Question Title: Acute digestive disorder (chronic pancreatitis???)

A female friend of mine is about 48 years old and has some severe
digestive disorder - she does not seem to be able to eat most foods.
She gets a bloated stomach, has to endure severe pain and develops
a fever (with pain all over her body, including burning/irritating
eyes) whenever she eats most foods - nuts, fruits, juices, dairy
products, potatoes, foods with even little protein content and
all foods that are even slightly sour in taste. All that she seems
to be able to eat is plain rice with some boiled vegetables without
any spices and apple juice. She also seems to suffer from severe
constipation, at times (not always) but if she takes laxatives,
she gets severe stomach pain.
She has consulted many doctors - a few said it is an extreme
case of IBS, after performing several tests. One doctor said she
had duodenal ulcers that were mostly healed. One recent doctor,
however, did several tests and concluded that she has chronic
pancreatitis and that her pancreas has many cysts. He also said
he observed "fatty degeneration" in her liver. She, however, has
normal blood sugar (no diabetes) . He also diagnosed "anterior
mitral leaflet prolapse", though I don't know whether that's
relevant to her digestive problems.
She currently consumes a zillion pills before every meal,
prescribed to her by her latest doctor, presumably all enzymes
to compensate for her malfunctioning pancreas. However, even with
these enzymes, she's only able to consume the foods mentioned
above and she says it's getting worse day by day, i.e., the list
of things she can consume is getting shorter. Even those foods
she can eat do cause some trouble, but she says it's tolerable.

With so many conflicting opinions by doctors, would you please
state what your opinion is about the latest diagnosis? Is there
anyway she could be treated, if it is chronic pancreatitis, for
a complete/partial recovery? Is it possible to have chronic
pancreatitis without having diabetes/insulin problems? Why are
all those enzymes not helping her and why is she getting worse?
Since she's not able to eat most nutritious foods, can she take
vitamin or mineral supplements to compensate for lack of balanced
diet or would that cause problems if she has digestive disorders?
Finally, would she need to be/can she be fed intravenously if her
digestive problems worsen?

I know that's too many questions, but she's really suffering and
I would really appreciate any help you could give.

thank you very much,
rs
____
Dear rs,
As you realize from reading many of the other e-mails, abdominal pain is a difficult diagnostic problem. Chronuic pancreatitis should have objective findings that will support the diagnosis. Abnormalities that can suggest pancreatitis include elevated serum amylase and/or lipase (although can be normal in chronic pancreatitis), pancreatic calcifications seen on x-ray, abnormal pancreatic duct wioth multiple strictures and dilations seen at ERCP. or fat in the stool. Although many people with chronic pancreatitis have diabetes mellitus (sugar diabetes), one can have chronic pancreatitis without diabetes.

The specific etiology of your friend's digestive problems can not be gleaned from the information that you provide. It is safe to conclude that the mitral valve prolapse and the fatty liver are NOT the cause of her problems. Because of the symptoms of bloating and pain (?diminished appetitie), gastroparesis should be considered as a possible cause of symptoms. Ask the physician about the possibility of performing a gastric emptying study.

Intravenous nutrition can always be tried if your friend has profound weight loss and malnutrition, symptoms that you did not describe. It should be understood that nutrition via the gastrointestinal tract is the preferred and safer route.

This information is presented for educational purposes only. Always consult your personal physician for specific medical questions.

HFHSM.D.-rf
*keywords: diet, abdominal pain, gastroparesis, chronic pancreatitis
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