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What Causes Upper Abdominal Pain And Back Pain Due To Pancreatitis?

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Posted on Sat, 24 May 2014
Question: Over the past week I have been experiencing pain/aching in my lower abdomen that wraps around to my back. At times it has gotten back enough that I have vomitted profusely. I visited the ER, a Gastro and even had to be admitted to the hospital for 24 hours because of the severity. Blood work was all normal except that my lipase is high (174) and white blood cells were apparently present in my stool. They did two CT scans (one with contrast) as well as an ultrasound which all came back normal. They released me basically still saying that it was some sort of food poisoning or virus and didn't ask to check my lipase again in the future which suprised me. I'm still having the admoninal discomfort which is causing me to not sleep at night and from what I have researched online it would appear to me that I have pancreatitis (also what the ER doc initally thought) but my gastroenteroligist says no. I am a 35 five year old male, I do drink more than I should (approx. 15 drinks per week on average) and I was drinking the night that the symptoms started. Not sure what to do at this point as my gastro specialists essentially says not to worry about it and that I'll be fine. Any insight on this would be greatly appreciated.
doctor
Answered by Dr. Ashish Verma (3 hours later)
Brief Answer:
could had even been a stone that passed out

Detailed Answer:
Hi,

Thanks for writing to HCM.

Pancreatitis, though associated with a raised lipase, mostly presents with an upper abdominal pain and back pain.

Your pain is lower abdominal.

These type of pain is seen mainly in ureteric colic or gastroenteritis. Both are associated with vomiting.

Your ct scan and usg are all normal, so either its gastroenteritis or a small ureteric stone that passed out before you got the scan.

If you were also having burning sensation during urination, it goes more in favor of the stone.

So i would suggest that you take a course of antibiotics for gastroenteritis (if already not prescribed by your gastro) and see if your symptoms improve.

And serum lipase is not only 90% sensitive for pancreatitis. But its advisible to cut down on your alcohol intake.

Hope i have been helpful.

Regards
Dr. Ashish Verma
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ashish Verma (16 hours later)
Thanks for the reply Dr. XXXXXXX

Two quick follow up questions if that is not one too many. First, is there a test they can do to determine if I am in fact in need of a round of antibiotics versus it being something that the body typically disposes of independently? At this point it has been 8 1/2 days since it started so not sure if the length of time with pain/discomfort might be the deciding factor. Also, should I demand to have my lipase tested again at some point or is a number like 174 not really a concern? My gastro insinuated that it was only elevated because of the gastroenteritis and is not worth the trouble of repeating.

Thanks again.

XXXXXX
doctor
Answered by Dr. Ashish Verma (14 minutes later)
Brief Answer:
its mostly infection only

Detailed Answer:
Hi XXXXXXX

I believe that they already checked your stools and it showed white blood cells, which is a marker of infection and inflammation.

Secondly, the normal rangebof lipase varies from 0-160 U/L. And yours is 174, i.e. just slightly elevated. So its not pancreatitis. Its mostly just a bowel infection.

And yes, the body has its own defences for them. But the thing is, we get symptoms when these defences fail to contain it. And you are now getting pain due to it, meaning your body's defense is not able to contain the infection and so it needs outside help, meaning antibiotics.

So i would suggest that you take a course of antibiotic, the response might be seen in a few days but do take a full course to prevent relapse.

Regards
Dr. Ashish Verma

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Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Ashish Verma

General Surgeon

Practicing since :2008

Answered : 1290 Questions

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What Causes Upper Abdominal Pain And Back Pain Due To Pancreatitis?

Brief Answer: could had even been a stone that passed out Detailed Answer: Hi, Thanks for writing to HCM. Pancreatitis, though associated with a raised lipase, mostly presents with an upper abdominal pain and back pain. Your pain is lower abdominal. These type of pain is seen mainly in ureteric colic or gastroenteritis. Both are associated with vomiting. Your ct scan and usg are all normal, so either its gastroenteritis or a small ureteric stone that passed out before you got the scan. If you were also having burning sensation during urination, it goes more in favor of the stone. So i would suggest that you take a course of antibiotics for gastroenteritis (if already not prescribed by your gastro) and see if your symptoms improve. And serum lipase is not only 90% sensitive for pancreatitis. But its advisible to cut down on your alcohol intake. Hope i have been helpful. Regards Dr. Ashish Verma