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What Causes Twinges In The Abdominal Area After Eating Fruits?
Question: I am 48 year old female, had lap cholecystectomy (multiple stones observed, but no duct obstruction) last September following acute pancreatitis (lipase level was over 10,000). Since discharge, have had 2 attacks similar to the pancreatitis, not quite as bad, pain passed after a couple of hours. Now I frequently experience "twinges" in same abdominal area. It has occurred after eating raw, fresh fruit, such as bananas and pineapple. I don't eat greasy foods more than once a week and I have never had an attack after such a meal. I have abdominal ultrasound scheduled for end of May. I also have really bad pruritis the last few months, mostly in my extremities. I do not drink alcohol (I can total the number of alcoholic drinks I have had in my lifetime and not use both hands), I was, however, diagnosed with hepatitis after a sexual assault when I was 10. My AST is slightly elevated, ALT also a bit high, GGT is normal, as is Tbili and Dbili; lipase was at very top of reference range. I am worried about pancreatic cancer, there is a history in my family. Also, I had gastric bypass surgery in 2007. Lately I have also been experiencing waves of nausea followed by sneezing.
Brief Answer:
ERCP, MRCP, EndoUS will help to get the exact diagnosis
Detailed Answer:
Hi.
Thanks for your query.
To recapitulate: Female/48 - Lap choley last Sept - for multiple gallstones - no duct *obstruction - following *Acute pancreatitis - since discharge 2 attacks similar to pancreatitis - pain passing off after a couple of hours - now twinges in same area - after *raw fresh fruits like banana and pineapple - no attack after greasy foods - ultrasound of abd scheduled on May 29 - *bad pruritus - mostly extremities - diagnosed as hepatitis after sexual assault at the age of 10 - AST and ALT elevated - GGT normal - lipase at top of ref range - worried about pancreatitic cancer as there is family history - waves of nausea followed by sneezing - gastric bypass 2007 ....
My opinion after reading your history carefully:
The commonest cause of pancreatitis is passage of small gall stones or impaction even by sludge in the common bile duct that opens in the duodenum after being joined by pancreatic duct. Even a temporary impaction by such as this can give repetitive pancreatitis attack and such stones may not always be detected by ultrasonography.
I would advise you the following:
Regular liver function tests including alkaline phosphatase.
Endoscopic ultrasound (EUS) can detect small stones that are nor picked up by routine ultrasonography of the abdomen and any mass or so.
MRCP that is Magnetic Resonance cholangio-pancreaticography also helps to see the stones, tumor, pancreatitis, cancer and so on.
ERCP: Endoscopic Endoscopic Retrograde Cholangio-Pancreatography
This way the proper diagnosis can be made and the plan of treatment can be charted to give you complete relief and curative treatment if feasible.
Possibility of a XXXXXXX small undetectable stone in the bile or pancreatitic duct can case
Raw fresh fruits might cause an allergy this way. Anything can cause allergy.
Pruritus is mainly caused by deranged liver function tests.
Good to know that you do not consume alcohol.
I hope this answer helps you to get an early diagnosis; discuss with with your Gastroenterolgist, get the said investigations and proper treatment.
I hope this answer helps you, please feel free to ask for further relevant queries if you feel that there is a gap of communication.
ERCP, MRCP, EndoUS will help to get the exact diagnosis
Detailed Answer:
Hi.
Thanks for your query.
To recapitulate: Female/48 - Lap choley last Sept - for multiple gallstones - no duct *obstruction - following *Acute pancreatitis - since discharge 2 attacks similar to pancreatitis - pain passing off after a couple of hours - now twinges in same area - after *raw fresh fruits like banana and pineapple - no attack after greasy foods - ultrasound of abd scheduled on May 29 - *bad pruritus - mostly extremities - diagnosed as hepatitis after sexual assault at the age of 10 - AST and ALT elevated - GGT normal - lipase at top of ref range - worried about pancreatitic cancer as there is family history - waves of nausea followed by sneezing - gastric bypass 2007 ....
My opinion after reading your history carefully:
The commonest cause of pancreatitis is passage of small gall stones or impaction even by sludge in the common bile duct that opens in the duodenum after being joined by pancreatic duct. Even a temporary impaction by such as this can give repetitive pancreatitis attack and such stones may not always be detected by ultrasonography.
I would advise you the following:
Regular liver function tests including alkaline phosphatase.
Endoscopic ultrasound (EUS) can detect small stones that are nor picked up by routine ultrasonography of the abdomen and any mass or so.
MRCP that is Magnetic Resonance cholangio-pancreaticography also helps to see the stones, tumor, pancreatitis, cancer and so on.
ERCP: Endoscopic Endoscopic Retrograde Cholangio-Pancreatography
This way the proper diagnosis can be made and the plan of treatment can be charted to give you complete relief and curative treatment if feasible.
Possibility of a XXXXXXX small undetectable stone in the bile or pancreatitic duct can case
Raw fresh fruits might cause an allergy this way. Anything can cause allergy.
Pruritus is mainly caused by deranged liver function tests.
Good to know that you do not consume alcohol.
I hope this answer helps you to get an early diagnosis; discuss with with your Gastroenterolgist, get the said investigations and proper treatment.
I hope this answer helps you, please feel free to ask for further relevant queries if you feel that there is a gap of communication.
Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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