Do I need a second opinion?

[thomasthecat]

I am 34 year old female who was hospitalized with my first bout of acute pancreatits a 5 weeks ago. Elevated amylase and lipase, and ultrasound confirmed non-gallstone pancreatitis. Alcohol trigger suspected as other common triggers ruled out. I was released after 5 days later with still elevated enzyme levels, but clinically doing much better. I followed up with the attending weekly and labs continued to show elevated enzyme levels close to 3X normal range. CT scan 2 weeks ago confirmed existence of pancreatitis with no biliary obstruction. I saw a gastroenterologist yesterday who re-did labs and ordered an MRI/MRCP to be taken in three weeks to give a chance for pancretitis to resolve. Clinically I feel extremely fine, but I have changed by diet considerably since hospital stay -- no alcohol and very light, non-fat foods. Questions: (1) if there is a biliary obstruction (e.g., sludge/crystals in gallbladder) will pancreatitis resolve without removal of obstruction?; (2) Is MRI/MRCP the best way to rule out obstructions not observable on CT scan/ultrasound or other physical triggers?; (3) What other causes might the procedure uncover?; (4) What's the next step if this procedure does not uncover any causes?; (5) Should I seek a second opinion from another gastroenterologist to confirm that the MRI/MRCP is the best course of action at this point?

[Kevin Pho, MD]

To answer your questions:
1) If there is a biliary obstruction, it is unlikely that the pancreatitis will resolve - although this will depend on the degree of obstruction.

2) The MRCP is a very comprensive test to evaluate the biliary tree.  

3) Essentially, it will look for any blockages and obstruction in the biliary tree as well as imaging the pancreas.  

4) An MRI or endoscopic ultrasound of the pancreas can be considered as the next imaging steps after MRCP.  

5) Obtaining a second opinion can always be considered if you are not comfortable with the course of action.

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.
http://www.straightfromthedoc.com

[JRRR]

This sounds like my case as well.  I just had another blood test, and the results are normal Amylase and laplase, however a high level of trypsin
I have no pain.  I was first admitted to the hospital last October with back pain and nauseas.  Blood test showed high amylase and laplase close to 2000.  I had CT scans MRI’s Liver tests ultrasounds, all showed normal functioning.  I had one more hospital visit a few months later and was back to normal.  
The doc now wants to do an ERCP.  I’ve read about the test and all the results are bad.  Has anyone ever had positive results from getting an ERCP?
I’m not sure I want to have this.  I’m male 48 and don’t drink enough to have this a the problem.