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Avatar universal


I have been fighting this pain for about ten years now.  Have gone corn and gluten free which helped initially but now back to the same thing.  Pain was getting worse and now had my gallbladder out.  Now realize all along it has been my pancreas.  Ended up in the ER with elevated amylase and lipase.

I just recently had an MRCP and have some questions on the results.  It showed mild intra and extrahepatic bile duct dilatation with some beading involving the biliary system of the left lobe of the patient's liver.  No retained stones.  Normal appearing pancreas.

My question is does this mean I have chronic pancreatitis or can you not tell on a MRCP? Does the duct dilatation set off an inflamation of the liver and pancreas and cause the pancreatitis pain?  Also can the duct dilatation heal on its own in time?  

I have no desire to undergo an ERCP as I've heard such nightmare stories from people who have undergone but yet I'm so tired of not feeling good and having pain and just would like to feel good again.

Thanks for your help.
7 Responses
Avatar universal
If the liver enzymes are elevated, it more typically is the result of the portion of the common bile duct - below the level of the entry of the pancreatic duct - to be in spasm. Probably somewhere in the vicinity of the opening to the duodenum. When that happens it means that the pancreatic fluid and the bile backs up. The liver enzymes rise because they have no outlet and they're spilled into the blood. The pancreatic juices back up into the pancreas and they start to destroy the pancreas from the inside and pancreatic enzyme levels also enter the blood stream.

It sounds a bit more like the unifying issue may in fact be the common bile duct.
Avatar universal
Bikerblue, the MRCP report really doesn't say much about the pancreas in what you wrote here. The mention of dilatation could be the result of the removal of the gallbladder. For some unknown reason the duct may/can enlarge after the surgery. It may or may not mean anything at all. Talk to your doc about the size of the enlargement which might be of significance.

In some cases the enlargement can be due to spasms of the common bile duct further down the tube system. When that happens, the bile and pancreatic fluids back up the ducts and if it happens long enough and often enough the ducts can enlarge.

Did they say anything about the pancreatic duct?

Are you following a low fat diet and taking pancreatic enzymes? And have you been checked for autoimmune pancreatitis?
Avatar universal
Hi and thanks for your response! I am eating a very low fat diet. In fact I haven't branched out much with my diet as I'm afraid of another attack. I dont know if it was the chicken breast or maybe the overactivity but ended up in the hospital a couple of weeks ago with elevated amylase and lipase. The removal of the gallbladder really set things off for me.

I am taking Pancrealipase with all my meals now & try to eat every few hours as I've lost almost 20 pounds in the last six weeks.

After surgery my liver levels were also very high but have now returned to normal & they were thinking everything inflamed from surgery.

There is no mention of the pancreatic duct and no focal liver lesion identified. The last two days I've been inflamed but praying over time it is going to heal.
Avatar universal
My surgeon called me today saying he was surprised by my MRCP results as they did an MRI when I was having the gallbladder surgery and no ducts were dilated at that time.  Said he was taking my films to a GI doc to see what they had to say as the next step and go from there.  Makes me very nervous.  

I'm hoping the dilatation will go down on its own as an ERCP really scares me in setting off an acute attack.  Pain today and yesterday and not sure what from.  :(
Avatar universal
The idea of an ERCP probably is frightening to anyone facing the issue. If you have to have an ERCP, please make sure it's WITH a manometry step to measure the pressure in the duct and at the sphincter. You want to find out if the condition could possibly be SOD, sphincter of Oddi dysfunction.

Also talk to the doc - if an ERCP has to be done - about stenting the ducts. Not a nice thought, I know, but stenting can cut down on the possibility of setting off an attack.
Avatar universal
I have another question for you.  Is it normal for the liver levels to jump with a pancreatic attack?  Mine have the last two times.  Or could it be because of the bile duct dilatation involving the biliary system of the left lobe of the patient's liver?  

I've decided not to do the ERCP.  I'm feeling good otherwise and not having constant pain and hoping it will continue by eating very low fat and being very strict.
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