problems

[saverite]

Dr. Schiano,
I am asking here because you are a liver specialist and GI.  I have a history of alchohol abuse for about 10 years or so up until about 2 years ago when I quit drinking.  I have been sober since then.  I have been concerend about any possible damage because of it.  I recently had a bout of acute pancreatitis that resolved in about 2-3 days.  I had been eating a pretty high fat diet for a few days and was taking tylenol 3 for a dental procedure.   AP was verified via CT w/contrast but my panc enzymes remained normal throughout the attack.  I am concerened that the attack may be a sign of a cronic conditon due to my previous history of alchohol.  The CT scan did not show anything other than the hazy pancreas, impression pancreatitis.  All ducts, lymph nodes etc were normal and there was no fluid. No mention of other pancreas damage or calcifications. Ultrasound and mrcp showed only sluge and polyp in gallbaldder and all duct were normal size w/o stones.  I am monitored by a cardio and all my blood test and lft have been normal for a couple of years although they did rise during the ap attack with only the bili being elevated out of normal ranges.  Dr thought this was probably due to the amount of morphine used in the AP attack. Recommend taking out GB due to sludge and possiblity of it causing the AP.  My lipids are withing normal levels and my weight is normal for my height. Your thoughts on the possiblity of liver damage or cronic pancreatitis?  After 2 years of abstinence what are the possiblitlies of something coming up regarding the liver or pancreas?  Thank you.

[Thomas D Schiano, MD]

i would not take out the gallbladder at this point.  as long as you remain abstinent i think your liver should be fine.  stones could cause the pancreatitis--I would just watch closely for now, especially if liver tests nor normal.

[bjaecks]

Hi My name is Tiffany Jaecks. I am 18 years old. A couple days ago I had an ultrasound on my stomach b/c of some abdominal pain and back pain. I then had a CT scan due to a spot found on my liver..They found a mass on the right lobe of my liver measuring 9.0 x  8.3 in size. The G.I. says that he beleives it is focal nudlar hyperplasia. It is a constant pain right below my rib cage and in my lower back, sometimes through my stomach. I take darvocet for the pain but it doesnt seem to help me through the night.I cant get comfortable. I am a basketball player and suppose to be leaving for college Aug.15th. Can they remove it? Should i have it removed? Is there any suggestions you can give me?

[Thomas D Schiano, MD]

good luck

[saverite]

Thank you again for your prompt, curtious, reply.  I just saw a surgeon today and he still wants to take the GB out due to the sludge, poylp, and pancreatitis.  He believed the elevated bilirubin was probably caused by a blockage of a stone or sludge that passed and is concerend about further blockage.  I will get another opinion.  Thank you again your advice has been very informative and valuable.  

[Thomas D Schiano, MD]

if you are otherwise healthy 1 episode of pancreatitis does not warrant cholecystectomy. although there are several 100 thousand of these procedures performed annually I wouldn't have it done unless we are 100% sure that you had gallstone pancreatitis, which from  the data you are giving me, i am not.

[saverite]

Can you elaborate on your reason not to remove the gallbladder.  I am concerned that sludge or a passed stone caused the pancreatitis and another attack could cause damage to my pancreas.  Thank you for your concern.

[saverite]

PS. I forgot to mention, CT, ultrasound, mrcp and xray all show normal liver, bladder, cystic duct, common bile duct, pancreatic duct, and the kidney and spleen are unremarkable with no evidence of choledocholith.