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Need Guidance regarding Idiopathic Pancreatitis
My husband is 29, non-drinker, non-smoker, fairly good shape, no cholestral, no family history of pancreatitis. One day he experienced severe abdominal pain. At the ER, a CAT scan, resulted in an "inflamation of his pancreas," and consequently admitted to the hospital. A triple lumen on his chest was inserted, the past three weeks he has not had a drop of food and liquid (except ice chips).Daily blood tests and blood cultures taken.
Week 1: Severe pain, majority of pain on left and lower middle of his abdomen
Abdomen physically bloated, hard,tender.
Given antibiotics,(even though no sign of infection)
Fever, excessive sweating, cold sweat, nausea (given anti-nausea medication), difficulty breathing, high pulse
Week 2: Second CT scan showed pancreas actually grew and much bigger than the first CT, however the fluid around the abdomen had lessened.
Pain is focused on the left side of his abdomen.
Sugar levels are high, given insulin
Placed on extra fluids, excessive sweating
Week 3: Fever broke
High Blood sugar, given insulin
Abdominal pain on left side, stomach alittle softer, less tenderness
Feels hungry and very thirsty
Extremely week, no energy to move or speak
Extremely dry throat, almost lost his voice
Restless, feels like inside his body is extremely hot,
Stomach feels on fire, given pepcid
Amylase and lipase levels coming down from 300, to 68 for amylase
It has been 3 weeks, and there doesn't seem to be much improvement, what can we do?Can you tell me more about the fluid, where it comes from and goes? Enzymes and levels? Fluid inside the pancreas?
Week 1: Severe pain, majority of pain on left and lower middle of his abdomen
Abdomen physically bloated, hard,tender.
Given antibiotics,(even though no sign of infection)
Fever, excessive sweating, cold sweat, nausea (given anti-nausea medication), difficulty breathing, high pulse
Week 2: Second CT scan showed pancreas actually grew and much bigger than the first CT, however the fluid around the abdomen had lessened.
Pain is focused on the left side of his abdomen.
Sugar levels are high, given insulin
Placed on extra fluids, excessive sweating
Week 3: Fever broke
High Blood sugar, given insulin
Abdominal pain on left side, stomach alittle softer, less tenderness
Feels hungry and very thirsty
Extremely week, no energy to move or speak
Extremely dry throat, almost lost his voice
Restless, feels like inside his body is extremely hot,
Stomach feels on fire, given pepcid
Amylase and lipase levels coming down from 300, to 68 for amylase
It has been 3 weeks, and there doesn't seem to be much improvement, what can we do?Can you tell me more about the fluid, where it comes from and goes? Enzymes and levels? Fluid inside the pancreas?
I just saw your message today. Ultrasounds are not as clear or definitive as a CT-scan is for looking at pancreatic masses. The gallbladder and pancreas are connected to each other via the main bile duct. Enzymes are producted in the pancreas which then pass through the duct into the gallbladder. If there were a mass or fluid collection in the pancreas, it would usually be enlarged or swollen, which in my case, caused enough pressure for it to press against the stomach, causing the stomach to be compressed and pushing against the left ribcage. The pancreas is normally only about 6-8 inches long and is nestled in a little lower and behind the stomach, toward the back, and above the gallbladder.
When my saga with acute pancreatitis and chronic pancreatitis began, it would seem to come and go, so I understand what you mean about "it going away". If your doctor couldn't see anything definitive in the ultrasound, you might see if he would recommend a CT-scan for better clarity. I had ultrasounds done first, and they could only see some sort of vague mass, but when they did the CT-scan the pseudocysts (explained in the post above to SaraB) very clearly.
I will check again tomorrow to see if you saw this post. You can email me if you have any more questions.
Nanny
***@****
When my saga with acute pancreatitis and chronic pancreatitis began, it would seem to come and go, so I understand what you mean about "it going away". If your doctor couldn't see anything definitive in the ultrasound, you might see if he would recommend a CT-scan for better clarity. I had ultrasounds done first, and they could only see some sort of vague mass, but when they did the CT-scan the pseudocysts (explained in the post above to SaraB) very clearly.
I will check again tomorrow to see if you saw this post. You can email me if you have any more questions.
Nanny
***@****
Sara,
I just saw your message from Oct.10 today. I tried to post a new reply at the top of the list but the forum was full for the day. You have probably already learned that the cysts that they found in your husband's pancreas are pancreatic pseudocysts. They sometimes develop after an acute pancreatitis attack. I was found to have multiple pseudocysts after my first attack. One was very large (6 cm.) and when they are that size, or larger, the usual option is to drain them, for they can be life threatening if they rupture. I had my largest pseudocyst partially drained, and then it was decided by my GI to see if the others would resolve on their own without further invasive procedures. That was a year and a half ago, and the pseudocysts have slowly reduced in size, they are all now about 3 cm.
