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Pancreatitis
I have been having discomfort in my stomach area, especially the right side, and back ache that moves up and down, since January. I have had ultra sound, upper GI, Endoscopy, CT scan, MRI, MRCP. Hida Scan, back xrays, and all the lab work, that includes blood test for pancreas and liver. They did find two side branch lesions about 1 cm each in the pancreas. The radiologist and my pancreatic specialist said they need to be monitored and no real concern at this time. The endoscopy found mild gastritis. All other test are normal.The pancreatic specialist did not mention pancreatitis at the time and only prescribed nexium and sulcrafate for the gastritis. I am 67, and never had a previous bout with pancreatitis. Moderate beer drinker. How should I be treated?
MEDICAL PROFESSIONAL
Hi!
I can understand your apprehensions regarding the lesions in pancreas. Side branch lesions are usually intraductal papillary mucinous neoplasms (IPMNs). However, depending on the image created they can also be benign lesions such as cysts, or cystadenomas or cancerous lesions such as adenocarcinomas.
If the side lesions are IPMNs then given your age and the slow conversion of these lesions into cancer in about 30% cases, a wait and watch approach is often adopted. Usually, for any given size of lesion (1 cm in your case) side branch IPMNs are less aggressive than main duct IPMNs in terms of conversion to cancer and hence a wait and watch policy is often adopted with regular screening with CT or MRI. Since all your lab works and imaging studies are otherwise normal and you never had any bout of pancreatitis before, a wait and watch policy is likely to be the best course of action for you. Also, the risk of surgery to pancreas is high, so since the side branch lesions are usually harmless, a wait and watch policy is adopted for most lesions less than 3 cm which do not cause dilatation of the main pancreatic duct nor have a solid mass or nodule within them. Sometimes, smaller lesions, as in your case, may need to be removed through surgery if they start showing irregular borders or grow further in size or cause main pancreatic duct dilatation or start causing symptoms.
Along with this, you are being given medications to control gastritis. Along with these a few lifestyle changes may help you to feel better. Life style changes that may help include: Drink cold milk at night or take a late night snack. Avoid heavy meals and eat frequent small meals. Avoid too much of caffeine, tea, smoking, fried food and drinks both alcoholic and non alcoholic fuzzy ones. Avoid heavy exercises within 4 hours of a heavy meal. Raise the head end of the bed by pillows to 30 degrees. Avoid lying down for least 2 hours after food.
Hope you find this information useful and it helps you understand your problems and course of treatment. Good Luck and take care!
I can understand your apprehensions regarding the lesions in pancreas. Side branch lesions are usually intraductal papillary mucinous neoplasms (IPMNs). However, depending on the image created they can also be benign lesions such as cysts, or cystadenomas or cancerous lesions such as adenocarcinomas.
If the side lesions are IPMNs then given your age and the slow conversion of these lesions into cancer in about 30% cases, a wait and watch approach is often adopted. Usually, for any given size of lesion (1 cm in your case) side branch IPMNs are less aggressive than main duct IPMNs in terms of conversion to cancer and hence a wait and watch policy is often adopted with regular screening with CT or MRI. Since all your lab works and imaging studies are otherwise normal and you never had any bout of pancreatitis before, a wait and watch policy is likely to be the best course of action for you. Also, the risk of surgery to pancreas is high, so since the side branch lesions are usually harmless, a wait and watch policy is adopted for most lesions less than 3 cm which do not cause dilatation of the main pancreatic duct nor have a solid mass or nodule within them. Sometimes, smaller lesions, as in your case, may need to be removed through surgery if they start showing irregular borders or grow further in size or cause main pancreatic duct dilatation or start causing symptoms.
Along with this, you are being given medications to control gastritis. Along with these a few lifestyle changes may help you to feel better. Life style changes that may help include: Drink cold milk at night or take a late night snack. Avoid heavy meals and eat frequent small meals. Avoid too much of caffeine, tea, smoking, fried food and drinks both alcoholic and non alcoholic fuzzy ones. Avoid heavy exercises within 4 hours of a heavy meal. Raise the head end of the bed by pillows to 30 degrees. Avoid lying down for least 2 hours after food.
Hope you find this information useful and it helps you understand your problems and course of treatment. Good Luck and take care!
Dr Kokil, duriimg my barium test, the radiologist reported a finding that I had a organoaxial malrotation. My GI did the endoscopy and said I did not have a malrotation. Which test is better? And if I do have a malrotation, would that explain my symtoms?
MEDICAL PROFESSIONAL
Yes, possible but cannot say for sure.
Since I had every test under the sun, is it safe to say I do not have any organ in the digestive system that has inflammation, other than the stomach, which does show mild gastritis.
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