Bizarre symptoms

Three years ago I began having episodes of severe chest pain/vomiting/sweating that would come on and not let up. Episodes last anywhere from a few hours to a several days. It is not intermittant pain it is constant. Ultrasound showed one stone. Two years later I underwent cholecystectomy. I am still having these attacks every few months. I finally went to the ER and my test results were AST 378, ALT 441, Troponin .10, Abs NEUT 9.0, dilated pancreatic duct. Follow-up ultra-sound and labs showed enzymes were normal, pancreatic duct was normal, common hepatic duct now dilated. Follow up MRCP showed no stones. Had a CT scan after another attack which showed intraheptaic ducts were now dilated and the others normal. Enzymes WNL. CT scan says it can not rule out a cyst in the common duct. A little history: I am a recovering alcoholic with fatty liver who was sober during these attacks. Also, my mother died from pancreatitis and liver disease which led to pancreatic cancer. There was an onset of other symptoms around the same time this started. I don't know if it is related but I will give you all the info in hope of it helping. Peripheral neuropathy. The saddle and perineal anesthesia went away but I still have pins and needles in bilteral legs and feet. Adrenal mass, extra-renal pelvis found on tests. Also during the midst of all of this I began having trouble swollowing. CT scan of the neck showed a large amount of reactive nodes. The doctors are clueless to what might be going on. Possibly more than one thing. I feel like I am being blown off because no one knows the answer. I hope you can help me.

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation with the MRCP and ultrasound.

You can further evaluate the dilation of the hepatic duct with an ERCP - which can be more sensitive than the MRCP.  However, this is a more invasive test and can lead to pancreatitis.  The ERCP can also be coupled with a Sphincter of Oddi manometry - which can detect possible Sphincter of Oddi dysfunction.

If the tests continue to be non-revealing, you can consider a liver biopsy to further evaluate the elevation in liver enzymes.  

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_b

[NickyIsHere123]

Was the neuropathy there before the gallbladder was removed?

If it was not, then there is a possibility that during the operation, a nerve was damaged.

[NickyIsHere123]

You might want to request a stress test too. Checking out your heart is where i would start if I were you.

[georgie439]

I hope you e-mail me at ***@****

[georgie439]

sorry I hit the post tab on accident, but I have so much in common with you it is weird!  I have had ercp last month although they did not check pressure, I dont know might have it again, because taking narcotics (opiate pain killers) for the pain does make it worse and this can be a sign of sphinctor of oddi!!  I hope I hear from you. I had my gb out 3 yrs ago!