Acute/Chronic Pancreatitis

[team468]

I recently got out of the hospital for an attack of acute pancreatitis.  They did a cat scan, MRI and EDG and couldn't find the cause of my attack.  The cat scan and MRI showed that I had multiple lymph nodes in my retroperitoneum.  They were under 10mm on the cat scan but as large as 17mm on the MRI.  I'm a 41 year old female and I don't have a history of alcohol abuse.  I smoked for 25 years but I quit after having this attack.

Four days after my attack the doctor did an endoscopic ultrasound.  It noted that I had echogenic foci and strands visualized in the pancreas that were suggestive of mild chronic pancreatitis.  Everything else was normal.  I'm very concerned about this because chronic pancreatitis sounds very serious.  Could this have shown up because it was done so soon after an acute attack or is this something that shows up only with chronic pancreatitis?

Last week I had an abdominal ultraound which showed sludge in my gallbladder.  Could this be what caused all of this?  If so, could I still have chronic pancreatitis or would the sludge have caused the echogenic foci and strands to show up on my endoscopic ultrasound?  I've never had a classic gallbladder attack.

For the last 3 years I've also had a problem with having multiple bowel movements in the morning.  The first one is normal and then they get runny from there.  They don't look greasy or float.  About once every three or four months I have a bout of yellow stools which lasts for a couple days and then goes away.  I had a colonoscopy and EGD done in the past which were normal.  The doctor told me I had IBS.  Could this be due to chronic pancreatitis or the sludge in my gallbladder?  I should also mention that my blood sugar has been slightly high for the last few years too.  It's been 100-110 at fasting.  I am overweight though and I thought that's what was causing it.

I'm following up with a specialist but I would appreciate your help as I'm very anxious about all of this.  

[Kevin Pho, MD]

I agree with the workup done thus far, and with the MRI and endoscopic ultrasound, there has been thorough workup of the possible causes for chronic pancreatitis.

Alcohol use can lead to pancreatitis, and use should be moderated.  Also, if there is any blockage within the biliary tree, that can contribute as well.  

You may want to consider an MRCP to see if this is the case.

Otherwise, I can't think of further testing to suggest, and would wait until the GI evaluation to discuss the next step.

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 Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[team468]

Thanks but could you please tell me what the echogenic foci and strands mean?  My doctor originally told me he wasn't sure if this was from my acute attack or if it was chronic pancreatitis.  Also, could sludge in my gallbladder be causing all of this?