When is it ER time with a gallbladder attack?

March 25, 2012 1:54 AM

How do you know its time to go to the ER with gallbladder issues? Can I wait 24 hours? Please calm my nerves! It's 3:30am, I just had two bouts of loose stool and one episode of throwing up.

So, it's early and I'm with my parents visiting a city. We are heading back to where I live later this morning, and will be there by noon. I have been diagnosed with one teeny tiny stone and gallbladder "distended" a couple of years ago but it wasn't surgery time then. Earlier this week I tried to go low carb and probably ate too much fat. Right now I am lying in bed in pain in the gallbladder area. It's not unbearable, but I have a high pain threshold and it is really bothering me. I've already thrown up and I hope that doesn't happen again. I don't plan on eating again ANYTIME soon.

So, when do you head to the ER with this? Can I wait it out and go to the doctor on Monday? I don't want to deal with the ER, and I surely don't want to do it until I'm home, but I also don't want to be dangerous. There are urgent cares in my hometown I could go to tomorrow. I have also never had surgery (laser wart removal doesn't count) and I tend to "tough it out" and not go to the doc. I need some clarifying thoughts, some reassurance, or something! I'd rather not have surgery this week if I can avoid it...or at least wait until Tuesday.

posted by MultiFaceted to Health & Fitness (20 answers total)

Can you call a nurse hotline? A lot of insurance companies provide one. They will be able to answer your questions at lot more ably than most internet people will be able to.

If you were my friend I'd be urging you to get yourself to the ER. (So...consider yourself urged.) Yes, it's inconvenient, but it sounds like complications from gallbladder stuff can be very nasty and it doesn't seem like the kind of thing you'd want to gamble on.

I wish I could offer more concrete help. I hope you feel better soon.
posted by Arethusa at 2:52 AM on March 25, 2012

Best answer: A gallstone passing should sort itself out within an hour or two. I.e. the pain will ramp up to extreme, and then gradually decrease. If it's still the same pain level after two or three hours, that's when I'd go to the ER. (That is, in fact, when I have gone to the ER in the past, and that was when I turned out to have an infection in the gall bladder itself that took several days to stop hurting at that level.)

So if you are going to get relief, it will probably happen well before Monday (and then you should maybe see your doctor anyway). But if you don't, head to the ER soon.
posted by lollusc at 2:57 AM on March 25, 2012 [1 favorite]

I had gallstones a few years ago, and got to know the pattern of my attacks. Mine tended to be extreme pain, with or without vomiting, and then after a while (1-5 hours) it was as if the stone stopped blocking whatever it was blocking, snapped back into place, and the pain would disappear very abruptly.

After a few months of this, during which I got my diagnosis, I was scheduled for non-emergency surgery to remove the gallbladder. All has been well since then, and I never went to the ER for the pain (I'm also a "tough it out" kind of person).

However, I'm hesitant to recommend that you do the same, though; or if you try to tough it out, be on the lookout for danger signs like fever, shivering etc that might signal infection. You'd need emergency surgery if you had an infected gallbladder.

FWIW my triggers for attacks were similar to yours, and I tried to eat as fat-free as possible until my surgery date, which kept the attacks at bay apart from that one time I ate some cheese.
posted by altolinguistic at 2:59 AM on March 25, 2012 [1 favorite]

I think shivering and hot flushes are normal during a gallbladder attack, but again, should resolve within a few hours. Even if you do start to feel okay soon, watch out for jaundice (yellowish skin and eyes) over the next while. Gall bladder issues can screw with your liver too.

I am absolutely not a doctor: I have just had many years of personal experience with gall bladder issues, and have asked my doctor lots of questions.
posted by lollusc at 3:02 AM on March 25, 2012

I would go.

I had a couple of stone attacks, and my physician diagnosed them as 'reflux incidents' and told me to take some OTC stuff.

When the Big One hit, it lasted six hours before I said 'the hell with this' and went to the ER. (Staying with my parents at the time, and did not wake them up. I still catch hell for that to this day, 5 years later.)

There's no good reason to have the pain. Traveling may well make it a bit worse. If you MUST do this trip (problems with insurance in where you are, or getting back home afterwards if you've had something removed), then have them drop you off at the ER. No, really. That much pain is a sign you are having problems and they really need to be dealt with before something goes bad.

