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Suggest Treatment For Pain In The Upper Right Quadrant
Question: Hello,
I've asked a few times on here about this pain in my upper right quadrant.
I finally saw my GI doc and he ordered some tests. I got the call that they were irregular; low pancreatic enzyme counts (which I assume is EPI?) They said that this medication that I'm getting tomorrow (I forget the name) should remedy the issue, and I have a follow up in just under two weeks. Like an idiot, I googled what could cause this, and the first thing that popped up was pancreatic cancer.
My question is how common it is for this issue to be caused by cancer in a 29 year old male that's never drank more than 5 times in my life?
If not cancer, what could cause this to happen?
I should also mention that my gallbladder was removed (by the same GI doc) due to it being constantly filled with stones, 11 years ago.
Thank you,
XXXX
I've asked a few times on here about this pain in my upper right quadrant.
I finally saw my GI doc and he ordered some tests. I got the call that they were irregular; low pancreatic enzyme counts (which I assume is EPI?) They said that this medication that I'm getting tomorrow (I forget the name) should remedy the issue, and I have a follow up in just under two weeks. Like an idiot, I googled what could cause this, and the first thing that popped up was pancreatic cancer.
My question is how common it is for this issue to be caused by cancer in a 29 year old male that's never drank more than 5 times in my life?
If not cancer, what could cause this to happen?
I should also mention that my gallbladder was removed (by the same GI doc) due to it being constantly filled with stones, 11 years ago.
Thank you,
XXXX
Brief Answer:
Not thinking of cancer,but due to gallbladder removal...see below...
Detailed Answer:
Hello XXXX,
I read your message carefully and understood your medical issue.
I see that you discovered low pancreatic enzyme counts in your tests. If you could remember the drug you have been prescribed it would be great for me to know. Usually, pancreatic enzymes like Creon are prescribed in this case.
Low pancreatic enzymes mean exocrine pancreatic insufficiency or EPI, but I don't think you should consider cancer causes EPI. Pancreatic cancer may be common in people over 70 but it is quite rare in patients under 40.
Cancer is not the only cause for lowering the pancreatic enzymes. Most common cause is pancreatitis. Also, celiac disease (gluten intolerance) and colitis (ulcerative or Crohn's disease) may cause the pancreatic enzyme to lower.
You mentioned that you ran a surgery 11 years ago and removed your gallbladder. This is a situation that may contribute on lowering your pancreatic enzymes. Gallbladder collects these pancreatic enzymes and the fact that the gallbladder don't exist anymore gives the message to the pancreas to produce less in order to prevent the duodenum irritation.
You doctor will see your enzyme levels and will note how normal they are in a person who lacks the gallbladder. Do not compare your numbers with normal values of enzymes in people who have a gallbladder. Also, people with recent surgery may develop EPI. You can send the reports to me so I can evaluate the numbers there and tell if they are normal for a patient who have had the gallbladder removed 11 years ago like you.
Just continue avoiding drinking alcohol use and do not eat fatty foods and follow a healthy diet.
I hope this is useful for you XXXX.
Dr.Albana
Not thinking of cancer,but due to gallbladder removal...see below...
Detailed Answer:
Hello XXXX,
I read your message carefully and understood your medical issue.
I see that you discovered low pancreatic enzyme counts in your tests. If you could remember the drug you have been prescribed it would be great for me to know. Usually, pancreatic enzymes like Creon are prescribed in this case.
Low pancreatic enzymes mean exocrine pancreatic insufficiency or EPI, but I don't think you should consider cancer causes EPI. Pancreatic cancer may be common in people over 70 but it is quite rare in patients under 40.
Cancer is not the only cause for lowering the pancreatic enzymes. Most common cause is pancreatitis. Also, celiac disease (gluten intolerance) and colitis (ulcerative or Crohn's disease) may cause the pancreatic enzyme to lower.
You mentioned that you ran a surgery 11 years ago and removed your gallbladder. This is a situation that may contribute on lowering your pancreatic enzymes. Gallbladder collects these pancreatic enzymes and the fact that the gallbladder don't exist anymore gives the message to the pancreas to produce less in order to prevent the duodenum irritation.
