stones since delaying or avoiding surgery could be very hazardous in these cases.