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Gastroenterology (Expert Forum)
Need Guidance regarding Idiopathic Pancreatitis
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Need Guidance regarding Idiopathic Pancreatitis
by SaraB, Oct 06, 2002 12:00AM
My husband is 29, non-drinker, non-smoker, fairly good shape, no cholestral, no family history of pancreatitis. One day he experienced severe abdominal pain. At the ER, a CAT scan, resulted in an "inflamation of his pancreas," and consequently admitted to the hospital. A triple lumen on his chest was inserted, the past three weeks he has not had a drop of food and liquid (except ice chips).Daily blood tests and blood cultures taken.
Week 1: Severe pain, majority of pain on left and lower middle of his abdomen
Abdomen physically bloated, hard,tender.
Given antibiotics,(even though no sign of infection)
Fever, excessive sweating, cold sweat, nausea (given anti-nausea medication), difficulty breathing, high pulse
Week 2: Second CT scan showed pancreas actually grew and much bigger than the first CT, however the fluid around the abdomen had lessened.
Pain is focused on the left side of his abdomen.
Sugar levels are high, given insulin
Placed on extra fluids, excessive sweating
Week 3: Fever broke
High Blood sugar, given insulin
Abdominal pain on left side, stomach alittle softer, less tenderness
Feels hungry and very thirsty
Extremely week, no energy to move or speak
Extremely dry throat, almost lost his voice
Restless, feels like inside his body is extremely hot,
Stomach feels on fire, given pepcid
Amylase and lipase levels coming down from 300, to 68 for amylase
It has been 3 weeks, and there doesn't seem to be much improvement, what can we do?Can you tell me more about the fluid, where it comes from and goes? Enzymes and levels? Fluid inside the pancreas?
Week 1: Severe pain, majority of pain on left and lower middle of his abdomen
Abdomen physically bloated, hard,tender.
Given antibiotics,(even though no sign of infection)
Fever, excessive sweating, cold sweat, nausea (given anti-nausea medication), difficulty breathing, high pulse
Week 2: Second CT scan showed pancreas actually grew and much bigger than the first CT, however the fluid around the abdomen had lessened.
Pain is focused on the left side of his abdomen.
Sugar levels are high, given insulin
Placed on extra fluids, excessive sweating
Week 3: Fever broke
High Blood sugar, given insulin
Abdominal pain on left side, stomach alittle softer, less tenderness
Feels hungry and very thirsty
Extremely week, no energy to move or speak
Extremely dry throat, almost lost his voice
Restless, feels like inside his body is extremely hot,
Stomach feels on fire, given pepcid
Amylase and lipase levels coming down from 300, to 68 for amylase
It has been 3 weeks, and there doesn't seem to be much improvement, what can we do?Can you tell me more about the fluid, where it comes from and goes? Enzymes and levels? Fluid inside the pancreas?
Do a search on the web for acute Pancreatitis for more information than you can read.
Then do one on Chronic Pancreatitis and see the differences.
Hope things improve.
Spike
Your husband is receiving the standard medical treatment for a severe acute pancreatitis attack. Often severe cases can take several weeks to subside. The doctors are controlling his nausea and replacing his fluids and allowing the pancreas total rest by restricting solid food. The antibiotics were given as a safeguard in case any infection resulted from his attack. This, too, is standard procedure after an acute attack. It looks like they are keeping his nutritional needs met, and his enzyme levels have calmed down to a normal level.
Now it is just a waiting game. Your husband appears to be in good hands. The doctors will need to determine the cause of this attack once your husband regains his strength, so they can counsel him and treat him on what to do to prevent further attacks. Post again if you have any specific questions.
Nanny
This is a cut and paste from a medical resource which explains the fluid collections:
There is a lot of confusion about the definitions and management of acute fluid collections in acute pancreatitis, approach to diagnosis and the management policy to be followed. The present article defines the fluid collections and presents a rationalised policy about the various diagnostic and therapeautic modalities in the management of fluid collections.
Definition
According to the Atlanta international symposium1 in 1993, acute fluid collections are defined as the collections which occur early in the course of acute pancreatitis and are located in or near the pancreas and always lack a wall of granulation or fibrous tissue. They are found in more than 50% patients with moderate to severe pancreatitis. They represent a serous or exudative reaction to pancreatic injury and inflammation. Since acute fluid collections do not have a communication with the pancreatic duct, they do not contain high concentration of pancreatic enzymes and the fluid composition is similar to that of plasma. Table 1 gives the differentiating features between the acute fluid collections and acute pseudocyst.2
Natural history
Majority (85%) of fluid collections resolve spontaneously, however few persist, get walled of and develop into pseudocyst over 6-8 weeks. Fluid collections are frequently found along the anterior surface of the gland.3 The fluid may perforate into the lesser sac or extend beyond the pancreas into the anterior, posterior pararenal space, conforming to the space of the compartment. When the fluid escapes from the lesser sac into the greater peritoneal cavity through the foramen of Winslow, it produces pancreatic ascites. More commonly lesser peritoneal sac fluid escapes into the fissure ligamentum venosum, that separates the caudate lobe of liver.
Presenting symptoms
Majority are asymptomatic by themselves and detected on followup imaging during the course of acute pancreatitis. However a small percentage of patients do become symptomatic and may produce :
1.Upper abdominal discomfort due to large collections.
2.Compression of the GIT e.g. stomach, duodenum producing fullness or vomiting especially after meals.
3. Sudden onset pain, increase in size of lump, associated with fall in haemoglobin due to bleed from pseudoaneurysms of adjacent vessels.
4.Pain and fever