I went in at 4 AM, they ultrasounded my guts at 8 AM when it opened up, and at 3 PM they rolled me into an operating room and knocked me out, and I woke up around 9 PM without a gall bladder. They kept me until Thursday morning, and then my boss at work told me he'd see me in a couple weeks.

This does not have to be a horrible thing, but I'd see a doctor or hit the ER the best possible time.
posted by mephron at 3:11 AM on March 25, 2012

If they are only few and small would you consider trying to pass the stones naturally?

My partner had very bad issues with this and although his doctor didn't believe it possible he managed to pass the stones, various sizes over about one week of adjusted diet (apples , apple juice) then olive oil / lemon juice, I found this page here which is basically the same process he followed (although he ate only apples with apple juice during first 4-5 days, nothing else )

He has adjusted his diet significantly since then & has no issues whatsoever anymore & gall bladder intact.

Anyhow that may not help with the immediate pain your having but thought I'd mention all the same.
posted by Under the Sea at 3:46 AM on March 25, 2012

My husband ignored his gall bladder attcks for years and then ended up having to have emergency surgery because of a serious infection. Waiting it out a few hours to see if the stone passes is fine. Avoiding medical treatment long term is a seriously bad idea--scheduled, uncomplicated wholly laproscopic gall bladder surgery is easier, cheaper, and has a much faster recovery than unscheduled emergency surgery where they have to switch from laproscopic halfway through because of the damage done from many years of gall stones.
posted by hydropsyche at 4:56 AM on March 25, 2012

What hydropsyche said, I had my gallbladder taken out laproscopically and I was home and did a load of laundry the same evening. It was my only surgery to date. I had a few really painful attacks the weeks previous, and finally one big long one that had me hospitalized, they put a stent in to let some of the stones pass (i didn't have to be knocked out for it, but i sure don't remember it actually happening - it was like being SUPER DRUNK).

I apparently would've been in a lot of trouble if I'd let it slide another day, since my liver was being affected by it. Since I had a two year old and a one month (!) old at home at the time, I'm glad I went and got it taken care of.
posted by kpht at 5:33 AM on March 25, 2012

Best answer: What color is your urine? I had a stone block my bile duct and my urine looked like Coca-cola because my liver enzymes were all jacked up. I thought I was just severely dehydrated because I was having trouble keeping water down. The coke colored urine finally made me go to urgent care, where they ran a liver panel and then sent me over to the hospital.
posted by chiababe at 5:36 AM on March 25, 2012

Please ignore the advice about the apples/olive oil/lemon juice thing. Research has shown that the "stones" passed after drinking that concoction are created from the olive oil and lemon juice through a process of "saponification".
posted by lollusc at 5:58 AM on March 25, 2012 [13 favorites]

My friend had a severe attack of gallstones when I was visiting her in another state, and we ended up in the emergency room in the middle of the night. It was her first bad attack and we were not sure what it was. They did some scans that showed up the stones, which she did pass and went home the next morning, but with laproscopic surgery scheduled a few weeks later. The surgery went fine, she has not had problems since, but the ER doctors said she would have had to have emergency surgery had the stones not passed when they did. Do not let this go too long.

Please let us know how you are doing.
posted by mermayd at 6:13 AM on March 25, 2012

Best answer: Bear in mind that the stones don't necessarily "pass" like kidney stones sometimes do; they can occasionally pass into the gut, but an attack can end when a stone stops blocking a duct. So if you have been found to have one stone, and an attack ends, don't assume you don't have gallstones any more; chances are you do.

Many people have gallstones and never know about it, but once you start having attacks it's definitely time to consider surgery, as the attacks are a quality of life issue, and can carry risk (of jaundice and infection, as outlined above). But whether one particular attack justifies a trip to the ER is less straightforward, in my view.
posted by altolinguistic at 6:28 AM on March 25, 2012

Response by poster: Thanks everyone! The pain got sharper then subsided, so I got a couple of hours of sleep. We are now on the road back to my town...should be there in less than 2 hours. I feel more comfortable going to the doc at home since they have records of my issues in the past. Right now I feel "sore" in that area. My urine looks fine, but I'll keep an eye on it...I didn't know it would turn dark like that so thanks for that info.