The doctors will also check to make sure that these are not cancerous tumors. With me they did a needle aspiration biopsy to test for cancer, before they performed the drainage. It took several weeks before I started feeling much better, and before the fluids went away.
If you see this message, post again tomorrow, or I will check and see if I can send another message to you. Try not to worry.
Nanny
***@****
I just saw your message from Oct.10 today. I tried to post a new reply at the top of the list but the forum was full for the day. You have probably already learned that the cysts that they found in your husband's pancreas are pancreatic pseudocysts. They sometimes develop after an acute pancreatitis attack. I was found to have multiple pseudocysts after my first attack. One was very large (6 cm.) and when they are that size, or larger, the usual option is to drain them, for they can be life threatening if they rupture. I had my largest pseudocyst partially drained, and then it was decided by my GI to see if the others would resolve on their own without further invasive procedures. That was a year and a half ago, and the pseudocysts have slowly reduced in size, they are all now about 3 cm.
The doctors will also check to make sure that these are not cancerous tumors. With me they did a needle aspiration biopsy to test for cancer, before they performed the drainage. It took several weeks before I started feeling much better, and before the fluids went away.
If you see this message, post again tomorrow, or I will check and see if I can send another message to you. Try not to worry.
Nanny
***@****
Hi:You really seem to be educated on this whole subject, I hope you have aminute to read this and respond.
I have pain under right ribs and in the middle of ribs, which shows up many gallstones and they are worried about a possible
blockage because I told them I have this feeling under my left rib-cage, such a weird feeling, I had it 2 years ago for several weeks and it literally "just went away". I wonder if gallbladder and pancreas are connected, I mean I kind of know they are by the bile ducts??? I feel like there is a mass of something there maybe like a baloon under my left ribs filled with water or fat, cause I cant find it when I press down, and I seem to hit it accidently, sometimes with my ribcage when I move a certain way. I'm sorry for not making to much sense. Do you think if I had this fluid by my pancreas it would show up on the ultrsound they did right, left, and middle areas of my abdomen??
Actually other then gallsones what else can they see on ultrasound?? Thank you for taking the time!!
I have pain under right ribs and in the middle of ribs, which shows up many gallstones and they are worried about a possible
blockage because I told them I have this feeling under my left rib-cage, such a weird feeling, I had it 2 years ago for several weeks and it literally "just went away". I wonder if gallbladder and pancreas are connected, I mean I kind of know they are by the bile ducts??? I feel like there is a mass of something there maybe like a baloon under my left ribs filled with water or fat, cause I cant find it when I press down, and I seem to hit it accidently, sometimes with my ribcage when I move a certain way. I'm sorry for not making to much sense. Do you think if I had this fluid by my pancreas it would show up on the ultrsound they did right, left, and middle areas of my abdomen??
Actually other then gallsones what else can they see on ultrasound?? Thank you for taking the time!!
Hi Nanny,
If you are reading this...there was another CAT Scan done today...however there was some bad news. There is a new development of 2 cysts. All his blood tests, enzyme test, insulin levels are normal...the hardness that was on the left side of his tummy is soft...however, the Scan says there is a formation of 2 cysts. He still has a severe insulation, it hasn't gotten any better at all. What are these cysts and why is it not getting anybetter?
If you are reading this...there was another CAT Scan done today...however there was some bad news. There is a new development of 2 cysts. All his blood tests, enzyme test, insulin levels are normal...the hardness that was on the left side of his tummy is soft...however, the Scan says there is a formation of 2 cysts. He still has a severe insulation, it hasn't gotten any better at all. What are these cysts and why is it not getting anybetter?
Sarah,
This is a cut and paste from a medical resource which explains the fluid collections:
There is a lot of confusion about the definitions and management of acute fluid collections in acute pancreatitis, approach to diagnosis and the management policy to be followed. The present article defines the fluid collections and presents a rationalised policy about the various diagnostic and therapeautic modalities in the management of fluid collections.
Definition
According to the Atlanta international symposium1 in 1993, acute fluid collections are defined as the collections which occur early in the course of acute pancreatitis and are located in or near the pancreas and always lack a wall of granulation or fibrous tissue. They are found in more than 50% patients with moderate to severe pancreatitis. They represent a serous or exudative reaction to pancreatic injury and inflammation. Since acute fluid collections do not have a communication with the pancreatic duct, they do not contain high concentration of pancreatic enzymes and the fluid composition is similar to that of plasma. Table 1 gives the differentiating features between the acute fluid collections and acute pseudocyst.2
Natural history
Majority (85%) of fluid collections resolve spontaneously, however few persist, get walled of and develop into pseudocyst over 6-8 weeks. Fluid collections are frequently found along the anterior surface of the gland.3 The fluid may perforate into the lesser sac or extend beyond the pancreas into the anterior, posterior pararenal space, conforming to the space of the compartment. When the fluid escapes from the lesser sac into the greater peritoneal cavity through the foramen of Winslow, it produces pancreatic ascites. More commonly lesser peritoneal sac fluid escapes into the fissure ligamentum venosum, that separates the caudate lobe of liver.
