Possible Chronic Pancreatitis???

[judibry]

41 F 5'6" 170#. 2 yrs of moderate Vicodin usage d/t DDD. smoker,nondrinker  Acalculous cholecystitis Removed 3 yrs ago (7% function).  >1 cm colon polyp removed '04 (father died of liver/colon cancer).  In March had upper & lower GI, beginnings of Barrett's and diverticlitis.  Chronic diarrhea for over 4 wks (mucus,fatty), lost 20 lbs, couldn't eat much, severe mid abdominal and back pain.  Slight elevation of amalayse and white count.  Dr sent me to hospital poss d/x pancreatitis.  Cat scan normal.  ER Doc d/x gastritis.  On Levbid & Previcid.  
Over last 2 wks, vomiting, every 3-4 days, several times in a row.  Emesis ranges from undigested food that had been eaten up to 8 hrs prior to green/grey fluid.  Always nauseated. Appetite erratic- some days I can eat, others not.
Also now severely constipated.  If I use an enema, I have a hard stool with a small amount of blood.  If I use a laxative after not going for many days, I have one huge BM that's light brown/grey, very hard to start off but then slightly loose, small amount of frank blood.
Mid back and abdominal pain constant ranging from a 3 to a 9.  Severe itching all over body.  Trouble sleeping.
No bm for 4 days, so I took a laxative last night.  No results but vomiting green/grey fluid again.
Due to see Doc on Monday, but I may move up appt.
Everything does seem to point to chronic pancreatitis...
Any suggestions on tests to do? or other possible dx?

[Kevin Pho, MD]

A negative CT scan will make chronic pancreatitis less likely.  

However, with the itching, you can consider other liver disease, such as primary biliary cirrhosis.  

Blood tests such as liver function tests (specifically the alkaline phosphatase), as well as autoimmune antibodies would be helpful.  

A liver biopsy can be considered if this diagnosis is still suspected after the blood tests.  

As for the other symptoms, you can consider both an upper and lower endoscopy (more comprehensive than an upper or lower GI).  The upper endoscopy can evaluate for ulcers or obstruction that can lead to the nausea.  The lower endoscopy can evaluate for any pathological source of bleeding.

These options can be discussed with your personal physician.

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

[judibry]

Followup....
Ended up going back to ER d/t vomiting and pain.  Dr there couldn't get past low term narcotic use.  Didn't want to hear anything else, blamed all symptoms on meds and sent me home.  What a waste of time and money.
Cat scan shows enlarged spleen and notes a small hemithorax lipoma that wwas not clearly visualized due to limits of scan.

Family Doc thought that the gastro DR had followed up and scoped me, so he was upset it hadn't been done yet.  Will have endoscopy as soon as scheduled.

[charchar]

Sorry to hear you are feeling bad. If it is pancreatitis then get ready to hear ALOT more of the blaming of the meds and the not believing you when you tell them you are in pain. Been there done that. It is the most awful thing that I can imagine. My daughter went through the same exact thing. vomiting and severe pain  and elevated enzymes that kept her in and out of the hospital . But there is hope. Keep looking for the right dr. that will believe you . They are out there. It took us 10 months of pure ---- ! But we found someone that believed her and she now has had a tp\ict and doing great . If you want any info on pancreatitis there is a web site that will tell you everything you need to know. People on there are either going through pancreatitis  at this time or they have had some kind of procedure that has gotten them over this.Just let me know and I will be glad to post it.

[malcom]

Hi Charchar
i am in a lot of pain for the last 2 yrs, i did all kind of tests there is with normal result, can u tell me what your daughter did for her, what is "pain tp\ict and doing great mean" what kind of tewst or procedure is that.
thank you.