Have Crohn's, new symptoms:pancreatitis, strictures or bc mets?

[lizziecee]

I have had Crohn's for 38 yrs, stable on weekly injections of 12.5mg methotrexate. Last 6-7 weeks suddenly got severe nausea,total loss of appetite, weight loss 14 lbs, bloating, steatorrhea, pain under right ribs spreading to right armpit,shoulder and neck after eating and pain in lower abdomen.I saw my gastro 2 weeks ago and he has ordered a CT scan of pelvis,abdomen,liver and pancreas June 26th, and an upper endoscopy under sedation 9th July. I see him in clinic 9th July for results.  Meantime he has prescribed domperidone for the nausea and omeprazole in case ulcers in the mall intestine are the cause.   I had an MRI Nov 2007 where 2 strictures were found in my small intestine (through adhesions), but I was asymptomatic, and nothing done. Don't really know why gastro ordered the MRI as I was doing well.

I am pretty convinced these symptoms are not a Crohn's flare, as I do not have diarrhea or a raised temperature. I also have slight constipation and unable to have a movement some days.  What are the dx possibilities for these symptoms? Could it be pancreatitis (not had it before) or could the strictures be causing a partial blockage?  Colon cancer has of course occurred to me, as my father died of this aged 59 yrs, and I am therefore at very high risk of cc, having Crohn's for so long, and father's cancer.

I also have breast cancer, invasive ductal carcinoma, stage and grade 2, 2 cm tumour with DCIS, with spread to the lymph nodes, had lumpectomy and total axillary removal, 6 x FEC chemo, 25 rads, on Arimidex for 4 yrs but stopped it recently due to bone pains and low bone density, on advice of my GP. I am currently waiting an appt with a new bc Oncologist for alternative adjuvant bc medication, as mine retired last year. My research, and experience of other bc ladies, leads me to believe that if the bc is going to metastasise, it is usually to the bones,lung, or liver and occasionally, the brain.  Could it be possible for my bc to have spread to my intestines? (I have intractable PanCrohn's Colitis)

My mind is in a whirl.....I have a very positive attitude towards my diseases and believe I can cope with anything - just need a diagnosis, let me know what to do, and get it fixed please!

Any advice and/or experience with these symptoms will be most appreciated.

Liz,in England.

[lizziecee]

Hi - think we met on this forum some years ago and always enjoyed your articulate and erudite postings.

Methinks you may either be telepathic or hit the nail on the head! It had never, ever, occurred to me that my current problems may be due to gall bladder symptoms. Although I have had Crohn's for 38+ yrs, I truly have never heard of a connection with the gall bladder, well, at least in England.

When I saw my gastro of 5 yrs, 2 weeks ago, he was visibly shocked by my appearance, having lost so much weight in such a short period of time. 6 weeks. I am always weighed in the Crohn's clinic before I see him, so there was no point in fudging the issue. My IBD nurse had advised him the previous day of my symptoms, and I hardly sat down when he started writing out orders for a CT scan and upper endoscopy, so he is taking it seriously.

He did make me laugh, and diffused a tense consultation though when I had my latest blood test print-out from my GP and he said: What is your c-reactive protein level Liz?"...Erh.10, what does that mean? My husband and I just dissolved into laughter when he said: "One less than 11, 1 more than 9". That is a guy I can relate to. He certainly has my best interests at heart, and considering our socialised medicine system in England, I am getting very quick tests.

I do have very comprehensive monthly blood tests at my GP's surgery for mtx, only things out of kilter are my MCV, MCH and c-reactive protein levels, so know it is not a Crohn's flare just normal reactions in my bone marrow to mtx.

My latest LFT results (3 weeks ago) are:
Serum total protein 70g/l
serum albumin 43 g/l
Serum globulin 27 g/l
Serum alkaline phoshptase 14 iu/l
serum total bilirubin level 9 umo/L
AST - aspartate transam (SGOT) 14 u/l.
All seem within normal range according to the lab tests, so don't feel my liver is compromised by bc mets. There is obviously another problem, to add to Crohn's and breast cancer! My GP told me some yrs ago, after bc dx that I was handed a bad hand of cards when born....I just smiled at him and said: "Well, I play a great hand of poker".

Calgal I am so very grateful for your response.....I have always eaten a low fat, high protein and little fibre diet, since being dx with Crohn's, and I guess the steatorrhea also concerns my gastro. My stools, when I do go now, float and are greasy, but then, I have often had this problem. The severe nausea and weight loss is something I have only had recently when on FEC chemo for breast cancer and spent 4 months on hospital prescribed Fortijuice - no food at all. The pain under my right ribs/shoulder/neck I originally put down to rheumatism and old age....I need to get real don't I?

As far as I know I have never had checks of liver and pancreas enzymes....if the scans and endoscopy don't show masses/strictures, I will ask for these tests.

A zillion thanks for your input...I'll post when I have some results.

Thank you for caring and sharing.
Cyber hugs,
Liz.

[CalGal]

Your symptoms sound very much like gallbladder issues, and I'm sure you know that there's a higher probability of having gallbladder issues in someone with Crohn's. You may want to ask your doc to run liver and pancreatic enzymes, since problems with the gallbladder can often impact the pancreas.

Constipation can be a result of gallbladder issues especially if the common bile duct or sphincter of Oddi is 'reacting' to gallbladder discomfort, or if sludge is present and has spilled from the gallbladder into the common bile duct and has irritated the duct/sphincter. If the color of your stool lightens severely and ends up on the 'whitish' side, it may be tied into gallbladder issues and your doc should be notified.

A CT may or may not show what's going on with the gallbladder. For gallbladder issues, blood tests to check liver and pancreatic enzyme levels, a gallbladder ultrasound and a HIDA scan with CCK injection should be done. However, even with those tests a 'clear' diagnosis may not be able to be made unless stones/sludge are present and a lowered ejection fraction is found.

Can't be sure, but your pain presentation suggests checking the gallbladder. You may want to consider a low fat diet to see if that's of help.