Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Severe Attacks Of Midepigastric Pain With History Of Cholecystectomy?
Question: Im a 55 yo male with 25 yr h/o gerd. Treated with omeprazole 20 bid and pepcid 20 tid. Had cholecystectomy 10 yrs ago for severe biliary dyskinesia with +ve response to cck on hida and EF 8%. Was asymptomatic for 5 yrs had severe attack of midepigastric pain unresponsive to meds which abated in 2 wks. 2 yrs ago had another one of these attacks but would not remit. Had ercp with sphincterotomy of cbd manometry revealed pressure of 90 on that side. Stent was placed in pancreatic duct. All for suspected sod type3. Had pancreatitis and transaminitis after procedure but course was uncomplicated and symptoms and return of normal labs were in check by day 7 after procedure. Symptoms returned 8 days ago but have gotten progressively better with some waxing and waning symptoms related to diet . Back on clear liquids symptoms improving. Dr Lo does not want to repeat ercp referred me to episod study and wants to give it time and advance diet slowly . Im the medical director of a geriatric psyche program 60 beds, so misding wirk is devastating . But was so bad in friday had to take off. So my ? Is does all this sound right, is there something i can take symptomatically or should i put myself on anxiolytics lol. Thx for ur time- XXXXXXX
Brief Answer:
Find out the cause first...
Detailed Answer:
Hi there,
I have gone through your medical history and understood your concerns.
Your symptoms are indicative for pancreatitis relapse. Further lab investigations are needed:
- pancreas function test( amilase;lipase)
- abdominal ultrasound
- CRP
First, there is no need to repeat ERCP. During the last procedure, you had had sphincterotomy. In other words, ductus is definitely closed, therefore, there is no need for ERCP. Furthermore, ERCP is an invasive procedure and is indicated when strongly needed. Moreover, you experienced pancratitis as complication of ERCP procedure, which is a strong contra-indication for you not to run this procedure.
I advise to:
- continue with diet changes and PPIs
- start anti-inflammatory drugs
- and pancreatic enzymes
- take antibiotics
Wish fast recovery!
Dr.Klerida
Find out the cause first...
Detailed Answer:
Hi there,
I have gone through your medical history and understood your concerns.
Your symptoms are indicative for pancreatitis relapse. Further lab investigations are needed:
- pancreas function test( amilase;lipase)
- abdominal ultrasound
- CRP
First, there is no need to repeat ERCP. During the last procedure, you had had sphincterotomy. In other words, ductus is definitely closed, therefore, there is no need for ERCP. Furthermore, ERCP is an invasive procedure and is indicated when strongly needed. Moreover, you experienced pancratitis as complication of ERCP procedure, which is a strong contra-indication for you not to run this procedure.
I advise to:
- continue with diet changes and PPIs
- start anti-inflammatory drugs
- and pancreatic enzymes
- take antibiotics
Wish fast recovery!
Dr.Klerida
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thx amylase lipase LFTs all normal cbc normal US CT abd and pelvis normal
Brief Answer:
Then,nothing serious,common viral infection,wait a
Detailed Answer:
Hi back,
If all the tests you mentioned were normal, no need for ERCP.
Furthermore, from what you are saying, I do not think you have a serious problem. It might be due to any common temporary viral infection. It will be gone in a few days. Have more patience for other few days and see how it goes.
Meanwhile, you can take anti-inflammatory drugs and pancreatic enzymes to relieve the symptoms.
All the best!
Dr.Klerida
Then,nothing serious,common viral infection,wait a
Detailed Answer:
Hi back,
If all the tests you mentioned were normal, no need for ERCP.
Furthermore, from what you are saying, I do not think you have a serious problem. It might be due to any common temporary viral infection. It will be gone in a few days. Have more patience for other few days and see how it goes.
Meanwhile, you can take anti-inflammatory drugs and pancreatic enzymes to relieve the symptoms.
All the best!
Dr.Klerida
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thx much last question is slmetimes sudden movements will exacerbate Symptoms and just wondering if my myositis can be contributing. Thx again- XXXXXXX
Brief Answer:
Myositis is involving all body muscles...
Detailed Answer:
Hi back XXXXXXX
Myositis is an inflammatory disease that will affect the skeletal and smooth tissues. It does not cause pain, but would alter the functioning of your body muscles.
During myositis, the body muscles become weak. If sudden movements will exacerbate the symptoms (pain), then, most probably, your pain is involving skeletal muscles and not involving internal organs.
Further investigations are needed as mentioned earlier if they will persist.
Hope it helped!
Dr.Klerida
Myositis is involving all body muscles...
Detailed Answer:
Hi back XXXXXXX
Myositis is an inflammatory disease that will affect the skeletal and smooth tissues. It does not cause pain, but would alter the functioning of your body muscles.
During myositis, the body muscles become weak. If sudden movements will exacerbate the symptoms (pain), then, most probably, your pain is involving skeletal muscles and not involving internal organs.
Further investigations are needed as mentioned earlier if they will persist.
Hope it helped!
Dr.Klerida
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
