Doc: Without pain, surgery doesn’t seem so urgent
Dear Dr. Roach: I am 66 and am generally healthy, with a pacemaker. I started to feel a small, very mild pain in my right side, under my ribs. My doctor checked my liver, and it was normal, with diffusely increased echogenicity (diffuse hepatic steatosis). Then I was sent to imaging, where they checked my gallbladder. My gallbladder functioned only 18 to 30 percent. It was recommended that I remove my gallbladder. That was two months ago, and since then I hardly feel a pain, just sometimes a very small one. My question: Do I still have to remove the gallbladder if it isn’t bothering me too much?
Dear P.K.: It sounds like you are describing functional gallbladder disorder, a condition of recurrent abdominal pain, similar to the pain that comes from gallstones, but without gallstones being seen on an ultrasound.
The diagnosis is made more likely by a HIDA scan, a nuclear-medicine study where the ability of the gallbladder to squeeze is measured after stimulating it with a hormone called CCK (I bet that’s what you had to get the gallbladder function number). Your result suggests that you have functional gallbladder disorder. However, other conditions, especially stomach ulcers, reflux disease and heart disease, can have very similar symptoms and should be excluded before considering this diagnosis. The HIDA scan is not definitive.
The most effective treatment for functional gallbladder disorder is removal of the gallbladder; surgery makes the pain go away completely in the vast majority of people.
When considering any surgery, one always has to weigh the risks against the benefits. Gallbladder surgery is relatively simple and safe, but if you are hardly ever having pain, I can understand your reluctance. It all depends on how frequent and severe your symptoms are and whether there is an alternative explanation. I think it’s worth discussing with a surgeon.
Dear Dr. Roach: I had a chest X-ray, which showed I have an enlarged right hilum. The doctor never explained what that means. I have had cancer two different times, so I worry about it. Could you explain a little more?
Dear D.B.: The hilum of the lung is where the blood vessels (artery and veins) and the airway enter the lung. Lymphatic vessels and nodes also are prominent in the lung hila. Enlargement of the hilum generally means there is an enlarged structure in the area. The pulmonary artery may be enlarged in pulmonary hypertension, while the pulmonary veins are enlarged in someone with congestive heart failure or valvular disease. However, in someone with a history of cancer, there is always the concern about enlarged lymph nodes. This does not mean cancer is present, as lymph nodes can become enlarged in infectious or inflammatory processes.
Often, the key is whether the hilum is continuing to enlarge. Size stability is reassuring. A CT scan usually is the best test for identifying what structure is causing the hilum to appear enlarged. Occasionally, a CT scan shows that there are no abnormalities, even if the chest X-ray suggests it.
Dear Dr. Roach: I read your recent column about pancreatitis, which I have had twice. Both times, the cause was statins. Two percent of the population can get pancreatitis from statins.
I kept telling my physician that I don’t drink and don’t have a gallbladder, and therefore the problem had to be something else. She insisted that I drank or had gallstones.
Dear H.C.: Two percent of statin-treated patients getting pancreatitis sounded like a high number, so I looked up a recent review, which showed 204 cases of pancreatitis among participants in clinical trials on statins, but that was from among over 150,000 participants (a rate around 0.3 percent), and the group assigned to placebo had a higher incidence of pancreatitis than those taking statins. It is always important to consider drug treatment as a potential cause of any new side effect, but the risk for pancreatitis among statin users appears to be low.
Email questions to ToYourGoodHealth@med.cornell.edu.