High Lipase After Gallbladder Removal

The liver produces bile to digest dietary fat and stores it in the gall bladder. Stones (usually made up of cholesterol) may block the passage of bile into the bowel, resulting in vomiting and pain on the right side of the abdomen, especially after ingestion of fatty foods. Surgical removal of the gall bladder typically relieves this condition but gallstones can also affect adjacent organs, such as the pancreas. When lipase levels are high after removal of the gallbladder, it is a sign that inflammation is present in delicate pancreatic tissues. This condition may take weeks or months to heal.

Gallstone Pancreatitis

• The gallbladder and the pancreas share a common duct. Lipase is an enzyme normally secreted by the pancreas. Along with amylase, it is released into the small intestine to aid in the digestion of starches and proteins. Just as gallstones can block the secretion of bile from the gallbladder, resulting in a painful "attack," the stones can also block the secretion of lipase and amylase from the pancreas. When they cannot be released into the bowel, the enzymes remain in the pancreas, "digesting" and damaging the tissues there. Some enzymes leak into the blood stream where doctors can measure them. The range of normal lipase is seven to 58 U/L. Lipase levels that are more than five times above normal and amylase levels that are double what they should be indicate pancreatitis, or inflammation of the pancreas. Pain may be felt in the middle of the abdomen and radiate to the back or left shoulder. If gallstones are the cause of this condition, they are removed surgically along with the gall bladder and symptoms should subside slowly as the pancreas heals. In most cases, a few days to a few weeks are all that are needed to make a full recovery.

  Pancreatitis may also be caused by long-term abuse of alcohol. The condition is more common in women than men, and in those who are white, over the age of 40, and overweight.

Treatment

• Resting the pancreas is essential to recovery. Ideally, treatment centers around maintaining good nutrition and achieving pain relief while waiting for the pancreas to heal on its own. Monitoring is done with bloodwork, CAT scans or MRI.
  Gelatin or broth and clear liquids may be allowed, or the stomach may be kept empty with a nasogastric tube connected to suction while intravenous fluids provide support. Vitamins and fats might be given directly into major veins, or a feeding tube might be used to bypass the pancreas and give high calorie nutritional drinks. If vomiting can be controlled and pain relief can be achieved, the patient may be able to eat small frequent meals of soft foods and take enzymes by mouth to aid digestion. Alcohol, caffeine, fried foods, sodas and the use of tobacco must be strictly avoided.

  In severe cases, pockets of fluid form in or around the pancreas. They may become infected and require the insertion of drainage tubes. Sometimes the damage is irreversible; part of the pancreas must be removed. The degree of intervention needed determines how much pancreatic function is lost. Surgery is a last resort.

  Although it takes time, gallstone pancreatitis usually resolves completely and the person regains normal health. Weaning off of addictive pain medication can be a problem; the assistance of a pain management team is invaluable. A support group such as Narcotics Anonymous can also provide help for some people.