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Gastroenterology (Expert Forum)
Connection Between Chronic Pancreatitis/Idiopathic and Liver Disease
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
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.
Connection Between Chronic Pancreatitis/Idiopathic and Liver Disease
by isoabch, Apr 30, 2007 12:00AM
I am a 51 yr. old mother of three daughters - ages 11,14, and 17. I work full time and 4 yrs. ago I was diagnosed with chronic pancreatitis of an idiopathic nature. I have recurrent stenosis of my biliary ducts and severe gastroparesis. My biliary ducts have been reopened several times in the past four years. I am careful about what I eat, no dairy, little or no fat, and no red meat. I don't drink alcohol and have never smoked or used drugs. I currently take the following meds: Protonix, Cymbalta, Provigil, Vicodin, Creon, and Excedrin PM which helps me sleep because of achiness. Without the Provigil, I cannot stay awake during the day and cannot function without it. I consume very little food, but continue to increase in size in my mid-section and my cholesterol has gone from 165 to 280 in 5 months. My liver enzymes have been elevated for approx. the same period of time and I am now very worried about what is going on. My urine and hands have a musty odor and my potassium level is often depleted -- I urinate frequently. I am not diabetic.
In addition, I have developed severe palmar/plantar hyperkerotosis which causes my feet to hurt, and my cervical spine has developed problems which cause severe neck pain and in my occipital nerves. Although my internist has recommended a 3 mile a day walk or riding a bike, in hopes of lowering my cholesterol, the thought of exercising make me feel ill because my bones hurt so badly. I have episodic falling where I fall for no reason -- my legs simply collapse under me.
Your thoughts on possible causes would be appreciated. I have started on a combination of the 20/30 diet and Weight Watchers in an attempt to lose the weight -- but I know that I have been eating under 1200 calories a day since I became sick 4 years ago.
Please help.
In addition, I have developed severe palmar/plantar hyperkerotosis which causes my feet to hurt, and my cervical spine has developed problems which cause severe neck pain and in my occipital nerves. Although my internist has recommended a 3 mile a day walk or riding a bike, in hopes of lowering my cholesterol, the thought of exercising make me feel ill because my bones hurt so badly. I have episodic falling where I fall for no reason -- my legs simply collapse under me.
Your thoughts on possible causes would be appreciated. I have started on a combination of the 20/30 diet and Weight Watchers in an attempt to lose the weight -- but I know that I have been eating under 1200 calories a day since I became sick 4 years ago.
Please help.
Doctor's Answer
by Kevin Pho, MD, May 01, 2007 12:00AM
, May 01, 2007 12:00AM
Difficult to say without examination.
Further evaluation of the elevated liver enzymes can be done with imaging, an ultrasound or an MRCP to evaluate the biliary ducts. I suspect that many of these tests have already been done. If the enzymes are persistently elevated or rising, a liver biopsy can be done for a more definitive diagnosis.
The increased urination can be due to infection and a urine sample should be done. Metabolic diseases like diabetes (which you said has been ruled out), thyroid disorders or diabetes insipidus (not the same as diabetes mellitus) can be considered. The latter disease can be evaluated with a water restriction test.
As for the cholesterol, I agree with the lifestyle changes. If this is not enough to bring the cholesterol down, medications like the various statin class of drugs can be considered.
These options can be discussed with 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.
Kevin, M.D.
kevinmd_
Further evaluation of the elevated liver enzymes can be done with imaging, an ultrasound or an MRCP to evaluate the biliary ducts. I suspect that many of these tests have already been done. If the enzymes are persistently elevated or rising, a liver biopsy can be done for a more definitive diagnosis.
The increased urination can be due to infection and a urine sample should be done. Metabolic diseases like diabetes (which you said has been ruled out), thyroid disorders or diabetes insipidus (not the same as diabetes mellitus) can be considered. The latter disease can be evaluated with a water restriction test.
As for the cholesterol, I agree with the lifestyle changes. If this is not enough to bring the cholesterol down, medications like the various statin class of drugs can be considered.
These options can be discussed with 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.
Kevin, M.D.
kevinmd_
I also have the increase in weight that is not the usual case with a chronic pancreatitis patient. Right now I am unable to eat anything and am on TPN at home via a PICC Line in my arm. Hopefully all of this will be a thing of the past after I recover from this surgery.
I hope you find some relief soon!!
There is a GREAT website for support for people with CP or family members.
http://www.eboards4all.com/692933/index.html
Try that! It has helped me SOOOOO MUCH!!!
People who have had pain and are experiencing pain