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What Causes Persistent Headache?
Question: Hello doctor, I am having pain in right side of Head above my temple. there is no pain in eyes. Pain comes and go like their is pressure thing there.. What shoud I do. I am on ATT with Rcinex 1000 and combutol 1200 from last 8 months
I also want to update that I am on ATT for Peri pancreatic and Porta Lymphnodes. In my last EUS Doctor report was .
" Pancreas parenchyma is atrophy with Hyperechoic foci in body and tail reason. There were strands lobulations. However no strictures and stones and no calcification. Additionally there was 2 cysts in body and tail largest of 2cm
Diagnosis : Evolving chronic pancreatic.
Can u pls. tell at what stage this is .. I am not having severe abdomin pain only there is some discomfort after meals
I also want to update that I am on ATT for Peri pancreatic and Porta Lymphnodes. In my last EUS Doctor report was .
" Pancreas parenchyma is atrophy with Hyperechoic foci in body and tail reason. There were strands lobulations. However no strictures and stones and no calcification. Additionally there was 2 cysts in body and tail largest of 2cm
Diagnosis : Evolving chronic pancreatic.
Can u pls. tell at what stage this is .. I am not having severe abdomin pain only there is some discomfort after meals
Brief Answer:
Headache should investigated
Detailed Answer:
Hello XXXX
Welcome to HCM and thank you for your query.
If the headache is persistent, I think you should have a CT or MRI of the brain as there is a possibility of tuberculoma or meningitis as you have tuberculosis.
You might have had abdominal pain and pancreatitis in the past. Small clear cysts may be found in normal pancreas and in chronic pancreatitis.
These cysts are better evaluated with a MRI of the abdomen.
If you take alcohol as it is the commonest cause of chronic pancreatitis.
Other conditions that may cause chronic pancreatitis in you are
Autoimmune problems (when the immune system attacks the body)
High levels of triglycerides in the blood (hypertriglyceridemia) and
Hyperparathyroidism.
There is no clinical staging that is recognized.
I am available for further queries,
Take Care,
Dr. Noble Zachariah
Headache should investigated
Detailed Answer:
Hello XXXX
Welcome to HCM and thank you for your query.
If the headache is persistent, I think you should have a CT or MRI of the brain as there is a possibility of tuberculoma or meningitis as you have tuberculosis.
You might have had abdominal pain and pancreatitis in the past. Small clear cysts may be found in normal pancreas and in chronic pancreatitis.
These cysts are better evaluated with a MRI of the abdomen.
If you take alcohol as it is the commonest cause of chronic pancreatitis.
Other conditions that may cause chronic pancreatitis in you are
Autoimmune problems (when the immune system attacks the body)
High levels of triglycerides in the blood (hypertriglyceridemia) and
Hyperparathyroidism.
There is no clinical staging that is recognized.
I am available for further queries,
Take Care,
Dr. Noble Zachariah
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Sir, My question is I am not having anysevere pain and neither any calculi, strictures, stones and calcfification is there..
So,only on the basis of Hyperechoic foci, strands and lobulations does It means I am having chronic Pancreatitis.To add I am also borderline diabetic from last few8 months ( Diagnosis was at the same time as TB).
and what is meaning of EVOLVING CHRONIC PANCREATITIS ?Additionally I was occassional drinker ( 1-2 times per month) in past and additionally I am not having
High levels of triglycerides in the blood (hypertriglyceridemia) andHyperparathyroidism.
So,only on the basis of Hyperechoic foci, strands and lobulations does It means I am having chronic Pancreatitis.To add I am also borderline diabetic from last few8 months ( Diagnosis was at the same time as TB).
and what is meaning of EVOLVING CHRONIC PANCREATITIS ?Additionally I was occassional drinker ( 1-2 times per month) in past and additionally I am not having
High levels of triglycerides in the blood (hypertriglyceridemia) andHyperparathyroidism.
Brief Answer:
Developing chronic pancreatitis
Detailed Answer:
Chronic pancreatitis unless it is due to a calculous disease does not usually produce severe pain. The abdominal pain after food, borderline diabetes and some malabsorption are suggestive.
It is possible that the cause of your pancreatitis is alcohol as you do not have the other usual risk factors.
The diagnosis of chronic pancreatitis is typically based on tests on pancreatic structure and function. Serum amylase and lipase may or may not be moderately elevated in cases of chronic pancreatitis. A secretin stimulation test is considered the gold standard functional test for diagnosis of chronic pancreatitis but not often used clinically. The observation that bi-carbonate production is impaired early in chronic pancreatitis has led to the rationale of use of this test in early stages of disease (sensitivity of 95%). Other common tests used to determine chronic pancreatitis are fecal elastase measurement in stool, serum trypsinogen, computed tomography (CT), ultrasound, EUS, MRI, ERCP and MRCP.
