Transcription:

Melanie Cole (Host):  Many people suffer from various types of abdominal pain. They think are diet or stress-related when in fact it could be a hernia or gallbladder problem that are easily treated. My guest today is Dr. Michael McAllister. He’s a general surgeon with Aspirus. Welcome to the show, Dr. McAllister. When is a stomach pain and abdominal pain something that people should be concerned about?  

Dr. Michael McAllister (Guest):  Okay. Well, with respect to abdominal pain, that can be due to issues with the gallbladder. Gallbladder pain typically is a result of the pain underneath the rib cage, usually on the right side in the area of the liver. It can go up to the right shoulders, sometimes the back. When it’s due to the gallbladder, it typically comes on anywhere from 15 minutes to 45 minutes after eating, and it can last for a couple of hours. Most of the time, when it’s related to gall stones, it results in a sharp pain in that area, but there are other problems with the gall bladders such dyskinesia, which is when the gall bladder isn’t working properly. And those can be felt as less specific sorts of pain, sometimes more in the mid to upper abdomen, usually felt as more of a soreness and can be accompanied by feelings of nausea that can last for several hours. And those sorts of things we can look into with specific tests like ultrasound and a radiology test called a hidascan. With respect to abdominal pains, it can be more relating to the stomach, such as an ulcer. That can be felt as a burning pain in the upper abdomen, sometimes in the left side upper abdomen. It can be made worse with eating and sometimes made better with eating, and it can be accompanied by issues with G.I. bleeding. Sometimes abdominal pain can be a harbinger of a hernia, such as a groin hernia. If you have a pain in the left or right groin that’s made worse with bowel movement or restraining or especially if you have a bulge in that area, that needs to be looked into by a surgeon because that can represent a groin hernia that is usually easily reparable. And when it’s fixed, the associated pain typically goes away. 

Melanie:  Dr. McAllister, while some hernias may not be emergent unless you’ve had them for a while, and as you say, sometimes, you can see them or feel them when you’re trying to have a bowel movement, are gallbladder symptoms, the ones you’ve described, are they emergent? Are they something that if you have some of those symptoms, you need to get right into a doctor or go to the ER? 

Dr. McAllister:  Well, with respect to gallbladder pain, usually these are not considered to be emergent issues, although they can be. If someone is having bad problems with fever or chills, feeling generally run down, they have a constant pain in the right side of the abdomen, or if they have a change in the color of their bowel movement—specifically, if the bowel movement’s a clay white appearance—that can indicate a blockage of the liver and that sometimes needs to be addressed either by a surgeon or a gastroenterologist. But with respect to biliary dyskinesia and chronic issues with the gallbladder, such as gallstones, they typically don’t need to be addressed emergently. But if you have fever or chills associated with it, that needs to be seen as soon as possible. 

Melanie:  What do you do for that? What do you do for gallstones, for example, or some of the other gallbladder problems? 

Dr. McAllister:  Well, with biliary dyskinesia, surgery is typically optional. That is to say, when the gallbladder is not working correctly. Sometimes, the symptoms can be mitigated with changes of the diet and losing weight. With respect to gallstones, the gallbladder typically has to be removed surgically. There really aren’t medications that work well for getting rid of gallstones. In this day and age, removal of the gallbladder is considered to be a standard of care, and that’s typically done laparoscopically, with three or four small cuts as opposed to the old way, with a large cut underneath the edge of the rib. And it’s typically, an in-and-out procedure. Patients can be discharged the same day almost all the time. 

Melanie:  What about hernia surgery? We hear a lot about it. It seems to be much more common these days than it used to be. Tell us about this. Is it minimally invasive? How long is the recovery? 

