is it possible for him to come here and go to the mayo clinic? they will find out what is wrong.
i am having similar troubles-- and they don't know what is happening-- have they checked his amylase level and lipase level?
Patients with acute pancreatitis typically complain of upper quadrant abdominal pain that radiates to the back, is relieved by sitting up, and is associated with nausea and vomiting.
Some, however, can have nonspecific complaints and varied findings on physical examination.
Clinicians must thus rely on such laboratory tests as serum amylase and lipase to support the diagnosis. Because the serum amylase assay tends to be less expensive and more readily available than lipase assay in most hospitals, most clinicians will obtain amylase measurements first in cases of suspected pancreatitis.
Recognizing factors that reduce the sensitivity and specificity of serum amylase and lipase can help prevent unnecessary invasive diagnostic procedures and allow for appropriate treatment.
One factor that can lead to spuriously normal amylase values is hypertriglyceridemia. Specific treatment to reduce serum triglycerides can hasten clinical recovery during the acute episode and allow risk factor modification.
Patients with acute pancreatitis and concomitant hypertriglyceridemia most commonly report a history of poorly controlled diabetes, alcoholism, predisposing pharmacologic agents (such as estrogens, diuretics, or glucocorticoids), or dietary risk factors.
The incidence of hyperlipidemia in patients with acute pancreatitis has been reported in the range of 12 to 38 percent, which encompasses patients with transient, mild lipid abnormalities that would not precipitate acute pancreatitis.
Our report, however, refers specifically to the 4 to 19 percent of patients with acute pancreatitis who have elevated concentrations of particulate triglycerides in their plasma.
In this subset of patients, hypertriglyceridemia can act as both a precipitating cause and a continuing risk factor for pancreatitis.
Hypertriglyceridemia compounds the diagnosis of acute pancreatitis by causing spuriously normal amylase levels. Patients with hypertriglyceridemia can also have a more insidious course of disease progression than other patients with acute pancreatitis, resulting in normalization of amylase levels by the time they seek medical help.
Treatment of acute pancreatitis generally includes intravenous fluid replacement, pain management, restoration of fluid and electrolyte balance, and observation either in the intensive care unit or on the medical unit depending on initial clinical assessment.
Patients who fail to improve within 72 hours or who deteriorate rapidly require dynamic contrast CT to rule out necrotizing pancreatitis.
Symptomatic patients with necrotizing pancreatitis should undergo CT-guided fine-needle aspiration to rule out infection and to determine whether surgical intervention is required.
Overall, although pancreatitis caused by hypertriglyceridemia has the same prognosis as other causes of the acute episode, early recognition and treatment have been shown to hasten clinical recovery.
In addition to insulin, which promotes tissue uptake of lipids, specific treatment modalities can include fresh frozen plasma and plasmapheresis. Plasmapheresis has been shown to cause dramatic clinical improvement in patients with acute pancreatitis and to prevent disease recurrences. The benefits of these treatments might relate to the elimination of excessive plasma proteases associated with acute pancreatitis, either by direct removal by plasmapheresis or replenishment of protease inhibitors, such as alpha2-macroglobulin, by donor plasma.
In the recovery phase, treatment should also include elimination of secondary causes of hypertriglyceridemia, dietary modification with pharmacologic reduction of triglycerides, if necessary, and avoidance of alcohol consumption.
A 41-year-old woman was admitted for evaluation of severe abdominal pain of 1 day's duration accompanied by nausea, vomiting, and subjective fever. Her medical history was notable for diabetes mellitus and hypercholesterolemia. The patient was a nonsmoker, and she denied any alcohol consumption. Her only medication at admission was subcutaneous insulin for her diabetes.
At admission, the patient's temperature was 100