Problems with the old pancreas...

[lemonhead]

I am a 39F. Was hospitalized in December 02 for acute pancreatitis for six days. Had the usual care -- NPO, IV's, demerol etc. When I was admitted, my serum lipase was 38,000 and amylase 1500. Now, eight weeks later, my amylase is back to normal, but my lipase is still elevated. Nothing like the 38,000 but it's 700. I'm on Pancreas 8 weeks-- no change in levels yet.

Med History: this was my second bout of pancreatitis. Last one was in 1998 which led to a lap chole a few months later. I don't drink. I don't abuse drugs. I am thin. I eat a low-fat diet (especially now). I work out. I don't take any other medicines.

I went to a GI doc who sent me to have an MRCP. It came back ok but then another radiologist read it and found a beaded dilated pancreatic duct and a cyst in my pancreas. Obviously, no one knows if this cyst is a pseudocyst or a cystic neoplasm at the moment, but I'm having an EUS and perhaps a ERCP next week.

I am also going through tests to see if i have an auto-immune disease, since my thyroid antibody test came back high and my ANA was "significantly elevated". (Waiting for results of all those Ai tests today.)

I have a few questions:
a) What is the likelihood that my pancreatitis was caused by an auto-immune disease?
b) What is the treatment for a pseudocyst? Mine is not too big - 2.5cm x 1.5 cm. Wait and see? Fine needle aspiration?
d) Should I worry about cancer?
c) What is the likelihood that I have chronic pancreatitis? In which case, what is the treatment and outlook for someone with that?

Sorry this is so long. Thanks
lemon

[Kevin Pho, MD]

Hello - thanks for asking your question.  You have asked several questions that require a lot of detail.  I will discuss some aspects of your question here - if I don't touch on all your points, please re-ask them at the next opportunity.  

1) Pancreatic pseudocysts
Pseudocysts develop in approximately 10 percent of patients with chronic pancreatitis. They arise in areas of inflammation and necrosis, where fluid accumulates in regions of exocrine cell loss. Pseudocysts may be single or multiple, small or large, and can be located either within or outside of the pancreas. Most pseudocysts communicate with the pancreatic ductal system and contain high concentrations of digestive enzymes.  

It used to be thought that drainage was indicated if they become greater than 6 cm in diameter or persisted for more than six weeks. However, that approach was challenged by studies which found that pseudocysts can be safely followed up to one year and up to 12 cm in size. Indications for drainage include rapid enlargement, compression of surrounding structures, pain, or signs of infection. Endoscopically derived pancreatograms may be helpful prior to drainage to rule out a stricture of the pancreatic duct which can lead to persistent drainage from the pseudocyst.

2) Pancreatitis and cancer
There are some data suggesting that patients with nonhereditary chronic pancreatitis (both tropical and nontropical) are at increased risk of developing pancreatic cancer. The total risk reached 1.8 percent at 10 years and 4 percent at 20 years, independent of the type of pancreatitis in one study.

I have not touched upon autoimmune pancreatitis and the diagnosis and treatment of chronic pancreatitis.  I hope that you can understand that I am limited in the amount of time I spend on each question in this forum.  Please feel free to ask these points again at the next opportunity, or you can utilize my fee-based medical information service.

In the meantime, please see the resources below - they should be able to help.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Other resources:
National Library of Medicine
       (http://www.nlm.nih.gov/medlineplus)

National Institute of Diabetes and Digestive and Kidney Diseases
      (http://www.niddk.nih.gov/)

American Gastroenterological Association
      (http://www.gastro.org/)

National Pancreas Foundation
      P.O. Box 935
      Wexford, PA 15090-0935
      (http://www.pancreasfoundation.org)

[TazLady]

Hi,

I have Severe Chronic Pancreatitis.  And just wanted to tell you that my heart goes out to you.  I live a fairly normal life.  I know that I will have pain in some form for the rest of my life.  I know that diabetes will probably be in my future at some point.  I have been through so many surgeries for this that when I feel like giving up I read about and talk to others who are more sick than I am and it gives the strength to go on.  That and my families support.

I have been lucky to not have any cysts yet.  But I know of a website for pancreatic sufferers and there are plenty of people on there that will know exactly what you will be going through and what the options are for you.


www.pancreatitis.org.uk    Click on communuty and then on new forum.  Post your message just as you did here, word for word and you will get plenty of replies back.  There are many knowlegable people on that site.  We all suffer from pancreatitis in one form or another.  NO ONE on the site is a doctor.  Just other people going through the same thing your going through.


As far as cancer goes...if your a smoker and it turns out that you  have herditary pancreatitis, your chances of getting pancreatic cancer are 40% higher than those of someone with idiopathic or other forms of the disease.  I have idiopathic pancreatitis but quit smoking cold turkey when I read that.  Also I just had a CT Scan which, from what I was told, is one of the most effective ways to find pancreatic cancer.  Mine came out with a clean bill of health as far as cysts, cancer, or other problems goes.

Go to the other website and post.  You will get answers to your questions the same day.

Good luck to you,
TazLady

[lemonhead]

Thanks for your comments, Tazlady. Yes, I've read a lot about CP and it sounds like it's one tough disease to have. :-( So I'm sorry you have it.

I forgot to add that I'm not a smoker. Never have been. Always been very athletic and so it doesn't really go with that lifestyle.

Thanks for the UK pancreatitis website. I checked it out and left my message. Will have to wait and see.

Thanks again. I appreciate your response. Take care.

lemon