I have no desire to eat much of anything today (or for the rest of the week for that matter!) but if everything stays calm today I'll be seeing my doctor tomorrow. If not, the urgent care and ER are 5 min from my house and I will head that direction. After last night I am ready for surgery so I will probably go ahead and schedule it soon. I do not want to do that ever again.
posted by MultiFaceted at 7:41 AM on March 25, 2012 [1 favorite]

Glad it all worked out OK. The surgery is no big deal, all things considered - most surgeons do loads of such procedures, and in most cases it can be done laparoscopically. Surgery's never nice but far better to have this done as a routine procedure than to be rushed in as an emergency. Cut out the fat for the time being and see if that helps. You will want food again eventually, I promise.

Good luck!
posted by altolinguistic at 8:12 AM on March 25, 2012

Glad to hear you're going to be seen soon, even though the pain mostly subsided. I've seen people who tried to ignore their gallbladder problems for too long, and by the time they come to the hospital the thing is so inflamed that the surgeons won't take it out, because it would require a huge open incision. Instead they have a drain placed, which is a flexible tube that drains the pus out of the inflamed gallbladder into a bag that you have to wear inside your clothes for several weeks, and send you home on antibiotics. Only once the inflammation comes down will they do the laparoscopic (3 tiny cuts instead of a giant slice) surgery. Delaying coming to the hospital adds a few weeks of grossness and misery to the whole process, and puts you at risk for sepsis or even dying if you don't get the medications soon enough.


call a hospital, ask for the maternity ward (3am is like primetime), speak to a nurse, and she'll tell you what to do
Incidentally, please don't do this. The nurses in the maternity ward are busy with people having babies, who need them. They also likely haven't dealt with gallbladder problems since nursing school, because they focus on moms and babies. Neither you nor the actual patients are going to get good care by going this route. If your insurance doesn't have a nurse line and you really feel you must call someone rather than just showing up, call the Emergency Room and tell them you're wondering whether you should come in, and ask if there's a nurse you can speak to.
posted by vytae at 9:32 AM on March 25, 2012 [9 favorites]

then olive oil / lemon juice, I found this page here which is basically the same process he followed (although he ate only apples with apple juice during first 4-5 days, nothing else )

Yeah, this is total bullshit--it won't necessarily hurt you, but it's not going to do anything to help your gallbladder, either. Don't waste your time or olive oil.
posted by pullayup at 5:04 PM on March 25, 2012

I know this has been resolved, but this seems important to note--it could be very dangerous to do any dumb "home remedy" to pass gallstones. The doctor in the ER when I was first diagnosed with gallstones told me that I should absolutely not try to pass gallstones by drinking large amounts of oil/lemon juice/Epsom salts because it could kill me at worst and at best would send me into emergency surgery. I believe he said that if I drank that much oil then my gallbladder would contract enough to guarantee that it would cause a stone to block a duct and cause problems beyond what I would have from just having an overly fatty meal. (Granted I had quite a few gallstones and this was after lot of morphine, so I think his "you could kill yourself doing this" warning was overly strong to make sure I wasn't going to try it.) Hope the several previous warnings and this is strong enough to convince anyone with gallstones not to try this.
posted by thesocietyfor at 9:10 PM on March 25, 2012 [3 favorites]

Response by poster: I wanted to give everyone a gallbladder update. After having an ultrasound (which showed a normal gallbladder with no stones) I had a HIDA scan which showed gallbladdder function at 40%. That's the tail end of the normal range. Surgery usually happens when you hit 30%, unless you have stones or something else happening.

So, no surgery yet, but it appears as though it might be in my future at some point. The plan right now is to watch what I eat, and try to identify the foods that really screw things up. So far cheese seems to be an issue which is surprising because I used to never have a problem with cheese.

The Chronicles of Multifaceted's Gallbladder Part I has come to an end. Hopefully.
posted by MultiFaceted at 3:36 PM on April 12, 2012

Just reread this post and want to say thanks to all for input on my initial response, obviously the responses on this forum should not be taken as legit medical advice and I was only acting in best interest based on my / partner experiences. Having said that I will be checking him in for a full checkup this week. Sorry for any misleading suggestions
posted by Under the Sea at 5:23 AM on April 14, 2012

Under the Sea, I'm glad your partner is getting checked out. He may well not have passed stones at all (they're not like kidney stones) - the mix of olive oil and apple juice can resemble stones, and a change in diet to eradicate most fat can prevent attacks, which would make him think he had no stones.

MultiFaceted, I'm glad you have a better idea of what's going on - that's always good :)
posted by altolinguistic at 7:58 AM on April 14, 2012