Opioid Pain Medication KILLING Gallbladders

Recently found this post, then looked into the issue. Looks cirtian, the latest big Phama business plan to keep Americans hocked on drugs, killing 89 a day at present from Opioid overdoses ( Dec 2017) is also having a spinoff for the gallbladder surgery business.

“One class of drugs that’s proven to cause this are opioids. So if you’ve taken them when you started having GB problems then this could well be the cause. In 2006 I was using an opioid to treat a problem and I began to have GB pain. My hida revealed my GB function was 5%. I didn’t have the surgery and made a full recovery in a year and a half with a 60% function on another hida. I never knew it was opioids that caused this until recently, when I started taking opioids again for a problem and now my GB symptoms have all returned.

Also, due to the nature of opioids, it’s possible to have your GB out and still not have resolution because they can also affect the oddi as well. This can cause you to have a well functioning GB on HIDA but still have GB type symptoms.

If you have this type of GB problem, it might be a good idea to avoid opioids.
Dec 01, 2009

It is well known amongst the medical community (specifically since 1990) that Opioid pain medication can cause the sphincter of Oddi to become un-responsive, or under-responsive.The Oddi is what opens and closes to let the bile enter the duodenum (small intestine traversing just below the stomach).(BELOW, at end is a short but comprehensive explanation of the Hepatic system with Gallbladder and functions)Persons who have Gallbladder (from here on will be noted as GB) issues AND are taking opioid pain medication (i.e. any morphine based/derived product– percocet, dilaudid, vicodin, morphine, etc… any drug derived from the poppy plant (known as an opiate, e.g. opioid (meaning opiate-like)) may not need surgery.

Here lies the reason:

Opioids cause a number of bodily effects, from pain relief to elongating the intestine (hence causing constipation) to making the GB and its parts react slowly or lazily.

In tests done persons having had HIDA scans done (in real time) were injected with Naloxone (Narcan, an ‘anti-opioid’) had thier GB’s and the Oddi go from little to no function– to fully functional within a span of several minutes or less.

The patient had GB problems, and took opioid pain medication as well. When the opioid effect was removed the GB function was restored fully, or nearly so.

There is, and can be, a viscious cycle with regards to this.

For example, a person takes pain medicine for one reason, the medicine can cause GB issues, which causes pain. The patient takes more medication for the pain, causing the GB issues to worsen, and so on.

Conversely, a person with GB issues who starts taking opioid pain medication can mask the pain for a while, thus allowing it to go undiagnosed for a span of time until it becomes too pernicious to avoid, therefore needing surgery because a rupture from distention of the GB and biliary duct (either with calculi (gall-stones: made of calcium, magnesium, sodiums, etc)) from having gone undiagnosed too long.

So, there is a double-edged sword with regard to pain medicine. On one hand it can make real issues like GB disease, either infection, or with calculi, go undiagnosed by covering up the problem.
On the other hand, it can cause the GB, biliary duct, (both to elongate and enlarge) and the Oddi to malfunction by having had taken opioid pain medicine.

How does one distinguish between the differences?

One: simple Physician-patient exam using the hand placed under the right rib-cage while patient inhales fully will give a general yes or no to begin with (at the end of this post I will describe the technique of checking for Murphy’s Sign).

Two: Ultra-Sound of right upper quadrant of the abdomen will rule out calculi (stones), and also note the dimensions of the biliary duct (general 1cm or 5-6mm in length normally), the size and dimensions of the GB itself, can vary according to body size but will be noted if larger than expected. The right kidney will also be noted on the exam ( in the report as well).

Three: HIDA scan (a GB function test) will check to see how well it reacts. Whether it stores the bile adequately; and whether it releases it sufficiently. A 70%+ is generally normal.

NOW, with all this information in hand.
Rule out calculi…
Rule out infection… (if possible)
Are you on opioids…

If you can say NO..NO..Yes… Then you may have several or more options without having to have surgery. Some of which will be effective within a week to 10 days maximum.

