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SLE cause of recurrent ABD pain
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MedHelp Member's Question

SLE cause of recurrent ABD pain

by nurseRN, Jun 17, 2002 12:00AM
Tags: pain, colitis, ercp
I am a 40 year old female with mild SLE X 15yrs. Never on steroids and no renal invovlment. Since early disease I have had episodic splenic flexure area, severe colicky pain, worsened by anything PO, assoc. with occassionally diarrhea, other times vomiting. These episodes are self resolving in 1-2 dyas with bowel rest.Flex sig was negative, flat plates show dilated loops when having pain. Recently I have had localized, hepatic flexure area pain with a clean gallbladder sono and no rise in LFTs. This pain also comes on suddenly, is colicky, localized, tender to mash on, worsens to extreme colciky pain 30 min after even fluids, is associated with nausea, obvious hyp0motility and malaise. After aprox 2-3 hours and being NPO except for sips the pain gradually decreases.CT of the ABD was essentially negative though there was some question of bowel wall thickening.  Question is; could this be recurrent, intermittent bowel ischemia from SLE???
Member Comments (20)

by XEMT, Jun 17, 2002 12:00AM
if its ok with your dr. try gas x and see if that stops the pain.what is sle? take the gasx when you first start hurting.

by taylee, Jun 17, 2002 12:00AM
I too wonder if I was having the intermittent ischemic pain, but from fibromyalgia and being too thin. The doctor said very thin people are more prone to it. I too have the same symptoms, but don't have SLE, (lupus) although my daughter tests positive=high ANA, no abnormal complement studies, so far.

I had the MRA, (magnetic angiogram to see if I had intestinal ischemia, and it was negative. It does hurt in the flexure areas, mostly hepatic, but once and a while on the splenic side.

I was then told I may have Sphincter of Oddi dysfunction, type 111 and need ercp to fully diagnose.

Not sure what is causing your pain and discomfort, but wanted to share my story, as I have similar problems.

Taylee

by Lor, Jun 18, 2002 12:00AM
I'm wondering if you ever had a Hida scan with ejection fraction done? A nonfunctioning gallbladder would cause this type of pain, also sphincter of Oddi Dysfunction. Unfortunatly SOD isn't found until after the gallbladder fails.

by taylee, Jun 18, 2002 12:00AM
To: lor
Can't SOD be present before the GB removal?

I think I had the same thing before the surgery, even though I thought it was something that developed afterwards.

Lor, you certainly are brave to get that ERCP!

Taylee

by Lor, Jun 18, 2002 12:00AM
To: Taylee
Yes, SOD can be present before. Some think this is what causes the gallbladder to go bad in the first place. That is only with a nonfunctioning gallbladder.

The ERCP is not as bad as some lead to believe. Yes, it does carry a risk, but doesn't everything? The more simpler ERCP is a lot safer than the more complicated ERCP with menometry. Unfortunately the simpler doesn't diagnose SOD. If this is the only way for someone to get rid of their pain. What choice is there? I couldn't see myself going on the way I was.

by Addie, Jun 18, 2002 12:00AM
I had a CT scan of the stomach last week.  They called and said I had dilation of the bile ducts, and something about extrahepatic and intrahepatic "something"



The radiologits requested to the gastro doc to order either a ERCP or a MRCP (cholangiopacreatiogram) plus a full abdomen MRI/MRA.



I went to a large teaching hospital and asked the radiolgosit if an MRCP is as good as an ERCP and he said, "it is better". And, this will pick up all the ducts and Oddie problems.  I am waiting on the results as I am typing this.  I feel there is something definatley wrong and perhaps a stone lodged in the cystic duct even though i had my gallbladder removed years ago.

by taylee, Jun 18, 2002 12:00AM
I was told that MRCP was not as good as ERCP and can NOT detect oddie problems or stones in ducts? Two different opinions?

LOR!

Can you answer this for us?

I had the MRCP and it was ok except for mild extrahepatic ductal dilation.

What does that mean?

Yes, and what choice in the end does one have except to do the test with manometry and find out once and for all?

Maybe I will get brave at the end of the summer.

Taylee

by Lor, Jun 19, 2002 12:00AM
To: Taylee
I have read that the ERCP is better than the MRCP. I believe the MRCP is done more like having an MRI. Where as the ERCP gets into the duct and then injects dye to look for obstruction. MRCP can't do that.

To have ductal dialation - you really should have an ERCP could be just inflammation. It could be something more like a cyst or small stone. The sooner you do it the better off you would be.

by Addie, Jun 19, 2002 12:00AM
I had an ERCP done in 1990.  It showed some dilation and the report states:  SOD on the 45 minute film most likely due to the administration of narcotic agent used in test.  I do not know if this was done with a mamomotry (sp)



I did not suffer any ill effects, i.e. pancreatitis with this test so perhaps I had a plain ERCP done.



I am still waiting to hear what the MRCP/MRI/MRA of the abdomen/bile ducts are, taken on Monday.  



I was also told that there are only a handful of radiologists in this city that know how to read the MRCP.  I had these tests done at a very large teaching facility. The draw back on these tests is holding your breath, sometimes up to 25-28 seconds as many as 8-10 times during these tests with the weight belt? stapped across one's abdomen.  I was told they did get very good clear pictures.



Waiting to hear something...........







by seashoretracks, Jun 19, 2002 12:00AM
I'm having an MRCP done next week at a large teaching hospital, so I am hopeful it will tell me something.  After that, my Dr. may be talking with me about an ERCP.  Taylee, I understand your concerns, and if I have to have an ERCP, it does make me a little nervous thinking about it.  However, if that is what it takes to get better, I hope I can do it.  It sounds like the plan ERCP maybe isn't so bad.  I have a friend who had one here at our small local hospital, and she had no problems at all.  I would not have done it here, but would rather be at a teaching hospital to do it.



By the way, with my fiend, it was right after gallbladder surgery that this happened.  She suddenly felt bad and her liver enzyemes were up, so they did the ERCP right away.  Didn't find anything, they determined that she has a fatty liver, but she has not had any problems since then.  I think she is avoiding very fatty food, but really is not on a restricted diet.  She seems to be able to eat what she wants and doesn't have pain.

by taylee, Jun 19, 2002 12:00AM
To: lor
Lor,

THe reason I really don't go forward with ERCP is because the Dr's tell me they really don't think they would find anything on the test, since I only had Chronic