Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
Question: RUQ Tenderness & Pain
|Kady - Thu Jan 27, 2005 11:45 pm||
I have been suffering with RUQ addominal tenderness and pain since 9/04, but the pain has been increasing in frequency and in strength. I have a history of a lap. chol in 8/00 and in May and June 2004, I had an Ileus, and then suffered 2 bouts of Acute pancreatitis. The first episode lasted 3 weeks and the 2nd episode occurred approx. 2 weeks after the first bout. The second time, after a week of GI rest/pain and nausea medication management, I underwent an ERCP with papillectomy/sphincterotomy. Currently, if I even lean or lie on my RUQ there is pain and the degree of the pain has increased. I recently saw my PCP (new doc, new town) and he did not even exam me. He stated that it was probably chronic pancreatitis and that I would have to deal chronic pain for the rest of my life? How does he know it is chronic pancreatitis with doing any diagnotic testing? I suggested he draw an amylase/lipase and he dismissed me telling me that my enzymes were probably high anyway...? Why would they be? I am seeing a GI doc at the end of Feb, but my pain has been increasing more every few days. The reason I am seeing GI is b/c I had elevated ast/alt levels a few months ago, and my rheumatologist ordered the consult.
I would like to know what diagnostic tests would appropriate for me to undergo? I am thinking that possibly I have some sort of biliary disease/obstruction, so would an ERCP be an appropriate test? Would it be normal for my lipase/amylase to be elevated in the absence of acute disease, as my PCP suggested? I feel as though I am being brushed off, and a trip to the ER isn't the answer, for what is currently going on unless I develop severe nausea and vomiting with the pain.
Thanks in advance.
|Dr. Tamer Fouad - Fri Jan 28, 2005 2:48 am||
You are absolutely right. The diagnosis, indeed the definition of chronic pancreatitis is still a major problem among physicians. It is not a condition that can easily be diagnosed without evidence.
First have a look at our chronic pancreatitis page for more info on the diagnostic tools available.
I think you should have a serum amylase and lipase done. Did you get an abdominal CT done recently to evaluate the possibility of hepatitis that you mentioned in your profile? If not that would also be advisable. Although it is more useful in decting advanced stages of chronic pancreatitis, it would rule out alot of causes for the pain you are experiencing.
Lastly, according to the results of the above investigations you may need another ERCP. Pain if due to chronic pancreatitis can be treated by celiac blockade quite effectively.
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