You taper off opioids and transition to another pain medicine(s): for example TalwinNX (pentazocine with Naloxone) is effective for mild to severe pain; and has no known effect (positive or negative) on the GB or hepatic system as a whole.
Start taking Ketoprofen (is an NSAID similar family as Ibuprofen) either 50 or 100mg capsules. Is ‘very’ effective in pain relief, and has an anti-inflammatory effect to help any irritation from the enlarged GB and constituent parts.

IN concert these two can work wonderfully for pain relief, most often MUCH better than the opioid counterparts.

If you have calculi you can have them removed without having the whole GB removed. Better alternative.

Switching medication from opioids rather than have a GB removal is preferable as well.

The side-effects from post-surgery GB removal can include transient ‘dumping syndrome’ (the bile dumps into duodenum and runs through you quickly) OFTEN, and in most cases this lasts only a few months or a few weeks, until your body adjusts.
Some pain at surgery site is common up to several months as it all heals and adjusts.

There are many other complications that can occur, however we are looking to avoid the surgery in general!

SO, THOSE with “Opioid Induced Hypo-functional Gallbladder disease” and not knowing it, can have relief, as well as alternate options.

These symptoms can often mask themselves as many things. The over-all symptoms are often so general they can easily be over-looked Or OVER-diagnosed.

A SIMPLE examination (prelim) that a physician can or SHOULD do when even the gallbladder is suspected is the test for Murphy’s Sign.
If you’ve had it you’ll remember. If you were positive for Murphy’s sign you’ll Certainly Remember! Is as follows and can be done with a partner.

Patient laying down- physician takes index through ring finger and gently places them just under the right rib cage one hand span away from middle of center front to a depth of one-two inches down and UP under the ribs. Patient takes a deep breath semi-quickly.

IF there is SEVERE BLINDING PAIN and patient cannot continue to inhale—-POSITIVE MUPRHY’S SIGN, one takes step 2 .Ultra sound and/OR–.HIDA SCAN
IF there is only general discomfiture NEGATIVE— Ultra Sound, perhaps HIDA scan still advisable under discretion of other symptoms.

The gallbladder is part of a large number of organs that work in concert with one another: The liver (produces bile, and enzymes, besides being the 2nd largest organ in your body, after your skin), the gallbladder (stores said enzymes waiting for a signal to release into duodenum just below stomach/into stomach), to biliary duct (which receives , or transceives the bile enzymes), to the sphincter of Oddi (which opens and closes letting out the bile into duodenum(small intestine below stomach)).

Symptoms of a gallbladder attack caused by disease, stones, enlarged biliary duct, or malfunctioning of the Oddi can be caused by numerous stimuli.

A very common, but UNDER-diagnosed cause of non-calculi (meaning no stones) gallbladder enlargement can be from taking prescription pain medication. The duct is enlarged, the gallbladder is enlarged, and upon having a HIDA scan (a routine gallbladder function test) you have a hypo-active gallbladder (under active) the cause may simply be the opioid pain medicine. Many people have been told to have surgery with that being the cause.

SYMPTOMS: common and uncommon of ALL types of hypo-active gallbladder can be from pain after meals, any — or none.
–Severe headache generally located at top of head.
–Mild to severe pain in abdomen, from right-center, upper OR lower to left side of abdomen as well.
–mild to severe pain in the back and/or side, to between right and/or left shoulder blades. can radiate to upper shoulder down to lower abdomen right side of trunk to middle.
–mild to Severe nausea after eating or drinking fatty, non-fatty foods. Drinking coffee, alcohol, heavy juices causing a stabbing pain on right central side to upper middle chest.

These symptoms can often mask themselves as many things. The over-all symptoms are often so general they can easily be over-looked Or OVER-diagnosed.

Source : https://www.steadyhealth.com/topics/gallbladder-disease-with-opioid-pain-medication-surgery-often-unnecessary?page=1




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