Abdomal pain

I was admitted to the ER for abdominal pain.  Pain was centered in chest at or just below the breast bone.  The pain was very severe. Abnormal labs were:WBC 16.0,Neutrophil % 80.4,Lymmphocyte %10.0,Monocytes1.2,Creatinine .78,Bili Total 1.1 ABD ultrasound and thought she saw a gallstone with sludge. 2nd ultrasound and no stones were seen but noted a polyp and sludge.  CT scan w/contrast was then ordered.Liver, spleen, adrenal gland, gallbladder, kidneys are normal .The pancreas appears hazy and there is stranding of surrounding fat. suggestive of pancreatitis.MRCP w/o contrast was ordered.All organs and ducts normal.Pain increase even with morpine but resolved to dull ache in 48 hours.My WBC came down.All other labs were normal except for increased Total Bili which went to 2.6 and then later down to 1.5 at time of discharge.Bili direct was .3 at discharge but was not taken prior.  All other LFT normal. Amylase and Lipase level both within normal ranges at 66 and 27.I am Not overweight.I have not had alcohol in 2 years but prior to that did drink. Over the past year and a half I have had a somewhat bothersome pain in my upper right chest area that felt similar to a side stitch you would get while exercising.  The pain would come and go often lasting for weeks.  I have lost 30 lbs over the last year..Lipids are almost normal with Cholesterol being 205 and LDL at 127. Triglycerides are normal. Recently eating fatty foods. Both the surgeon and GI felt the pancreatitis was probably caused by the gallbladder and recommended removal.I am currently on bland, no fat diet and a week later am free from pain.  
1.  Does this sound like a gallbladder problem to you?
2.  Would sludge cause pancreatitis?
3.  Should there be a concern about the polyp in the gallbladder?
4.  The doctor felt the increased biliruben was most likely caused by the pancreatitis and then increased  by  the morphine, your impression please?
5.  Any other recommendations you can think of?

[Kevin Pho, MD]

To answer your questions:
1) Gallbladder is certainly possible, although the imaging studies have been non-revealing.

2) If the sludge caused biliary duct obstruction, it can lead to pancreatitis.

3) Depends on the size.  Treatment can range from close observation to removing the gallbladder.

4) That is a plausible scenario.  

5) I would obtain a second opinion prior to removing the gallbladder.  An upper endoscopy can be considered to evaluate for other causes of your abdominal pain.

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.
www.kevinmd.com