Re: Could this be my pancreas or what causing my pain?

[gsue]

I have been experiencing extreme pain under my right rib that radiate towards my back for sometime. On Tuesday it became severe and I went to the ER the ER doc said it was gasttritis/pancreatitis Amylase normal, lipase 306, 52segs, 36 lymphs, 8monos, Alkaline Phos.148,mch 31.5.  However, when I went to my gastro doctor he insists that there is nothing wrong gastro wise because he had done an endoscopy,and EUS 1 week before the ER visit and there were no stones and everything was fine so my right side pain must be caused by kidney stones or something else.  Last time he had told me it was IBS or posibly my kidneys but because it was so severe this time it was my kidneys.  I'm a little confused though isn't unusual for a person to have elevated liver enzymes? Mine have been slightly elevated for sometime now not just this time.  I know I have a fatty liver but could that be causing some of this problem?  Everytime I eat or drink anything my stomach hurts on the right side just under the right rib.  Well, it hurts anyway but it hurts worse if I eat or drink something.  I'm at my end and no one here can seem to find out what to do.  I can't even figure out what kind of doctor to see any more.  Please tell me what you think.  Hope I haven't been too confusing for you and that I've posted my question correctly. Thanks!  Oh yes, the question everyone asks, I don't drink or do drugs so this not my problem.I took Zocor and cholestoral medicines for a while and they seemed to have messed up my liver enzymes and liver for a while could that still be what is happening, it's been over a year?

[Kevin Pho, MD]

Hello - thanks for asking your question.

Your lipase is elevated.  An elevated lipase is fairly specific for pancreatitis.  To further evaluate this, I would obtain a CT scan to evaluate the pancreas.  If there are positive findings, an ERCP or MRCP may be considered to see if the biliary tree is normal or if a blockage is causing the pancreatitis.  

You note a normal endoscopy - this would make dyspepsia (i.e. ulcers or gastritis) less likely.

Another test to consider would be a CCK scan.  This can measure the gall bladder ejection fraction.  If low, then there is a possibility may be acalculous cholecystitis - which can cause your symptoms without having gallstones.  People who have low gall bladder ejection fractions may require removal of the gall bladder to improve symptoms.  

In summary, I would pursue an abdominal CT to evaluate the pancreas.  If negative, I would consider a CCK scan - discuss these options with your gastroenterologist.  

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 name of the scan referred to above is a HIDA scan (which is the radioactive stuff they inject); CCK is usually given during the scan, because it causes the gallbladder to contract, which can be useful in allowing to see how it functions, and also to see if contraction causes the symptoms in question.

[gsue]

I guess I forgot to mention that I had my gallbladder removed already 2 years ago. Thanks I ended up having the ERCP done because the CT showed the ducts to be dialated.  This was done on Sunday and I was released from the hospital Wednesday. However, I'm surprised that my back area seems to still hurt but so far I'm thinking it is probably normal or because I tried to go back to work today. Nice to know I did the right things though so thanks.

[TESSALOU]

My daughter is in the hospital right now for similar pains. Abdominal pains that center on right side close to the belly button and radiates thru the back. She has been in the emergency room numerous times with the same thing. She has gastro bypass surgery 2 years ago, her gall bladder removed 1-2 months after the gastro bypass and kidney stones approx 3 months ago. Since the gastro bypass surgery, she has had problems with not being able to eat without becoming sick, abdominal pains so severe that they double her over, constipation and diareha. She has seen several different doctors and has had an endoscopy twice with nothing being noted. She will be released from the hospital today with no answers to this condition (once again). We are at our witts end trying to find a doctor who will take the time and interest to help her find out what is wrong. Intially she was told that an ultrasound showed her pancreas to be inflamed as well as her lower intestine, but no tests were run on these. I am looking to find a doctor who can help us.

If anyone knows of a doctor in the Houston TX area I would appreciate their name(s).