Pancreas or gallbladder?

[k2626]

For 4.5 yrs Ive had upper left stabbing pains on and off. Once my lipase was doubled and CA 19- (19 went down), however, ever since usually the lipase is no more than 20 pts high-though its been normal a couple of times. I also have bouts of diarrhea, or oily stool. Ive had SIX EUS-NONE show any pancreas issues, nor have the MRCP tests Ive had.

I have had a HIDA however and it showed to be operating at 27 vs 35. Could this be the root of my problem? No stones, or inflammation. I question this as drs are puzzled, my pain and lipase indicate my pancreas but all scans are totally normal without changes, and though the HIDA was off, my pain is primarily left sided. Alcohol has made it worse so I refrain from it totally.

[k2626]

Thank you very much for your response and insight.

If it were acute episodes, wouldnt my lipase levels be very high? Aside from my first attack (that was double normal), my levels are never more than 20 pts high. In addition, wouldnt the pain be unbearable to the point I would need to be in the hospital? My pains are a deep stabbing/squeezing pain. The can come hourly or I could just get two "stab/squeezes" the entire day.

Is it possible for an acute attack to resolve to feeling totally normal in an 8 hour period? Years prior to this, I had an attack of some sort in the middle of the night-terrible burning, feeling as I was being kicked in the gut, very very loud rumbling/churning, nausea, etc...I was going to go to the hospital as I thought something was going to explode inside of me, however, I was in too much pain to move so I rode it out at home. Three hours later it died down, and when I woke I was totally normal. Looking back I wonder if that was my pancreas.

The only thing that really makes me feel this is pancreas related, despite  6 totally normal EUS and several MRCP is the fact that during my first attack where my lipase was doubled, my CA19 was as well. My CA 19 went down to normal a few wks later and I believe the only three things that would cause both those labs to increase together is: pancreatic cancer , pancreatiits, or gallstones?

My dad did die of pancreatic cancer, hence all the EUS I have had.

[Ratnakar Kini]

Hi,
I went through your post.

You have mentioned that the pain is on upper left abdomen. This itself rules out gallbladder issue as the cause for your pain. Though the HIDA scan is showing a lower value, the gallbladder is not responsible for the pain you have on the left side.

EUS and MRCP are good imaging methods to detect diseases involving the pancreas. Since they have showed only normal pancreas, it is unlikely that your pain might be due to chronic issues of the pancreas. But recurrent acute pancreatitis is still a possibility. Imaging done at the time of having the symptoms may show changes in the pancreas.
Alcoholic gastropathy is a possibility. An upper GI endoscopy may be helpful in this case.
You have mentioned about loose stools and oily stools. Oily stools indicate fat malabsorption. Though pancreatic disease is a common cause, it has been ruled out in your case. The other causes of fat malabsorption should be looked in to which include small bowel issues and parasitic infestations.

I hope that answers your question.
Let me know if I can assist you further.
Regards,
Dr.Ratnakar