You doctor will see your enzyme levels and will note how normal they are in a person who lacks the gallbladder. Do not compare your numbers with normal values of enzymes in people who have a gallbladder. Also, people with recent surgery may develop EPI. You can send the reports to me so I can evaluate the numbers there and tell if they are normal for a patient who have had the gallbladder removed 11 years ago like you.
Just continue avoiding drinking alcohol use and do not eat fatty foods and follow a healthy diet.
I hope this is useful for you XXXX.
Dr.Albana
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the response.
The prescription he gave was Zenpep.
I do not have the reports unfortunately, they were sent straight to my doctors office (they called and told me that the enzymes were low).
I just have a few more questions...
EPI can occur more than a decade after gallbladder removal?
Zenpep is not covered by either of my insurances (somehow); is there another alternative?
And finally, would I have to take an enzyme medication for the rest of my life or just a certain period?
The prescription he gave was Zenpep.
I do not have the reports unfortunately, they were sent straight to my doctors office (they called and told me that the enzymes were low).
I just have a few more questions...
EPI can occur more than a decade after gallbladder removal?
Zenpep is not covered by either of my insurances (somehow); is there another alternative?
And finally, would I have to take an enzyme medication for the rest of my life or just a certain period?
Brief Answer:
Following answers to your queries...
Detailed Answer:
Hi back,
Thank you for following up.
Never mind for the reports.
To answer to your next questions:
- EPI has been present once you had problems with gallbladder stones. The inflammation caused to pancreas might have been associated with low pancreatic enzymes. What I want to rule out is chronic pancreatitis in your case. That's why I wanted to have a look at the lab reports.
In either cases, there is nothing serious unless chronic pancreatitis is fully diagnosed.
- Zenpep is the brand name for the pancrealipase. There are other brand names like Creon, etc. Depending on your insurance company we can see what brand has been covered.
- There are many factors to evaluate before determining whether you need this enzyme for a period of time or permanently. At this moment, I'd advise to take a course of these enzymes. I believe, any acute illness might have caused low pancreatic enzymes. Once it will be stabilized, and after taking a course of the enzymes, everything will be settled. However, should wait for the incoming days to see the changes.
Hope this answered your questions.
Dr.Albana
Following answers to your queries...
Detailed Answer:
Hi back,
Thank you for following up.
Never mind for the reports.
To answer to your next questions:
- EPI has been present once you had problems with gallbladder stones. The inflammation caused to pancreas might have been associated with low pancreatic enzymes. What I want to rule out is chronic pancreatitis in your case. That's why I wanted to have a look at the lab reports.
In either cases, there is nothing serious unless chronic pancreatitis is fully diagnosed.
- Zenpep is the brand name for the pancrealipase. There are other brand names like Creon, etc. Depending on your insurance company we can see what brand has been covered.
- There are many factors to evaluate before determining whether you need this enzyme for a period of time or permanently. At this moment, I'd advise to take a course of these enzymes. I believe, any acute illness might have caused low pancreatic enzymes. Once it will be stabilized, and after taking a course of the enzymes, everything will be settled. However, should wait for the incoming days to see the changes.
Hope this answered your questions.
Dr.Albana
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Gotcha. If it were to be chronic pancreatitis (the pain started just this year), what would be the solution or why would that beserious?
Brief Answer:
Not related to chronic pancreatitis in your case,see below...
Detailed Answer:
Hi back XXXX,
I am so sorry for my late reply due to my XXXXXXX clinical overload during these rainy days.
To answer your questions, :
In your case, we cannot judge over chronic pancreatitis as long as I do not have any result of your blood tests. Furthermore, taking into account your personal medical history and your age, I do not think it's case of pancreatitis although we look for blood figures to rule it out, it does not necessarily mean it's related to pancreatitis.
Usually, chronic pancreatitis starts in patients older than 45 years while in your case the stones and gallbladder inflammation are the main factors causing your actual problems.
Treatment of chronic pancreatitis depends on the severity of symptoms:
- if flare up, hospitalization is required
- maintenance therapy with analgesic/anti-inflammatories, pancreatic enzymes, and of course diet changes which are crucial.
