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Gastroenterology (Expert Forum)
Acute Pancreatitis? Can't get diagnosis. Please help.
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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Acute Pancreatitis? Can't get diagnosis. Please help.
by TiredOfThis, Jan 19, 2007 12:00AM
I really need another opinion because I can't get any definitive answers from my doctors on this problem. Thank you in advance for reading my long post - but I feel the need to be detailed.
I began having severe upper abdominal pain (directly under breast bone) in Sept. 2006. Doctors first thought it was gall bladder but blood and ultrasound were NEG. At first it wasn't bad, but began to increase in severity and frequency. On vacation for Thanksgiving in Florida, I went to the ER at Baptist Medical with severe abdominal pain (started after eating) - was admitted - and diagnosed with ACUTE PANCREATITIS. I was told that normal numbers for Pancreas were around 20-30... mine were over 2,000. I was put on an IV and not allowed to eat or drink. The following morning, about 8 hours after the first blood work, my numbers were down to 200-300. The doctors didn't know why I rebounded so quickly - but I was released in only 2 days. While at the hospital I was given the following tests: Ultrasound, CT Scan, and ERCP along with a lot of blood work. All tests were normal.
After returning from FL the pain returned days later. I was sent to a gastroenterolist and the following tests were performed: Ultrasound, MRI & additional blood work. All tests were normal.
At the end of my rope, I discussed gall bladder surgery with my GP. She thought it to be the most likely cause since I don't drink alcohol and had recently (8 months prior) given birth to my first child. I met with a surgeon a week later and he was convinced it was my GB. Three days later I had my gall bladder removed. This was six weeks ago (12/11).
Two days after surgery, I could tell the pain was still there. The doctors have run out options and are just feeding me random medicines to try to find something that will work. All the while, the pain is beginning to increase in severity and frequency yet again. Pain medicines (OTC nor hydrocodone) do not work. I have tried the following medicines: Pepcid AC/Complete, Prevacid OTC, Protonix, Dicyclomine, Carafate, Phenergan and random OTC pain meds.
I don't know what to do so have turned to you for another opinion on what to look for. The pain has been so severe this evening after eating Manicotti that I considered going to the ER. The problem is, it's an expensive visit just for pain relief and no long term resolution. I have not noticed any trend in foods that I eat and the pain coming or not. Pizza is fine one time --- kills me the next. The pain, a severe burning sensation, does seem to occur most often after I eat and seems to be more debilitating in the evening.
The only thing that semi-helps is bending and pressing on my stomach HARD. I can't stand up or hardly breathe deeply when the pain is occuring.
Bowel movements do not relieve the pain nor does belching. Stools are normal sometimes. Other times, diarrhea, foul smelling, green/brown. I don't know if this has anything to do with it or not.
Help please! I can't take care of my son.
I began having severe upper abdominal pain (directly under breast bone) in Sept. 2006. Doctors first thought it was gall bladder but blood and ultrasound were NEG. At first it wasn't bad, but began to increase in severity and frequency. On vacation for Thanksgiving in Florida, I went to the ER at Baptist Medical with severe abdominal pain (started after eating) - was admitted - and diagnosed with ACUTE PANCREATITIS. I was told that normal numbers for Pancreas were around 20-30... mine were over 2,000. I was put on an IV and not allowed to eat or drink. The following morning, about 8 hours after the first blood work, my numbers were down to 200-300. The doctors didn't know why I rebounded so quickly - but I was released in only 2 days. While at the hospital I was given the following tests: Ultrasound, CT Scan, and ERCP along with a lot of blood work. All tests were normal.
After returning from FL the pain returned days later. I was sent to a gastroenterolist and the following tests were performed: Ultrasound, MRI & additional blood work. All tests were normal.
At the end of my rope, I discussed gall bladder surgery with my GP. She thought it to be the most likely cause since I don't drink alcohol and had recently (8 months prior) given birth to my first child. I met with a surgeon a week later and he was convinced it was my GB. Three days later I had my gall bladder removed. This was six weeks ago (12/11).
Two days after surgery, I could tell the pain was still there. The doctors have run out options and are just feeding me random medicines to try to find something that will work. All the while, the pain is beginning to increase in severity and frequency yet again. Pain medicines (OTC nor hydrocodone) do not work. I have tried the following medicines: Pepcid AC/Complete, Prevacid OTC, Protonix, Dicyclomine, Carafate, Phenergan and random OTC pain meds.
I don't know what to do so have turned to you for another opinion on what to look for. The pain has been so severe this evening after eating Manicotti that I considered going to the ER. The problem is, it's an expensive visit just for pain relief and no long term resolution. I have not noticed any trend in foods that I eat and the pain coming or not. Pizza is fine one time --- kills me the next. The pain, a severe burning sensation, does seem to occur most often after I eat and seems to be more debilitating in the evening.
The only thing that semi-helps is bending and pressing on my stomach HARD. I can't stand up or hardly breathe deeply when the pain is occuring.
Bowel movements do not relieve the pain nor does belching. Stools are normal sometimes. Other times, diarrhea, foul smelling, green/brown. I don't know if this has anything to do with it or not.
Help please! I can't take care of my son.
Doctor's Answer
by Kevin Pho, MD, Jan 20, 2007 12:00AM
, Jan 20, 2007 12:00AM
You have clearly been through a comprehensive set of tests. The ERCP, MRI and CT scan can evaluate for many causes of gallstones or gallbladder stones.
In cases of refractory pancreatitis, gene mutations may be identified as a possible, uncommon cause.
There is some controversy as to specialized testing. Some have suggested Sphincter of Oddi (SO) manometry to evaluate for SO dysfunction.
Others have advocated for removal of the gallbladder.
Another option is to look outside the pancreas. For instance, upper GI disorders can present with similar pain. An upper endoscopy can be considered to look for these options.
These considerations can be discussed with your personal physician, or in conjunction with a GI referral.
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.
Kevin, M.D.
kevinmd_
In cases of refractory pancreatitis, gene mutations may be identified as a possible, uncommon cause.
There is some controversy as to specialized testing. Some have suggested Sphincter of Oddi (SO) manometry to evaluate for SO dysfunction.
Others have advocated for removal of the gallbladder.
Another option is to look outside the pancreas. For instance, upper GI disorders can present with similar pain. An upper endoscopy can be considered to look for these options.
These considerations can be discussed with your personal physician, or in conjunction with a GI referral.
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.
Kevin, M.D.
kevinmd_
Your symptoms are very similiar to the ones that i am suffering from.
But after 15 months of suffering, many blood tests, ct scan and mri scans the local hospital say i am suffering from IBS. I was told to go home and take pain killers.
I decided to seek help from a chiropractor and he diagnosed me has suffering from chronic pancreatitis.
He advised me to take pancreatin enzymes before each meal and 1 chromium supplement everyday.
I find these help alot to keep the pain under control, but I also have to control my diet and avoid fatty foods and wheat products.
I am still under investigation and seeking a second opinion to get a definate diagnosis.
Best of luck for the future.
I hope you eventually find a cure.
Alan