Presenting symptoms
Majority are asymptomatic by themselves and detected on followup imaging during the course of acute pancreatitis. However a small percentage of patients do become symptomatic and may produce :
1.Upper abdominal discomfort due to large collections.
2.Compression of the GIT e.g. stomach, duodenum producing fullness or vomiting especially after meals.
3. Sudden onset pain, increase in size of lump, associated with fall in haemoglobin due to bleed from pseudoaneurysms of adjacent vessels.
4.Pain and fever due to infection
5.Rupture into the peritoneal cavity leading to pancreatic ascites.
6.Jaundice secondary to bile duct compression.
INVESTIGATIONS
Ultrasound is helpful in detecting but fails to give information about the pancreas. Rapid infusion CT scanning provides the most accurate information about presence of fluid collections, morphology of pancreas and associated necrosis. [4] Heterogeneous densities in peripancreatic fluid represents a combination of fat necrosis with fluid collections. The possibility of infection is determined by the clinical findings of rising fever, tachycardia, raised white cell count, air bubbles in fluid collections.
I hope this helps answer your question.
Nanny
This is a cut and paste from a medical resource which explains the fluid collections:
There is a lot of confusion about the definitions and management of acute fluid collections in acute pancreatitis, approach to diagnosis and the management policy to be followed. The present article defines the fluid collections and presents a rationalised policy about the various diagnostic and therapeautic modalities in the management of fluid collections.
Definition
According to the Atlanta international symposium1 in 1993, acute fluid collections are defined as the collections which occur early in the course of acute pancreatitis and are located in or near the pancreas and always lack a wall of granulation or fibrous tissue. They are found in more than 50% patients with moderate to severe pancreatitis. They represent a serous or exudative reaction to pancreatic injury and inflammation. Since acute fluid collections do not have a communication with the pancreatic duct, they do not contain high concentration of pancreatic enzymes and the fluid composition is similar to that of plasma. Table 1 gives the differentiating features between the acute fluid collections and acute pseudocyst.2
Natural history
Majority (85%) of fluid collections resolve spontaneously, however few persist, get walled of and develop into pseudocyst over 6-8 weeks. Fluid collections are frequently found along the anterior surface of the gland.3 The fluid may perforate into the lesser sac or extend beyond the pancreas into the anterior, posterior pararenal space, conforming to the space of the compartment. When the fluid escapes from the lesser sac into the greater peritoneal cavity through the foramen of Winslow, it produces pancreatic ascites. More commonly lesser peritoneal sac fluid escapes into the fissure ligamentum venosum, that separates the caudate lobe of liver.
Presenting symptoms
Majority are asymptomatic by themselves and detected on followup imaging during the course of acute pancreatitis. However a small percentage of patients do become symptomatic and may produce :
1.Upper abdominal discomfort due to large collections.
2.Compression of the GIT e.g. stomach, duodenum producing fullness or vomiting especially after meals.
3. Sudden onset pain, increase in size of lump, associated with fall in haemoglobin due to bleed from pseudoaneurysms of adjacent vessels.
4.Pain and fever due to infection
5.Rupture into the peritoneal cavity leading to pancreatic ascites.
6.Jaundice secondary to bile duct compression.
INVESTIGATIONS
Ultrasound is helpful in detecting but fails to give information about the pancreas. Rapid infusion CT scanning provides the most accurate information about presence of fluid collections, morphology of pancreas and associated necrosis. [4] Heterogeneous densities in peripancreatic fluid represents a combination of fat necrosis with fluid collections. The possibility of infection is determined by the clinical findings of rising fever, tachycardia, raised white cell count, air bubbles in fluid collections.
I hope this helps answer your question.
Nanny
Does anyone know where the fluid comes from and where it eventually goes?
Sarah,
Here is the remainder of this article:
MANAGEMENT OF FLUID COLLECTIONS
Since a spontaneous resolution of these fluid collections is known to our in majority of cases, they do not require any specific therapy. However those which either fail to resolve within six weeks or become symptomatic develop complications (as mentioned above) require some form of drainage.
Modalities of treatment available for pancreatic and peripancreatic fluid collection :-
Nonsurgical
1. Radiological - Percutaneous drainage (USG/CT guided)
2. Endoscopic - a) Stenting for disrupture of pancreatic duct. b) Drainage - Transgastric; Transampullary
Surgical
a) External drainage
b) Pancreatic necrosectomy
NON SURGICAL TREATMENT
With emergence of increasing expertise in interventional radiology such as percutaneous drainage, surgical procedures can be avoided or delayed until the patients condition is stable.
