Septic Shock/Acute Pancreatis

[sharon__0__0]

  My mother was experiencing back pain and not feeling well for quite some time.  In October '97. Blood and Urine work was run and it was detected that her Total Bilirubin was elevated @1.13, platelet count 136., Bun 33. and Bun/Creatinine Ration 36.7. Her Urine indicated protein1+ Blood 1+ WBC30 and RBC 3-5.  She was sent for a CT scan and Ultra sound both indicated a "promience of the head of the pancreas measuring 3.52 x 3.69cm.  A ca19-9 test was order her level was 59.2.  Nothing happened after that.  She continued to get very tired, sleeping most of the day, lost her appetite and had back pain constantly.  She continued to push on although it was getting harder and harder for her to breath, as she had pulmonary disease from chronic bronchites.  In April we began to notice a change in her mentally, as if she was not getting enough oxygen, her eyes would become glassy and she would say very funny things.  She was leaving for a 50th Anniversary vacation to the Netherlands and went for a followup check up to her doctor.  More blood work was done, total bilirubin 2.21, direct bilirubin .39, LD 269, cholesterol down to 130, no urine work up done, her uric acid was always high she had tophi on her hands and elbows as she had been taking diuretics for many years do to hypothyroid probelm.  She had also developed a cough in April and thought she was getting bronchitis.  She left for vacation.  Within days she could no longer breath well and became completely disoriented and began gasping for breath was rushed to hospital in the Netherlands were she had multiple organ failure and went into a coma.  She was hypothermia very low blood pressure and a fever of over 106.  It was determined almost immediately that she had septic shock with her liver and pancreas enzymes #s in the 2400's and 3900s.  They continued to come down but she went into cardiac arrest three times in forty minutes.  She remained stable with life support but did not recover from the hepatic coma and was declared brain dead well into two weeks of staying in that state.   In the end her Dir. bil came down to 16, LDH down to 493,  SGPT 48 SGOT 47 Na146 Alb 12 and AF was at 53.  I quess my long winded question is, is it possible that she could have had pancreatic cancer based on her AF# and CA19-9 CT scan and Ulta Sound?  And then happened to  get septic shock ?  Or could she have had an acute Pancreatits that sent her in to septic shock?  I quess what I am trying to find out is, was she destined to die of cancer and septic shock spared her in some sick way from the painful death of cancer? Or did she unfortunately get taken untimely by a complicated infection that brought on septic shock.I apoligize for the length but I wanted to give you as much info as I could.  Thank you.  
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Dear Sharon:

We are very sorry about your mother’s death and we will try to answer your questions based on the information you E-mailed to us.
We can not be certain whether your mother had pancreatic cancer, when she was seen in October ‘97. Your Mom was having back pain and not feeling well, which can be a common presentation of patients with pancreatic cancer.  These common complaints, however, can obviously be related with many different causes besides pancreatic cancer.  The abnormal CT and ultrasound studies could indicate a cancer, although there benign conditions that could give this x-ray picture. However, at her age and without any history of "chronic pancreatitis" (chronic inflammation of the pancreas, usually due to alcohol abuse) a mass in the head of the pancreas is very suspicious for cancer.
The CA 19-9 is a "tumor marker", a substance that is elevated when certain cancers are present.  The CA 19-9 is the most specific (typical) marker for pancreatic cancer.  It is not a perfect tool, because it can be elevated in benign pancreatic diseases or could be normal when pancreatic cancer is present.  The normal value for the CA 19-9 is less than 40 (different laboratories may have different values).  I can not comment on the significance of the ca19-9 test levels without knowing the normal range for your assay.  
Unfortunately, the only way to confirm the diagnosis of cancer and to conclusively answer your questions is by direct tissue examination of the pancreatic mass under the microscope. It would be unusual for pancreatic cancer alone to produce septic shock due to cholangitis  (infection of the bile) because usually, the bile duct is almost completely blocked by the cancer..  Severe acute pancreatitis (very rapid and extensive inflammation of the pancreas) can produce a picture of "shock".  Finally, it is also possible that your mother had a disseminated infection that started as either pneumonia or a urinary tract infection.  The septic shock per se could cause the liver abnormalities that you describe.
We appreciate that reviewing this information may be painful for you.  we hope that we have answered your questions.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-ab
*keywords: pancreatitis, pancreatic cancer
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