Pancreas, Gallbladder or Something Else?

[Jimbo3]

I am a 32 year old male, who is relatively healthy other than mitral valve prolapse, which moderate excercise seems to help, and GERD/Acid Reflux, which Aciphex or Prevacid have both helped over the last few years.  I have a high stress job in a high stress industry, and I've worked tons of hours over the last six or seven years with only a handful of "real" vacations.  There is a history of pancreatic cancer in my family (my father and his brother were diagnosed and died from the disease in their fifties).  A few months ago, I started experiencing lower right abdominal pain before and after defecating.  The pain was very minor and seemed more like gas or cramps.  I also experienced an increase in flatulence and belching after meals (more than my usual).  I became concerned about a month ago when I had troubling defecating and the pain started to last longer.  I was constipated for almost two days, had pain, no real appetitie and a little bit of nausea.  My body temperature was normal the whole time.  I eventually relieved myself with a laxative and headed stratight for the doctor.  The doctor acknowledged that my lower right quadrant was "very tender."  He thought it might be IBS or maybe even Chrons or Colitis.  Due to my family history, I had CT scan of my entire abdomen, which showed no abnormalities other than the presence of lymph nodes.  I was informed that the nodes were "just present" and they showed "no signs of being swollen or enlarged."  The doctors suggested that I might be figting some type of virus in my abdomen.  The ascending colon showed some minor inflammation.  I followed up that test with a colonoscopy, which was normal (no polyps, tumors, infection or signs of colitis).  I started adding more fiber to my diet, including citrucel, and my regularity returned; however, the pain and tenderness still persisted (it was sometimes more severe and would move more towards the middle of my stomach, almost like somebody punched me in the stomach).  My stools have varied from brown to light brown and "seemed" lighter or pale when I would try to take on fatty foods.  I had diarreah or passed loose stringy stool only once or twice during the last month.  Although the rest of my stools felt and appeared solid, they seemed to break apart easy when I flushed (I don't know if that means anything?).  I returned to the doctor and had Upper GI with small bowel that turned out normal.  I also had an ultrasound of my liver, pancreas, gallbladder and kidneys, which showed nothing unusual.  Stool samples were tested for blood or bacteria and came back negative.  I took a blood test for pancreatic cancer and pancreatitis, and I was told that both tests were negative and that my "enzymes were perfectly normal."  I'm very worried about pancreatic cancer and wonder if I've taken enough tests to this point.  Is there any chance this could be gallbladder?  I've had some minor back pain upper and lower, but it doesn't keep me up at night.  Please advise...

[Kevin Pho, MD]

Surgeon has kindly addressed your question in his comments below and I agree with his assessment.

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.

Thanks,
Kevin, M.D.

[surgeon]

the pain pattern does not suggest gallbladder. With a normal gallbladder on ultrasound, it's highly unlikely to be the source of your symtoms. Likewise, pancreatic cancer nearly always would show up as a mass, visible on ultrasound or CT scan, especially if it were causing pain. And when it does cause pain, it is usually upper mid abdominal or back pain. So what you describe remains undiagnosed but seems highly unlikely to be related either to your gallbaldder or pancreas; it might, by a process of elimination (no pun intended) to be in the irritable colon category (irritable bowel syndrome, IBS).

[Jimbo3]

Thanks for your comments.  I recently had a Hydascan (a test on my gallbladder), which was normal.  Overall, I've been feeling better since I've been excercising, eating healthy (very little fat and alcohol and no grease or spicy foods) and keeping the stress level down.  However, my stools are still occasionally pale or clay colored.  For example, I had three days in a row of normal color (dark brown) stool that didn't float and sank to the bottom of the bowl.  Yesterday, following dinner, I became angry with a family member, got stressed out and had pain and cramps all night (pretty much identical symptoms I described in the above posting).  I didn't have diarreah at any point, but this morning my stool was pale/ligh clay colored and some of it floated in the bowl.  It seems that pale stool color occurs at least a couple of times a week.  Is there any corelation?  Can stress and anxiety disrupt digestion that much?  Two nights before that I experimented and ate a T-Bone steak and apple pie with ice cream, and the next day my stool was normal. I also had no cramps or indigestion.  What gives?  I have no symptoms of jaundice.  Can pale stool be the result of anything other than pancreas or liver issues?  My doctor doesn't seemed to be too concerned about pancreas issues, but I am due to my family history.  Should I take anymore tests?

[debinlost]

I have very high ast(sgot)levels too 331. I have a clear ct scan. They think it is pancceatius. I hope you feel better

[Jimbo3]

Kevin, can you please reply to my last posting.  Also, in reference to the last comment... what is "ast(sgot) levels" and the number "331" mean?  What is "pancceatius"?  Did you mean pancreatitis?  I had a blood test that measured pancreatic enzymes and it was normal.  Were you referring to some other type of test?

[LoriP]

Jimbo,
AST is an enzyme found in organs such as the heart, liver, muscles, and pancreas and if it's elevated it could indicate inflammation of such organs.  The test is usually done with ALT, another enzyme test.

Have you been tested for celiac disease.  I only ask because I read something that mentioned celiac and clay colored stools with abdominal pain and many of the symptoms you described.  I highly suggest you ask your doctor.  Celiac is a gluton intollerance disease.

I also suggest that you get a hard copy of your blood tests and check them for yourself.  Many times they will come back normal but a little on the high-normal side which could indicate problems.  Check your results and look up those results on the web.

I only suggest this because I have been having many gastrointestinal problems for the last year and I had to do my own research to find answers.  IBS should be the last resort diagnosis.

Good Luck,
Lori

[lashonda]

My Dad has been diagnosed with Pancreatic Cancer. They have yet to start him on chemo/radiation. We have an appt at Duke on Monday to go over the dynamics of the treatment that he will be taking. He had his liver functions ran at his family doctor on 2-2-04. His reading showed AST (SGOT) at 66 and his ALT (SGPT) at 124. I was wondering if you could tell me what this means and if it should cause great concern.