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How Can Upper Abdominal Pain And Extreme Nausea Be Managed When Diagnosed With Ulcerative Colitis?

Posted on Mon, 25 Jul 2022

Question: I have ulcerative colitis and have had it for 12 years. I know my symptoms, and for the past two weeks I've been having upper abdominal pain and extreme nausea. Doc suspected pancreatitis, but it's been two weeks without a call back about labs. When I was unable to keep water down yesterday, I went to the ER. My CT showed fatty replacement of the pancreas and bloodwork showed low lipase levels. They gave me antibiotics and painkillers and sent me home without even explaining what the pancreas thing meant. Help?

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For the liver, the CT said "focal fat along the falciform ligament" and " questionable mild steatosis"
Everything else but my colon and my gallbladder was listed as unremarkable. Colon shows inflammation consistent with UC, and the gallbladder has a "fold along the neck" in one view but not in another. No gallstones found.
The blood work was mostly fine, glucose a little close to the higher end, chloride above normal range.

Answered by Dr. Anders Mark Christensen (36 minutes later)

Brief Answer:
Pancreatitis is unlikely, gastritis or gallstones seem more likely.

Detailed Answer:

Hi,

It is difficult to say what fatty replacement means. In the absence of radiological signs of pancreatitis and a low lipase, pancreatitis is highly unlikely. What you describe could also indicate gastritis, or gallstone disease. What did the rest of your blood tests show? Anything else described on your CT?

Regards

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Brief Answer:
Ok, it all sounds perfectly fine.

Detailed Answer:

Hi,

OK, it all sounds perfectly fine.
Exactly where is your pain located? Is it constant, intermittent? Have you vomited? If so, was there blood in the vomit? Are there any provoking factors? What about your stools, are they bloody, watery, etc.?
Have you taken any medicine in the past two weeks, e.g. nonsteroidal anti-inflammatory drugs?
Did you have liver enzymes controlled in your blood tests?

Regards

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Anders Mark Christensen (31 minutes later)

I didn't see where they did a liver panel, unfortunately. I'm vomiting occasionally, mostly in the morning (I am not pregnant, I have been checked) but my UC has always been worse in the mornings. There is no blood. As for stools they are frequent, loose, watery, and often pale yellowish slime. Sometimes there is blood in the mucus, but there hasn't been any in my stool in general.

Answered by Dr. Anders Mark Christensen (1 hour later)

Brief Answer:
You should consult a gastroenterologist.

Detailed Answer:

Hi,

Your symptoms are suggestive of a (mild) flare of UC. However, the characterization of your stools could also indicate some problem relating to the exocrine function of the pancreas. To get closer to a definitive diagnosis, I suggest you see a gastroenterologist for analysis of fecal fat and inflammatory markers (calprotectin). Perhaps a colonoscopy is due. The suspected fatty liver should be examined further with liver enzymes, and this is something the gastroenterologist also should look at.

Regards

Above answer was peer-reviewed by : Dr. Nagamani Ng