What causes elevated amylase(mildly), pancreatic tail prominence, and severe abdominal pain on occasion?

[Zette]

I have had pancreas problems for almost 2yrs with no definite diagnosis.  Initially I had a bad gallbladder, it was removed.  Amylase was high then and has never returned to normal, I have severe upper abdominal pain sometimes that lasts from a few seconds to a few minutes.  Most of the time it wakes me up at night, then other times I have mild nagging pain with low grade fever that lasts for a week or more.  I have had several CTs, US, MRCP,EGD.  All confirm pancreatic tail prominence or fullness.  I think I just would like to know if this is something I just have to live with or should I continue to be tested, or could there possibly be something else besides pancreas problems.

[ok2531]

It sounds like pancreatitis and could possibly be in the chronic form.  My suggestion would be to find a good GI doctor who really works with pancreatitis patients.  

[abelardojarab]

Hi, ok2531, I need your help. I am facing a similar problem than you. I am 27 years old and I had gallbladder problems a year ago, I had an elevation of amylase to 143 then and they removed my gallbladder, though since then, I had 2 CTs saying that my pancreas was inflamated. I have pain on my left side, exactlly as the one you are describing, but the doctor after 6 months ordered a CT and a MRCP and they showed normal. Though the days it hurts is bad, I would like please to talk with you. I would like please to ask for your advice. Could you write to my email ***@**** with your phone number. Please if you would allow me to talk with you. Thanks so much, blessings for you.

[ok2531]

i too have mildly elevated amylase.  at times left sided pain more like in the rib area on the side.  i've had ct scan which was normal.  when i had my gallbladder out 2yrs ago my amylase was at the same elevation.  it ranges from 200 -300.  my lipase is always normal.  i've had no stool changes except for occasional yellow diarrhea which has been an issue ever since i had my gallbladder out.  my next step is ercp but my doc & i have held off because my pain basically disappeared.  now it comes and goes...it's really not pain just kind of an ache from time to time.  my doc told me that some people have problems with sludge & stones well after they take out your gallbladder you can develop them.  i've noticed when my diet is bad ie fatty then it bothers me...if i stay stick with healthier meals & avoid alcohol then no problems.  my doc suggested SOD. anywho, just know that there is someone out there with the same thing.  it's scary...i know but this site is a wonderful help.  and CalGal is GREAT!

[CalGal]

Almost forgot - if your doc hasn't suggested a diet change and enzyme supplements, you may want to discuss that, also.

[CalGal]

The question of what would cause the prominence or fullness of the tail of the pancreas is one that you should direct to your doc. It can be caused by pancreatitis, but it can also be due to other issues and would have to be investigated more fully by a variety of tests. The final impression would have to be given by your doc.

Pancreatitis can become an on-going problem, unfortunately. But I'm wondering if problems could be continuing due to some left-over stones or sludge from the now-gone gallbladder. I know that stones would show up with the MRCP in most cases, but it's possible that you might have some residual sludge that escaped during the surgery and it lodged, causing on-going irritation and problems? Have you discussed that with your doc? To my knowledge, the only way to know would be via ERCP with manometry. They would essentially be looking for a sphincter of Oddi dysfunction (SOD). In that condition, the sphincter or the common bile duct spasms and when that happens, both bile and pancreatic fluids back up causing problems.

With the ERCP they would also be able to hopefully look at the pancreatic duct and stent it, if necessary.