Pseudocysts are usually seen only in the early stage of the disease. It is suggested that acute pancreatitis, if it affects the intra pancreatic fat deposits, may evolve into chronic pancreatitis. Your radiologist feels that the disease is in the evolving stage and not full blown now with the typical symptoms of loose motion, malabsorption with or without diabetes.
You are welcome to ask more queries if you have any.
Dr. Noble Zachariah
Developing chronic pancreatitis
Detailed Answer:
Chronic pancreatitis unless it is due to a calculous disease does not usually produce severe pain. The abdominal pain after food, borderline diabetes and some malabsorption are suggestive.
It is possible that the cause of your pancreatitis is alcohol as you do not have the other usual risk factors.
The diagnosis of chronic pancreatitis is typically based on tests on pancreatic structure and function. Serum amylase and lipase may or may not be moderately elevated in cases of chronic pancreatitis. A secretin stimulation test is considered the gold standard functional test for diagnosis of chronic pancreatitis but not often used clinically. The observation that bi-carbonate production is impaired early in chronic pancreatitis has led to the rationale of use of this test in early stages of disease (sensitivity of 95%). Other common tests used to determine chronic pancreatitis are fecal elastase measurement in stool, serum trypsinogen, computed tomography (CT), ultrasound, EUS, MRI, ERCP and MRCP.
Pseudocysts are usually seen only in the early stage of the disease. It is suggested that acute pancreatitis, if it affects the intra pancreatic fat deposits, may evolve into chronic pancreatitis. Your radiologist feels that the disease is in the evolving stage and not full blown now with the typical symptoms of loose motion, malabsorption with or without diabetes.
You are welcome to ask more queries if you have any.
Dr. Noble Zachariah
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Sorry, doctor last question in this series..
As per above symptoms, statistically how much chances are that I will be having full blow chronic pancreatitis. I have left alcohol completely. And in how much time that can happen. Symptoms are :-
1) Pancreatic Astrophy with hyperechoic foci, lobulations and strands in body and tail
2) Borderline diabetic
3) No Calcification, strictures or stones
4) MPD is 3MM in body region
5) Elevated Lipase by approximately 3 times and Amylase by 1.5 times than upper range
As per above symptoms, statistically how much chances are that I will be having full blow chronic pancreatitis. I have left alcohol completely. And in how much time that can happen. Symptoms are :-
1) Pancreatic Astrophy with hyperechoic foci, lobulations and strands in body and tail
2) Borderline diabetic
3) No Calcification, strictures or stones
4) MPD is 3MM in body region
5) Elevated Lipase by approximately 3 times and Amylase by 1.5 times than upper range
Brief Answer:
Keep off alcohol and things would improve.
Detailed Answer:
Hello XXXX
Don't be so apologetic about asking queries that worry you.
If the cause for your developing pancreatitis is alcohol, now that you have stopped, the prognosis is good. There has been some atrophy but given time and no insult by alcohol, it may recover.
Normal size of MPD in the body region is 2.5mm. There are no stones or signs of obstruction . This dilatation is secondary to the atrophy of the pancreatic tissue.
The elevated lipase and amylase would decrease, unless you have autoimmune pancreatitis which is rare.
The diagnostic criteria for autoimmune pancreatitis are
I. Pancreatic imaging studies show diffuse narrowing of the main pancreatic duct with irregular wall (more than 1/3 of length of the entire pancreas).
II. Laboratory data demonstrate abnormally elevated levels of serum gamma globulin and/or IgG4, or the presence of autoantibodies.
III. Histopathologic examination of the pancreas shows fibrotic changes with lymphocyte and plasma cell infiltrate.
So keep off alcohol , also check Serum lipase and amylase levels after 6 weeks.
Wish you a quick recovery.
If you have further queries, you are welcome to ask.
Dr. Noble Zachariah
Keep off alcohol and things would improve.
Detailed Answer:
Hello XXXX
Don't be so apologetic about asking queries that worry you.
If the cause for your developing pancreatitis is alcohol, now that you have stopped, the prognosis is good. There has been some atrophy but given time and no insult by alcohol, it may recover.
Normal size of MPD in the body region is 2.5mm. There are no stones or signs of obstruction . This dilatation is secondary to the atrophy of the pancreatic tissue.
The elevated lipase and amylase would decrease, unless you have autoimmune pancreatitis which is rare.
The diagnostic criteria for autoimmune pancreatitis are
I. Pancreatic imaging studies show diffuse narrowing of the main pancreatic duct with irregular wall (more than 1/3 of length of the entire pancreas).
II. Laboratory data demonstrate abnormally elevated levels of serum gamma globulin and/or IgG4, or the presence of autoantibodies.
III. Histopathologic examination of the pancreas shows fibrotic changes with lymphocyte and plasma cell infiltrate.
So keep off alcohol , also check Serum lipase and amylase levels after 6 weeks.
Wish you a quick recovery.
If you have further queries, you are welcome to ask.
Dr. Noble Zachariah
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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