Any help in identifing what might be causing my husband to have the following problems would be greatly appreciated! He presented to the ER on Sept 15th with severe epigastric pain. Lipase was 11,000 & amylase was 5,331, liver enzymes normal, glucose normal, and triglycerides normal, Other abnormal labs included RBC 3.96(L), HGB 12.0(L), HCT 34.7(L), lymphs 15.1(L), ABS monocyte 0.6(H). He was admitted with acute pancreatis. Put NPO/given IV's and pain meds and sent home in 4 days. ABD U/S & CT scan showed no evid of stone disease. Pancreas was unremarkable, question of fatty liver/hemangioma in liver. The abdominal pain persisted & he was admitted back into the hospital on Sept 24th. His lipase had gone down to 4119, but his liver enzymes were now elevated with alk phos 157, AST 130, and ALT 262, bilirubin normal, other abnormal labs this time included RBC 4.24(L), HGB 13.2(L), HCT 37.8(L), Lymphs 17.7(L), EOSIN 5.4(H). He was kept again 4 days (NPO/IV/pain meds) and sent home. The pain still persisted. He underwent ERCP on 09/26 which found a stricture in the distal common bile duct which was stented, brushing were negative. His labs were then followed:
09/27/03 glucose 138(H), alk phos 198(H), AST 296(H), ALT 498(H), Bilirubin normal, Lipase 832(H), RBC (4.15(L), HCT 38.2(L), GRAN/NEUT 76.4(H), LYMPHS 14.0(L), ABN GRN/NEUT 6.6(H)
09/29/03 glucose normal, anion gap 6(L), calcium 8.2(L), albumin 3.1(L), alk phos 179(H), AST 110(H), ALT 371(H), Lipase 632(H), RBC 3.49 (L), HGB 11.3(L), HCT 32.5(L), eosin 6.5(H), ABS monocyte 0.6(H)
epigastric pain (with some pain in back) persisted. Repeat abdominal CT 09/29 showed some indistinctness & edema in region of pancreatic head. EUS on 10/28 showed signs of chronic pancreatitis. Doctor said that area around pancreatic head showed alot of "fluid" which made it hard to visulize, recommended repeat CT 6 weeks (which has not been done at this time). Stent was removed on 10/31. Labs were again followed:
10/31 AST 237(H), ALT 155(H), ALk phos 127(H), anion gap 7(L), bilirun normal. lipase not done
11/05/03 Glucose 126(H), Alk phos 196(H), AST 64(H), ALT 338(H), SGGT 227(H)
11/07/03 Hep B, Hep C, Ferritin, FE/TIBC/%sat, ANA Alpha Feto protein, Ceruloplasmin & epstein barr were all done- per physician all were normal except Ferritin showed an elevation at 445(H). He stated his liver enzymes had come down some-however still not in normal range.
At this point gastroenterologist continues to monitor bloodwork. He has mentioned possible liver bx. My husband is currently taking percocet for pain and pancreatic enzymes 3 pills/3 times a day. He still has pain that comes and go's. He used to drink often about 10 years ago before we were married, since we've been married he only drinks approx 10 times/year parties etc... The last time he had alochol was Labor day Sept 1st. He has no significant past med hx. He is not overweight (175 lbs). No nausea or vomiting, no jaundice. Any advice appreciated!!