We can say if chronic pancreatitis is serious as there is no specific treatment and is often associated with other complications.
Hope this answers your questions.
Dr.Albana
Not related to chronic pancreatitis in your case,see below...
Detailed Answer:
Hi back XXXX,
I am so sorry for my late reply due to my XXXXXXX clinical overload during these rainy days.
To answer your questions, :
In your case, we cannot judge over chronic pancreatitis as long as I do not have any result of your blood tests. Furthermore, taking into account your personal medical history and your age, I do not think it's case of pancreatitis although we look for blood figures to rule it out, it does not necessarily mean it's related to pancreatitis.
Usually, chronic pancreatitis starts in patients older than 45 years while in your case the stones and gallbladder inflammation are the main factors causing your actual problems.
Treatment of chronic pancreatitis depends on the severity of symptoms:
- if flare up, hospitalization is required
- maintenance therapy with analgesic/anti-inflammatories, pancreatic enzymes, and of course diet changes which are crucial.
We can say if chronic pancreatitis is serious as there is no specific treatment and is often associated with other complications.
Hope this answers your questions.
Dr.Albana
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
No worries Doctor.
I know how demanding it must be.
Yes that answered them. I was just a little disturbed by the statistics of serious pancreatic related illnesses (and even death) just from chronic pancreatitis. My doctor gave me a 30 day sample of zenpep (to see if it remedies), with today being day one.
My last questions (2) are:
If zenpep were to work, does it often help the symptoms on day one or take a few?
If this isnt solely an enzyme issue, what do you imagine would be the next step or that it MIGHT be?
I know how demanding it must be.
Yes that answered them. I was just a little disturbed by the statistics of serious pancreatic related illnesses (and even death) just from chronic pancreatitis. My doctor gave me a 30 day sample of zenpep (to see if it remedies), with today being day one.
My last questions (2) are:
If zenpep were to work, does it often help the symptoms on day one or take a few?
If this isnt solely an enzyme issue, what do you imagine would be the next step or that it MIGHT be?
Brief Answer:
Following answers to your new questions...
Detailed Answer:
Hi back XXXX,
Nice to hear back from you.
To answer your new questions, :
1. Zenpep is a proton pump inhibitor. It works by reducing the acid production by the glands on the stomach lining. And this is not done within a day; it requires a few days and after a couple of weeks, the true effect will be notable and will last for long time (months or even years).
Antacids on contrary give a fast and immediate solution that won't last that longer.
2. As I said since the beginning of our discussion, everything has to do with your gallbladder issues.
Although you have it removed, there are still intrahepatic biliary pathways that have the same function as gallbladder although at that extent. They can get inflamed or infected, and this can be reflected with pancreas inflammation and low enzymes levels.
Furthermore, if you have gone through a viral infection recently, that can be also a cause to your low enzymes levels too.
So, basically, in your case, these are 2 main explanations to low enzymes levels without thinking of chronic pancreatitis.
Hope that answered to your new questions.
Dr.Albana
Following answers to your new questions...
Detailed Answer:
Hi back XXXX,
Nice to hear back from you.
To answer your new questions, :
1. Zenpep is a proton pump inhibitor. It works by reducing the acid production by the glands on the stomach lining. And this is not done within a day; it requires a few days and after a couple of weeks, the true effect will be notable and will last for long time (months or even years).
Antacids on contrary give a fast and immediate solution that won't last that longer.
2. As I said since the beginning of our discussion, everything has to do with your gallbladder issues.
Although you have it removed, there are still intrahepatic biliary pathways that have the same function as gallbladder although at that extent. They can get inflamed or infected, and this can be reflected with pancreas inflammation and low enzymes levels.
Furthermore, if you have gone through a viral infection recently, that can be also a cause to your low enzymes levels too.
So, basically, in your case, these are 2 main explanations to low enzymes levels without thinking of chronic pancreatitis.
Hope that answered to your new questions.
Dr.Albana
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Oh I understand now.
I forgot to ask my doctor that, so it's good to know that Zenpep doesn't immediately work.
