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Forum Name: Gastroenterology Topics

Question: Do I have chronic pancreatitis?


 Wonderstruck - Fri Dec 01, 2006 7:04 pm

Hello. I am a 29 yr old female with a history of unexplained RUQ pain for approx five years now. Everytime I would have a severe flare up of pain I would have tests done to see if anything was going on, especially gallbladder problems. Everytime the results came back normal.

However this past Saturday night I was in such pain that I went to the ER. They did blood work as well as a CT scan and told me that the entire head of my pancreas was calcified. My blood tests were all within normal ranges. On the report it says "Extensive calcifications within the head of the pancreas. While this could be due to chronic pancreatitis, a mass cannot be excluded". When I went to a walk-in clinic with these results the Dr said he highly doubted that I had CP because I'm too young.

I have a history of high cholesterol (300) and I have lost 45 lbs without dieting or exercising. The weightloss stablized over the past month but I still have no clue as to why I would lose so much without even trying or changing my diet or activity level.

Does this sound like CP? Or can the pancreas calcify itself like this for no reason?

Thank you.
 Dr. Tamer Fouad - Sat Dec 02, 2006 1:52 am

User avatar Hello,

Pancreatic calcifications, often considered pathognomonic of chronic pancreatitis, are observed in approximately 30% of cases with chronic pancreatitis.

Calcified shrunken pancreas can be detected by abdominal CT scan in advanced cases. CT is less sensitive in early or moderate cases.

ERCP is the diagnostic procedure of choice. It allows the most accurate visualization of the pancreatic ductal system and has been regarded as the criterion standard for diagnosing chronic pancreatitis. One limitation of ERCP is that it cannot be used to evaluate the pancreatic parenchyma, and histologically proven chronic pancreatitis has been documented in the setting of normal findings on pancreatogram.

Endoscopic ultrasonography and Magnetic resonance cholangiopandreatography (MRCP) are being reviewed and improved as methods of diagnosis.

Has your doctor advised you on the next step to be taken?
 Wonderstruck - Sun Dec 03, 2006 9:47 pm

No he hasn't really mentioned anything about doing other tests. The report from the CT scan mentioned it could be due to CP but that a mass couldn't be ruled out yet. So right now I'm in the dark because the current Dr I am seeing gave me a script for percocet and told me to go to the ER should the pain get worse.

That doesn't help me nor does it tell me what is really going on. What are the usual causes of calcifications in the head of the pancreas? On one report it says they are 1.2 and 1.1 cm focal areas of calcification in the pancreatic head. So I'm really concerened as to why they are in there. The Dr at the ER said he was concerned it could be pancreolilathis and to see my Dr. I did and as mentioned above he just handed me a script and sent me home, so to speak.

I will look for a new physician but in the mean time do I have cause for alarm or are calcifications of the pancreas normal?
 Dr. Tamer Fouad - Mon Dec 04, 2006 1:17 am

User avatar Hello,

Chronic pancreatitis, especially as a result of alcoholic pancreatitis is the most common cause of calcification in the pancreas. However other causes of chronic pancreatitis can also cause calcification.

Along with hereditary pancreatitis, cystic fibrosis accounts for most of the pancreatic calcifications in children.

The most common primary pancreatic tumor, ductal adenocarcinoma, characteristically does not calcify. However, pancreatic carcinoma may develop in a pancreas with underlying chronic pancreatitis, or, they may develop in the setting of chronic pancreatitis that results from an obstructing ductal adenocarcinoma.

Islet cell tumors are rare tumors but are known for the presence of calcifications.

Mucinous cystic neoplasms (malignant) as well as serous cystadenomas (benign) can develop calcifications.

Solid and pseudopapillary epithelial neoplasms are low-grade malignant tumors. Another uncommon pancreatic tumor, the pancreatoblastoma, can also develop calcifications.

Calcifications have been reported in cases of metastatic renal cell carcinoma and metastatic colon carcinoma to the pancreas.

Occasionally, in patients older than 70 years old, intraductal calculi occur with no identifiable cause.

Several conditions may mimic pancreatic calcification such as calcification of the splenic artery, calcified gallstones or retained contrast in duodenal diverticula.

Getting a second opinion is a good idea. I hope this info helped.
 mgw1941 - Wed Apr 01, 2009 4:20 pm

please expand on your answer "several conditions may mimic pancreatic calcification such as calcification of the splenic artery,or retained contrast in duodenal diverticula.
 Dr. Tamer Fouad - Sat Apr 04, 2009 1:58 pm

User avatar Hello,

Thank you for your question. I am sorry I didn't put the reference to my response so I was unable to check for more details. I am not a radiologist, however, I assume that these structure can be confused with pancreatic calcification because of the proximity of these structures to the pancreas (splenic artery and duodenal diverticula). Hence any calcification in these structure could mimic a calcified pancreas, although I would assume that calcification in the pancreas would be far more common.

I hope that helps.
 fuego04 - Sun Oct 25, 2009 8:21 am

I am writing because I have been experiencing spasms in my abdomen area to include my right side chest. I have received an ultrasound and bloodwork. My doctor said my Gallbladder was fine but my bloodwork came back a little high for my Pancreas. The spasms I have been experiencing have been mostly on my right upper quadrant, but I have also felt them on my left upper quadrant as well. Recently I have started to feel the spasm under my right chest. The spasms are not painful but do worry me!! These spasms have been happening for about a month now. I have experienced diarrea off and on within the past 3 weeks. Any help would be appreciated!!

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