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Gastroenterology (Expert Forum)
First Time Experience w/Pancreatitus??
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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First Time Experience w/Pancreatitus??
by klgay, Apr 05, 2004 12:00AM
I have just had an attack of Pancreatitus. Was hospitalized for 2 and 1/2 days. When I entered the emergency room my Lipase/Amylase levels were well over 1500! They have returned to normal levels and I can now eat solid food. Many tests were run, including chest x-rays, ultrasounds and a CT scan of my abdominal areas. No blockage was found, only a polup on my gall bladder which two Dr's dismissed as a cause. Several reasons (other than possible blockage) were given as to possible cause: trauma to the abdomen; excessive alcohol; rapid weightloss; excessive exercise. None of these are true in my case. I have a lot of questions, but the most important is wishing I could point to something that caused this and stop it. Although I don't drink too much, a glass or two of wine with dinner occassionally, I am more than willing to stop if this is the cause. Although I cannot imagine not exercising, I must do something, I can change that too. But what? I did lose some weight, but only 4 pounds in 2 weeks, I consider that safe. What could have caused this for the first time in 42 years? Could I have experienced mild cases that I didn't recognize as needing medical attention, meaning, did I take Zantac or Alka Seltzer when I should have seen it as something else? I never thought I had acid reflux, yet I took Zantac and it seemed to help. Alka Seltzer, except for this last weekend always seemed to help. Could I have been experiencing pancreatitus all along? Are the levels I went in with considered dangerous? So many quesitons. I am scared, that's the size of it. Lastly, my Father's father and Aunt both died of Pancreatic Cancer. The Dr.s I saw this past weekend both said that there is no connection between pancreatitus and pancreatic cancer. But with that history, how can I be sure? If you can answer some or all of these questions, I would certainly be grateful. I am female and have never been pregnant, in case that is of importance.
Doctor's Answer
by Kevin Pho, MD, Apr 05, 2004 12:00AM
, Apr 05, 2004 12:00AM
Alcohol and gallstones are the most common causes for acute pancreatitis. If those causes have been evaluated for, you may want to consider other causes. This would include marked elevated triglycerides, high calcium level, genetic causes (i.e. family history of pancreatitis), as well as medications.
Here are a list of medications that are associated with acute pancreatitis:
AIDS therapy —didanosine, pentamidine
Antimicrobial agents —metronidazole, stibogluconate, sulfonamides, tetracycline
Diuretics —furosemide, thiazides
Drugs used for inflammatory bowel disease — sulphasalazine, 5-ASA
Immunosuppressive agents —L-asparaginase, azathioprine
Neuropsychiatric agents —valproic acid
Antiinflammatory drugs —sulindac, salicylates
Others — calcium, estrogen, tamoxifen (as noted above, estrogen and tamoxifen may act via the induction of hypertriglyceridemia).
In 30 percent of cases, there can be no defined cause. Further evaluation can be considered in the form of an ERCP or MRCP to ensure there is no biliary cause. These tests can be discussed wtih your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Chari et al. Etiology of acute pancreatitis. UptoDate, 2004.
Here are a list of medications that are associated with acute pancreatitis:
AIDS therapy —didanosine, pentamidine
Antimicrobial agents —metronidazole, stibogluconate, sulfonamides, tetracycline
Diuretics —furosemide, thiazides
Drugs used for inflammatory bowel disease — sulphasalazine, 5-ASA
Immunosuppressive agents —L-asparaginase, azathioprine
Neuropsychiatric agents —valproic acid
Antiinflammatory drugs —sulindac, salicylates
Others — calcium, estrogen, tamoxifen (as noted above, estrogen and tamoxifen may act via the induction of hypertriglyceridemia).
In 30 percent of cases, there can be no defined cause. Further evaluation can be considered in the form of an ERCP or MRCP to ensure there is no biliary cause. These tests can be discussed wtih your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Chari et al. Etiology of acute pancreatitis. UptoDate, 2004.
I have moderate-severe chronic pancreatitis. My longest hospitilaztion was 9 days. The highest recorded A & L levels were 2000 and 5000. So yes, 1500 is high and out of the normal range. It is possible you have been experiencing mild pancreatic attacks in the past and didn't know it. The alcohol is a MUST STOP! It causes attacks. Even that stray glass or 2 of wine will catch up with you one day and hurt. The pancreas is an organ that DOES NOT rejuvinate itself once damaged.
If you go searching the web for pancreatitis you will find that it tells you people who smoke cigarettes have a 40% greater chance of getting pancreatic cancer than non smoking pancreatic patients. I quit that same day I read that. But it does NOT necessarily mean you will get cancer because your family members did, although there is a greater chance of that...but you probably already know this.
Yes, overly STRENUOUS excersize, high fat foods, and CRASH dieting can bring on an attack.A doctor may tell you that excersizing has nothing to do with this, but any pancreatic patient will tell you thats wrong. It sounds as if you have been doing all the right things in regards to your health though. My advice is for you to seek the advice of a pancreatic specialist. A GI just doesn't know enough about this disease. Any good one worth their salt will tell you the same.
There is a good chance you may NEVER have another attack. But you have to follow the same rules as someone suffering chronically with this disease. No alcohol (watch cough syrups, so called non-alcoholic beverages, nyquil, raw vanilla) eat a low fat diet and watch fried foods. Some people have to stay as low as 30 grams of fat a day or less to feel well. I suspect you can do much more than that. Just watch the above mentioned items. You may also want to go to your vitamen store and purchase pancreatic enzyme pills. They let your pancreas rest and do the digesting of the food for you. I would ask for a fecal fat test to see if mal-absorption has set it. I bet you will be fine, but please don't let 1 or 2 ER doctors or a regular GI doctor dismiss this. It can be a very serious life threatening disease if left untreated. You owe it to yourself and your family to get the advice and help and answers you seek.
We have a wonderful pancreatic web site at http://health.groups.yahoo.com/group/pancreatitis/messages
that you can post questions on and other people suffering from different forms and stages of pancreatitis can help you with.
Good luck to you. Don't assume the worst until you have ALL THE ANSWERS you deserve.
Sandy