I do have one last set of questions doctor (I'm so sorry for dragging this conversation on), but Ive noticed these before (but including today)...
On occasion, mostly when I'm sitting upright, I'll notice a similar ache on my left side as well (not as strong or constant, but still there).
Could EPI cause pain on the left side as well? I'm asking, wondering if this could possibly be a kidney issue (being that there's one on both sides).
I've also noticed, again, on occasion, a cold sensation where the ache would be on my right side...would EPI cause this as well?
Not to be gross, but would needing to defecate within 20 minutes of eating be normal for EPI?
Thank you so much doctor.
Last questions, I promise.
XXXX
I forgot to ask my doctor that, so it's good to know that Zenpep doesn't immediately work.
I do have one last set of questions doctor (I'm so sorry for dragging this conversation on), but Ive noticed these before (but including today)...
On occasion, mostly when I'm sitting upright, I'll notice a similar ache on my left side as well (not as strong or constant, but still there).
Could EPI cause pain on the left side as well? I'm asking, wondering if this could possibly be a kidney issue (being that there's one on both sides).
I've also noticed, again, on occasion, a cold sensation where the ache would be on my right side...would EPI cause this as well?
Not to be gross, but would needing to defecate within 20 minutes of eating be normal for EPI?
Thank you so much doctor.
Last questions, I promise.
XXXX
Brief Answer:
Following answers to your questions;happy to be assisting you,no bother...
Detailed Answer:
Hi back XXXX,
I am happy to assist you while trying to find the answers to your health queries.
I'm not bothered at all. You make ask as many questions as you have; I'll be here to assist your accurately hoping to find the best answers to you.
Now, to answer your new questions:
- First, what I see from you is that you are thinking over EPI all the time. And you shouldn't. Exocrine pancreatic insufficiency (EPI) although a scary medical term, should not be misused.
It's great that you are taking appropriate medical help and I encourage to continue regular follow ups with your doctor.
- Next, when EPI is present, the pancreatic enzymes are low, this will cause maldigestion of foods. This on the other hand, will lead to less digested food and lots of gas or bloating.
When sitting upright, the gas will go up and will distend the large bowels (on the left) causing the pain you feel. Try having a lemon soda, and see if burping or passing gas will relieve the pain (I'm sure it will).
- When distended bowels will put pressure on the abdominal nerves, you might have strange feelings of pain including cold sensation.
- when there is lack of pancreatic enzymes, the indigested food will cause increase of intestinal peristalsis, and you'll have the feeling to defecate even 20 minutes after eating (this is the time for the stomach to start emptying into the duodenum and stimuli are given to intestines to start peristalsis).
Hope they all answered your questions.
Let me know if you need further clarifications. I'm happy to assist you further.
Dr.Albana
Following answers to your questions;happy to be assisting you,no bother...
Detailed Answer:
Hi back XXXX,
I am happy to assist you while trying to find the answers to your health queries.
I'm not bothered at all. You make ask as many questions as you have; I'll be here to assist your accurately hoping to find the best answers to you.
Now, to answer your new questions:
- First, what I see from you is that you are thinking over EPI all the time. And you shouldn't. Exocrine pancreatic insufficiency (EPI) although a scary medical term, should not be misused.
It's great that you are taking appropriate medical help and I encourage to continue regular follow ups with your doctor.
- Next, when EPI is present, the pancreatic enzymes are low, this will cause maldigestion of foods. This on the other hand, will lead to less digested food and lots of gas or bloating.
When sitting upright, the gas will go up and will distend the large bowels (on the left) causing the pain you feel. Try having a lemon soda, and see if burping or passing gas will relieve the pain (I'm sure it will).
- When distended bowels will put pressure on the abdominal nerves, you might have strange feelings of pain including cold sensation.
- when there is lack of pancreatic enzymes, the indigested food will cause increase of intestinal peristalsis, and you'll have the feeling to defecate even 20 minutes after eating (this is the time for the stomach to start emptying into the duodenum and stimuli are given to intestines to start peristalsis).
Hope they all answered your questions.
Let me know if you need further clarifications. I'm happy to assist you further.
Dr.Albana
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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