Gall Bladder Disease Results in Hospitalization for Michelle Duggar
"18 Kids and Counting" mother Michelle Duggar, 43, was airlifted from NW Arkansas to a hospital in Little Rock with abdominal complaints over the weekend. She is pregnant with her 19th child, due in the spring.
According to a TLC statement, Duggar’s problem is not the pregnancy but gallbladder issues. She and her unborn baby are reported to both be stable and resting.
Gallbladder-related disease is a common abdominal complaint. The presence of gallstones (cholelithiasis) occurs more frequently in pregnant women. Asymptomatic gallstones are seen in 3.5% to 10% of pregnancies. Symptomatic gallbladder disease occurs in pregnancy is 0.05% to 0.3%.
Gallstones can present as an obstructive disease or as cholecystitis (inflammation of the gallbladder secondary to gallstone obstruction of the cystic duct).
Multiparity is considered a risk factor for gallstone development, as is increased age, and changes in estrogen and progesterone.
Symptoms of gallbladder disease are colicky or stabbing pain in the right upper quadrant and/or generalized epigastric pain, which can radiate to the right scapula and flank area. Colicky pain often signals a stone obstructing the common bile duct. Tenderness or pain on deep palpation under the right costal margin during inspiration may be elicited. Other symptoms include anorexia, nausea, vomiting, dyspepsia, low-grade fever, tachycardia, and fatty food intolerance. Pregnant women usually present with acute epigastric pain.
The imaging method of choice in diagnosing gallstones is sonography. Ultrasound is approximately 95% effective in diagnosing gallstones and has no radiation exposure.
Clinical management will vary depending on gestational age and severity of symptoms. Conservative medical management is often the first consideration in the first and third trimesters of pregnancy. Conservative management includes the use of intravenous fluids, correction of electrolyte imbalance, bowel rest, narcotics, antispasmodics, broad spectrum antibiotics, and a fat-restricted diet. Fetal assessment and uterine monitoring are indicated, depending on trimester.
Unless symptoms are acute, surgical options are often delayed into the second trimester to avoid the risk of spontaneous abortion in first trimester. Some of this conservative approach during the first trimester is changing with improved outcomes from advanced surgical techniques.
Various surgical techniques are now available and include 1) endoscopic retrograde cholangiopancreatography, 2) open cholecystectomy, and 3) laparoscopic cholecystectomy. The choice of technique varies by institution, access, operator availability and skill, severity of symptoms, and gestational age. Most of these surgical procedures are used in patients with acute biliary colic, acute cholecystitis, and those with relapsing symptoms.