1. Percutaneous drainage : It involves either
a.percutaneous aspiration
b.percutaneous catheter drainage
Percutaneous drainage is usually done under antibiotic cover
A 7-12 Fr pigtail catheter is inserted into the collection over a needle inserted guidewire under radiologic screening (USG/CT)
Subsequent scans are done to assess the collection.
The catheter is usually placed for 4-6 weeks.
Percutaneous drainage is ideal for : accessible, well locaulated, single, small collections with low Ransons score (Less than four), APACHE II less than 16.5
Advantages of percutaneous drainage
1.It avoids the morbidity of surgery
2.It is safe in expert hands
3.It can be done under local anaesthesia.
Endoscopic procedures
The pre-requisite for endoscopic drainage is ductal disrupture. Endoscopic drainage is indicated in
Here is the remainder of this article:
MANAGEMENT OF FLUID COLLECTIONS
Since a spontaneous resolution of these fluid collections is known to our in majority of cases, they do not require any specific therapy. However those which either fail to resolve within six weeks or become symptomatic develop complications (as mentioned above) require some form of drainage.
Modalities of treatment available for pancreatic and peripancreatic fluid collection :-
Nonsurgical
1. Radiological - Percutaneous drainage (USG/CT guided)
2. Endoscopic - a) Stenting for disrupture of pancreatic duct. b) Drainage - Transgastric; Transampullary
Surgical
a) External drainage
b) Pancreatic necrosectomy
NON SURGICAL TREATMENT
With emergence of increasing expertise in interventional radiology such as percutaneous drainage, surgical procedures can be avoided or delayed until the patients condition is stable.
1. Percutaneous drainage : It involves either
a.percutaneous aspiration
b.percutaneous catheter drainage
Percutaneous drainage is usually done under antibiotic cover
A 7-12 Fr pigtail catheter is inserted into the collection over a needle inserted guidewire under radiologic screening (USG/CT)
Subsequent scans are done to assess the collection.
The catheter is usually placed for 4-6 weeks.
Percutaneous drainage is ideal for : accessible, well locaulated, single, small collections with low Ransons score (Less than four), APACHE II less than 16.5
Advantages of percutaneous drainage
1.It avoids the morbidity of surgery
2.It is safe in expert hands
3.It can be done under local anaesthesia.
Endoscopic procedures
The pre-requisite for endoscopic drainage is ductal disrupture. Endoscopic drainage is indicated in
I agree that this has all the indications of an acute pancreatitis attack. When I had mine, fluid was found in the pancreas, along with pancreatic pseudocysts. The collection of the fluid in my case was caused by debris and calicification around the pancreatic ducts. My amylase and lipase levels were also extremely elevated and returned to nearly normal within four weeks. I developed chronic pancreatitis as a result of this attack.
Your husband is receiving the standard medical treatment for a severe acute pancreatitis attack. Often severe cases can take several weeks to subside. The doctors are controlling his nausea and replacing his fluids and allowing the pancreas total rest by restricting solid food. The antibiotics were given as a safeguard in case any infection resulted from his attack. This, too, is standard procedure after an acute attack. It looks like they are keeping his nutritional needs met, and his enzyme levels have calmed down to a normal level.
Now it is just a waiting game. Your husband appears to be in good hands. The doctors will need to determine the cause of this attack once your husband regains his strength, so they can counsel him and treat him on what to do to prevent further attacks. Post again if you have any specific questions.
Nanny
Your husband is receiving the standard medical treatment for a severe acute pancreatitis attack. Often severe cases can take several weeks to subside. The doctors are controlling his nausea and replacing his fluids and allowing the pancreas total rest by restricting solid food. The antibiotics were given as a safeguard in case any infection resulted from his attack. This, too, is standard procedure after an acute attack. It looks like they are keeping his nutritional needs met, and his enzyme levels have calmed down to a normal level.
Now it is just a waiting game. Your husband appears to be in good hands. The doctors will need to determine the cause of this attack once your husband regains his strength, so they can counsel him and treat him on what to do to prevent further attacks. Post again if you have any specific questions.
Nanny
It sounds like he could have a stone blocking either the pancreas or bile duct. Have they done an ERCP to look for blockage?
This sounds more like an acute Pancreatitis attack. Chronic Pancreatitis, to my knowledge, does not have the type symptoms you indicate. Acute pancreatitis has high levels of amalase and lipase and is sometimes very critical as this one appears to be.
Do a search on the web for acute Pancreatitis for more information than you can read.
Then do one on Chronic Pancreatitis and see the differences.
Hope things improve.
Spike
Do a search on the web for acute Pancreatitis for more information than you can read.
Then do one on Chronic Pancreatitis and see the differences.
Hope things improve.
Spike
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