Dr. McAllister:  Well, there are different ways to fix a hernia, and it depends on what kind of a hernia it is and whether it’s the first time or the second time that it’s being addressed surgically. Hernias generally should be fixed. They don’t ever get any better than they are at the time when they’re found, and they can get worse. With respect to how it’s fixed, I tend to use an open surgical repair for groin hernias because that is the way that I was trained. That’s my most comfortable way to do it. We’ve done several studies about what’s the best way to fix a hernia, and the consensus opinion is that the best way to fix a hernia is whatever the best way that the surgeon was trained to do it, meaning the way that they’re most comfortable with. There’s advantages to doing it open and laparoscopically. Laparoscopic repair for groin hernia has a little bit more of a recurrence rate associated with it, and that’s one of the reasons I prefer an open approach. With respect to other hernias, such as what we call umbilical or ventral hernias, oftentimes the laparoscopic approach is a better way to go depending on the size and the patient and other specific factors that go into it. With respect to the recovery period of a hernia repair, groin hernia surgery tends to be associated with a little bit of a longer recovery. It is also considered to be an outpatient procedure. But people will tend to have some significant pain for a few days, and afterwards the associated pain often gradually go away by about two weeks or so. People need to be on a light-duty restriction for up to four weeks or so after any hernia surgery to allow the areas time to heal. With respect to laparoscopic abdominal hernia surgery, ventral hernia and umbilical hernia, those also tend to be outpatient procedures. There’s involvement in the internal organ in the hernias. Sometimes, it’s best to watch somebody overnight, but it’s typically an in and out type thing, and the recovery from that sort of a surgery is also in the neighborhood of four weeks for a full recovery, one to two weeks of time away from work. 

Melanie:  Can hernia be prevented? 

Dr. McAllister:  Well, there are certain things that will predispose people to the development of hernia, such as a chronic clot, a medical problem called COPD, but there is not much that can be done to prevent a hernia. Smoking can be terrible in terms of contributing to formation of hernias. But in terms of specific things that people can do to prevent them, there really aren’t a lot of things that can be done. 

Melanie:  Dr. McAllister, in the beginning you mentioned ulcers as one of the possible things that could be going on when you have abdominal pains. What might signal that you have an ulcer? What do you do about it? We hear a lot about stress and things that might be related to ulcers. Is there any truth to that? 

Dr. McAllister:  Well, there have been studies that have shown in recent years that the typical story of a businessman who’s got a stressful life and has stress-induced ulcers, that may not be as typical as we want. But a lot of times, ulcers are associated with an infection called Helicobacter pylori, or H. Pylori, which is a very easily treated bacterial infection of the stomach, contributes to abdominal pain and reflux disease. When we find it, either with a blood test or an upper endoscopy scope, it’s very easy to treat. With respect to treatment of ulcers in the stomach, we would typically place the patients on acid reduction medication regimen, usually, what we call a proton pump inhibitor or an H2 blocker for a few months, usually at least three to six. Sometimes people need lifetime acid suppression if they have a significant ulcer. If they do have an ulcer associated with an H. Pylori infection, they can complete an antibiotic course in between one and two weeks, and that’s typically adequate treatment for it.  

Melanie:  In just the last minute or so, Dr. McAllister, give the listeners your best advice for those suffering from abdominal pains they’re not sure why, and why they should come to Aspirus and see you to get diagnosed. 

Dr. McAllister:  Yeah. If you have abdominal pain and you’re not certain what the cause is, it’s important that you be seen by someone who is some sort of a specialist, either a gastroenterologist or a surgeon, because oftentimes they can be very easily addressed either with medication or surgery. Sometimes, if these things are left alone, they can progress and they can become a more difficult issue to deal with as opposed to if they were dealt with early. And I think you should come to see me at Aspirus because I will do my best to take care of you in as timely a fashion as possible, and I look forward to seeing you on my office if there’s anything I can do to help you. 

Melanie:  Thank you so much, Dr. McAllister. What a nice man you are. You’re listening to Aspirus Health Talk. For more information, you can go to aspirus.org. That’s aspirus.org. This is Melanie Cole. Thank you so much for listening.