Pancreatitis -Gallbladder

I have had terrible pain in my front  right & left ribs & in my sides that wraps about midways in my back somethime under both shoulderblades on both sides for the last 2 years after eating with weight loss that has leveled off some. I have had one mild elevation of Amylase around 135 at the beggining of 2006. I had high triglycerides which are now normal.I have had continual elevations of Lipase around 320 throughout the last 2 years.  Every thing else has been pretty much normal other than a mildly increased ANA that has since been normal. Kidney Function & Liver function normal.I have had normal MRCPs & ERCPS . I am 34 & 180 lbs& have been diagnosed of Hemochromatosis for the last 10 years with a liver Biopsy with Mild Fibrosis & increased iron in 1998- I have maintained a low Ferritin under 20 ever since 1998  .Docs say that  this is not from Hemochromatosis.Ive had a Normal Abdominal CT scan.Normal small bowel series. Ct of Chest showed a couple of very small benign densities on lung .I have no Lung or breathing problems.Ultrasound showed small focus consistent with a polyp near the neck of my gallbladder & mild fatty liver.One doc said this Lipase might be from my kidneys & another one disagreed .One doctor suggested a sweat test for Cystic Fibrosis But Im not sure about this, & am kinda getting tired of going in the wrong direction.. One doctor recommended  some test called a Hida scan & said that he doesnt recommend these very often, but in my case he might do so .Another  Doc said he didnt even believe in these Hida Scans at all ,so Im not sure where to go from here with these different suggestions.Would this Hida scan be Beneficial or cause more problems ? Can the Gallbladder cause pancreatitis & do you think I even have Pancreatitis?.Any other suggestions?.I take Toprol, Protonix & Viokase.

[cudagirl]

Hello
I would ask your dr about a test for Autoimmune Pancreatitis.  I had the same symptoms as you descibe, and I was just diagnosed with this in the summer.  It is very rare in the US but they are running into more and more of them.  The only difference between you and I, is I had a mass on the tail of my pancreas, and they thought it was cancer.  It wouldn't hurt for you to check with your DR about this.  Because of your elevated ANA it is a idea.  The test is called IgG4. It is a simple blood test.  And yes stones from you gallbladder can cause pancreatitis.  Good Luck

[CalGal]

Do check on the autoimmune pancreatitis, but it also might be a good idea to have the HIDA scan with CCK injection. It's a fairly simple test. They use a 'tracer' molecule that slowly filters through the liver and incorporates into the bile. The bile then flows and fills the gallbladder. When they can 'see' it, they inject the CCK to stimulate the contraction of the gallbladder and follow it's flow and figure out how much you're ejecting. It will show whether or not your ejection fraction is 'decent.'

If you're producing small stones or sludge, it can irritate the common bile duct and cause problems with the pancreas. Most people typically have some form of discomfort or pain in the URQ when something like that is going on - or they feel like they have a 'ball' lodged under their ribs.

[Bryant7]

Thank you so much, for the helpful info. I have been to a Rheumatologist (wasnt that impressed with him) he checked  ccp Igg, is this the samething?I dont think he was looking for Autoimmune pancreatitis , I think he was looking for lupus or or something.
  What was your treatment?. Was your ANA elevated to? Mine has been normal some also.

[Bryant7]

CalGal,

      Thank you for the helpful info. I am just a little bit concerned that a lot of docs are not doing the Hida scans & relying strictly on the Ultrasound for Gallbladder disease. My concern is that if I fail this Hida Scan that it doesnt still mean that my gallbladder is the culprit & that I might get it taken out & worsen things.This is just my fear & it may not be justified.

[cudagirl]

My ANA was slightly elevated, but my IgG4 was off the charts. IgG4 is the specific marker for AIP.   My DR was surprised to see that I wasn't producing a lot of ANA.  I have been on treatment for Lupus since 2002, so that could have been why it was not that high.  The treatment is LOTS of steriods.  I hate taking them, but if I don't I will relapse and cause more damage to my pancreas and increase my risk of cancer.  Steriods are awful, but life saving as well.  You just have to take the good with the bad.  I hope things turn out for you, having stomach issues can be a pain.  Just listen to your dr, and don't be afraid.  :-)

[georgie439]

Hi Cudagirl: I  was really intrigued by your post abt. AIP.  I have had problems with pain in that area and have gone for soo many test , 2 ercp, mrcp 2 eus, and 3 ct scans, also blood tests for cancer marker!!
I read abt AIP but did yours show up in any films or images in the bile ducts, mine are dilated, I have been told that they are dilated and then narrow, off and on throughout the ducts???

Did you go to a liver/panc specialist or just a reg. gastro?  I ask because I would like for them to do this test on me, my gosh I had soo many others and they never did this simple blood test!!!

Please comment...........Denise

[cudagirl]

I went into the hospital last April with pain in my left upper quadrant, that wrapped around to my back.  If I laid down on my back it was really be bad.  My husband woke me in the middle of the night saying I was moaning.  The pain was awful and contiued to get worse until I went to the hospital about a week later.  They did a CT scan and ran several blood test.  My CT scan showed a mass (4mm) on the tail of my pancreas.  My lipase and amylase were slightly elevated.  I also had masses in my kidneys, which is a symptom of AIP.  My doctors at first thought it was cancer, and rushed me to a pancreatic cancer specialist in Seattle.  I had 2 ERCPs done, but they just showed nacrotic cells.  Because this disease is SOOOO rare in the US they didn't know at first what I had, but they didn't want to take any chances with me so they scheduled me for surgery.  My Gastro dr did some research, ran an IGg4 and asked me to wait 2 weeks and started me on steriods. My mass shrunk , and with my IGg4 test showing positive I was officallly diagnosed with AIP.  Thank God my Gastro dr did that test.  I would have had half of my pancreas and all of my spleen removed for nothing. My doctor told me that usually it shows in the head of the pancreas and affects the bile ducts.  It wouldn't be a bad idea just to ask.  There are several articles on the internet about it.  Look in Medscape.  You may have to register, but it is free.  Or just type Autoimmune Pancreatitis in your browser.  It will give you some info.  I'm sorry that I wrote a book here, but I just want to inform others of this so people won't suffer like I did.  Going through that period thinking I had cancer at 42 was really hard emotionally.

Hope this helps..........Pam