pain in the back and upper left abdomen

[eapleta]

I am 35 y.o. female. When I was 10, I was diagnosed with chronic pancreatitis. I had epigastric pain. I had elevated levels of amylase and I also underwent function testings. My family has no history of chronic pancreatitis. I was treated successfully, was on a strict diet for a couple of years, and then I was symptoms -free for years. Occasionally, I would have periods of mild epigastric pain, they would do ultrasound for my pancreas and see no abnormalities. About two years ago I suddenly developed pain in my back (where the left kidney is). THe pain was dull and very persistent. I went to see a doctor. He ordered the ultrasound of the left kidney. It was normal. Meanwhile, the pain relocated to the upper left quadrant of the abdomen and the left side of the body. It was aggrevated by food. I told my doctor about my chronic pancretitis diagnosis at age 10. I then underwent 2 abdominal CT scans with contrast (with a 6 month interval between them), gastroscopy, MRI of the pancreas, 3 blood tests for amylase and lipase, gastric emptying study, X-ray of the intestines, and H.pylory test. They did not reveal anything abnormal. I tried prilosec, antispasmoid pills, and paxil with no improvement of my pain. The doctor told me that he does not see pancreatitis and also that I do not quite fit the profile for IBS. After more than a year, the pain disappeared for several months. Two weeks ago the pain came back for no apparent reason. It is mostly in the back (the same spot - the projection of the left kidney), sometimes it goes higher (just below the spatula). Sometimes the pain is in the left flank. I have mild pain in my epigastrium also. The pain is clearly aggrevated by food (any food, it seems to me). I noticed also that now the pain is more severe when I lay down on my back (I feel burning pain in the back at my waist that irradiates to just inferior to the spatulas). Sitting up somewhat releives my pain. This is a new symptom for me - before the pain would not intensify when I would be laying down on my back. I do not have nausea/vomiting, and I do not have diarrhea or constipation. The pain is very persistent, and I am very afraid that my pancreatitis came back after so many years. I am hesitant to call my doctor this time, because he told me last time he saw me that he could not find anything wrong with me. My husband tells me that I cannot have pancreatitis, since all the tests were negative. I want to beleive this, but I read in the literature that CT scan and MRI are not very reliable in diagnosing early or mild pancreatitis.  I am especially upset now that the pain gets worse when I am laying on my back (this interferes with my sleep), which is, as  I read in the literature, is a characteristic symptom of pancreatitis. Is it possible that the cause of my pain is still a chronic pancreatitis (despite all the negative tests so far) or can it be something else (I do not have a fever or some urinary problems)? Thank you! PS. I do not drink.

[Kevin Pho, MD]

Hello - thanks for asking your question.

You have clearly had an involved workup with a variety of tests.  The tests that you had have ruled out most of the causes of the discomfort.  I think that some more specialized tests should be considered.

One would be an ERCP or MRCP.  These tests can evaluate the anatomy of the biliary tree and determine if there are any anatomical abnormailies that may be contributing to your pain or chronic pancreatitis.  

Another consideration would be an evaluation of the gall bladder, as it can uncommonly present with pain on the left side.  An ultrasound, or HIDA scan with CCK stimulation can be considered.

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.

[TazLady]

Hi,

I  just wanted to comment.  I have moderate to severe Chronic Pancreatitis and SOD.  This has been proven by ERCP's, CT Scans, calcification of the pancreas on numerous times.  I am in a "good period" of time right now.  I have little pain and only certain foods are bothering me.  I have been told, and believe this, that once you have pancreatitis (and you said you were diagnosed with Chronic Pancreatitis, meaning irreversible damage) that it never goes away. It is not unheard of to go through MANY years with little or no pain, just to have it all come back in a blaze of glory.

I just went to a different doctor in Febuary for insurance reasons.  I have been treated at Stanford and UCSF.  Both places confirmed my diagnosis.  The new doctor I had to go see did 1 CT Scan and when it came back "normal" he pronounced me "cured" and told me to eat, drink and be merry!  He didn't care about any test or surgery done in the past.  Only cared about 1 ct scan that said nothing was wrong with me. I can tell you the newest Doctor is wrong.  Once you have Chronic Pancreatitis, it never goes away.  You must follow the low fat diet and no alcohol rule.  

Pancreatitis is a hard disease to diagnos and treat.  Many doctors truely don't understand it or how to treat it.  Please go to a specialist that will take into account your past history of it, your new symptoms of it too.  Pancreatitis is nothing to fool around with.  Suddenly after 1 test I am "cured" by 1 doctors standards even though all literature and past surgery reports and test results says differently.  You may also want to be checked for Sphincter of Oddi dysfunction.  Try asking for a blood test for Amylase and Lipase levels when the pain is present and when it isn't, so you have something to compare with.  But then again, since I have gone chronic, my levels do not raise anymore.  Also ask for a Fecal Fat Test to check for mal-absorbtion problems.  

I have been told by specialists at both Stanford and UCSF that charactoristics of pancreatitis can take on many forms.  And that it is very possible to go for years without a problem and then have it suddenly flare back up again.  If it does turn out that you are a sufferer again of pancreatits, consider yourself lucky to have gone so long without problems and take this disease very seriously and find a doctor that will do the same.  No one is doing you any favors by dismissing your past history with this disease.

Good luck to you,
TazLady

[surgeon]

Under the circumstances, I'd think ERCP would be a useful test, if it's not been done. It involves passing a scope into the stomach, then into the duodenum; the opening of the pancreatic duct can be found, and dye injected for taking an xray. To have had pancreatitis at age 10 makes the possibility a strong one that there is some sort of ductal abnormality. Some of them could be amenable to surgical correction. And it could help to nail down the diagnosis, or rule it out more effectively than ct scan.

[paty91356]

I have a Sphincter of Oddi disfunction, diagnosed about 20 years ago.  It was silent for about 10 years, but has flared up again following pancreatitis I developed from the narcotics I received for a total hip replacement.  The hip replacement was the easiest part...the pancreatitis was horrible, and my pancreatic and liver enzyme tests shot way up while I was in the hospital..also nausea, vomiting and diarrhea!  They have since returned to normal.  My gastroenterologist tells me that certain narcotics can cause the sphincter to spasm or constrict.
Diagnostically, I have had the usual cat scans with and without contrast dye, MRI, and even ERPC (EPRC?) done at a major university hospital, so I feel comfortable with the diagnosis.  I agree with what some of you have already said...alcohol is a definite no-no!  I tried drinking a glass of wine last week and am still paying for it.
My question...do any of you with pancreatic problems also have a tightness in the chest?  It's not shortness of breath, or difficulty breathing on exertion, but it's like the very beginning of the asthma I had as a child.  It doesn't cause me any problems other than annoyance and anxiety as to its cause.  I've also had several electrocardiograms and cardiac stress tests in the past few years...any other ideas?  I had a recent chest x-ray (normal) before the hip surgery. I have never smoked one cigarette in my life.

[binda44]

I have the pain in the left side runing from my waist to the lower back it is very painful and seems to be with me for two days now. I have been taking over the counter medication for to many years and now due to this I am to scared to seek help from my local GP Please advise me anyone

[Sweetie629]

A related discussion, Left Side Pain was started.