Q. I have severe abdominal pain with 9 mm gallstones. What should I do now?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on May 21, 2020 and last reviewed on: Jun 02, 2020

Hello doctor,

I am 62 years old. A week back, I had severe abdomen pain so I took an ultrasound. The report says I have 9 mm size gallstone. I have also checked my lipid profile which are normal. I request you kindly suggest further action required. I am currently taking Lipicard.

 

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Dr. Ajeet Kumar Lohana

Medical Gastroenterology
#

Hello,

Welcome to icliniq.com.

I have to have more information about this pain before I can tell you what is the cause of this pain.

Usually, the gall bladder stone of such size (less than 10 mm) in size does not cause pain, and if it does, then the pain has to be characteristic one like pain starts within half hour of meals and gradually increases in intensity within next 1 hour and then start declining for the next three to six hours. Vomiting can occur with increased severity of the pain. If you have any of symptoms as mentioned, then it is possible that pain is coming from gall bladder stones, and the definitive treatment is cholecystectomy i.e. removal of the gall bladder.

Again, I want to emphasize that most of the stones of such size usually do not cause pain and remain asymptomatic doing no harm to the patient throughout their life. The other cause of sudden and severe abdominal pain are ulcers within the stomach, food pipe or small bowel, inflammation of the pancreas called pancreatitis, diabetes and its complications, lead poisoning, drugs such as pain killers, and few other causes. Your lipid profile is normal, and ultrasound is otherwise normal except that stones which are clearly visible.

You can start capsule Esomeprazole 40 mg half an hour before meals, it will resolve the pain if coming from ulcers in the stomach. However, I highly recommend you to provide more information regarding your problem as I can be in a good position to diagnose and tell you what to do.


The Probable causes:

Peptic ulcer disease. ? symptomatic gall bladder stone. Pancreatitis. Drug-related functional pain.

Investigations to be done:

Complete blood count. Serum amylase, lipase, calcium, BUN, creatinine, and electrolytes. Stool for H.pylori antigen.

Differential diagnosis:

Pancreatitis. Drug related. Lead poisoing.

Probable diagnosis:

Peptic ulcer disease. Asymptomatic gallstones.

Treatment plan:

Capsule Esomeprazole 40 mg half an hour before meals once daily.

Regarding follow up:

Follow up to provide more information about the pain.


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