What might it be?

[JT McL]

I am a 23 year old male and am deeply concerned about some symptoms I've been having.  Earlier this year, I was treated for possible acute pancreatitis.  The cause of it was not determined, but I personally suspect that it was related to Paxil, which I was taking at the time.  My lipase reached about 150 a week after the abdominal pain disappeared and then it began to return to normal.  The doctor ordered both a CT scan and an ultrasound, but, except for a minor inflammation in the tail of the pancreas, nothing significant was revealed.

I don't ordinarily drink, but I did so one night at a party about 3 or 4 weeks after the symptoms had disappeared.  I think I drank a bit much that night.  Five days later I went to the hospital with abdominal pain and was hospitalized for 2 days.  My lipase was measured at 586 and increased while I was in the hospital.  My amylase levels were somewhat high also.  The doctor put me on an IV and ordered another CT scan.  The CT scan showed nothing abnormal.  The symptoms disappeared within a day or so and I was discharged from the hospital.  Follow-up appointments elsewhere revealed that my lipase reached about 2400 a few days after hospitalization.  As no symptoms remained, however, except for occasional gas and light-brown stools, I did not seek further medical treatment.  In time, even the gas and the stools returned to normal.

Two weeks ago I began to feel a mild and unlocalized pain in my abdomen.  Three days into it, I went into the doctor and a blood test revealed that my lipase was at 91 and that my amylase was normal.  The doctor suggested that I consume only clear liquids for a day, which I did.  I returned for a follow-up appointment with no major symptoms and the doctor told me to eat again.  A second blood test was taken but I did not receive the results.  I did, however, have a somewhat low blood pressure reading.

In the past week, I have had occassional discomfort- mostly on the right side of my abdomen.  I have had a little bit of gas and have had few bowel movements.  A few times I have felt what seemed like air bubbles in my intestine.  I cannot tell if eating or diet is the direct cause of this.  

I am very nervous that I may have a chronic form of pancreatitis, since I have read that some of the symptoms of it resemble mine.  Yet, I have only been drunk a few times in my life and never had any problems before April of this year.  I have not touched alcohol or Paxil since my visit to hospital nearly six months ago.  The doctor suggests that I may have a gallstone, but previous doctors had ruled that out as a likely possibility.  One suggested that I had a peptic ulcer, but another said no.  For five whole months, until two weeks ago, I had been fine.

I have a career in which I must be physically healthy.  It may be months before I can get to a gastroenterologist.  I generally feel all right, but am nervous nonetheless of what is going on.  What do you think of it?

[Kevin Pho, MD]

Most common causes of pancreatitis are gallstones and alcohol.  You have noted that alcohol shouldn't be a problem in your case.  That leaves gallstones.  The ultrasound noted to be negative.  However, bile duct stones can also cause pancreatitis and would have been seen with the tests you described.  

To evaluate for bile duct stones, an ERCP or MRCP would be reasonable.  These tests are normally ordered by a gastroenterologist and certainly should be discussed at your next visit.  

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.
Medical Weblog:
kevinmd_b

[himu]

I have similar symptoms for a year now. Lipase is around 178. Amalyse is normal.It has come down once to 128. My GI has put me on Enzymes and monitoring lipase, if it reduces.

I have pain on left side and in the back. My MRCP taken 6 months back was normal. In 1 year i am seeing 3rd GI already.First one thought i had IBS.Asked me to relax and drink lot of water. The one i am seeing right now thinks i have chronic pancreatitis. But it does not show in CT scan, MRCP on my pancreas. He think it is Idiopathic i.e not from alcohol or stones. Certain percentage of people may get it without these reasons. I have not other specific symptoms other than elevated lipase and pain on left side.

Do keep in touch regarding how your diagnosos progress is. I will also update you.

Also i am trting to take reduced fat diet and meditation since i get stressed due to the nature of this illness.

Hope this was helpful.

[JT McL]

I was a little confused by the doctor's reply.  Did he mean to say that bile duct stones would NOT have appeared on the tests I described (ultrasound and CT scans)?  Is that why he recommended additional tests, such as an ERCP?

No doctor I've seen thus far has suggested that I have chronic pancreatitis, and I probably shouldn't be performing my own diagnosis.  I just don't know what to make of it.  I'm not certain that my lipase has been continually elevated, as I have only received the results of one blood test since June.  

I will keep you posted.

[himu]

Yes, I think he meant the tests you have done may not reveal the stones present in the ducts. But be careful before you go for ERCP. There are chances to get chronic pancreatitis with that test.
My doctor is monitoring my lipase. He says CT scan,MRCP may not reveal the stones sometimes. But if i have idiopathic form of pancreatitis i might not have any stones still enzymes might be elevated.

I am also quite confused right now. Just going through the various tests.