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Have biliary pancreatitis and invasive lobular carcinoma. Gallbladder removed. Having abdominal pain. Any thoughts?

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Practicing since : 2001
Answered : 492 Questions
Hello, I was diagnosed with invasive lobular carcinoma, stage 1b, and had surgery and reconstruction last year but no chemo or 12 months ago. I had pancreatitis last April. My gastroenterologist had been monitoring my lipase periodically and it never went down to normal but was 'stable' in the 80s. I had severe abdominal pain one night a few weeks ago, 10 out of 10, but the severe pain only lasted about 30 minutes (put an ice pack on) and I did not have nausea or vomiting. It takes a lot to make me feel nauseous or vomit. Since that time I have had near constant epigastric pain, though not severe, just an annoying ache which occasionally radiates to my back, and I have a cough at times and terrible fatigue..I just don't feel really well ever. My primary care doctor checked my lipase three weeks ago after the nighttime episode of pain and it was 85. I had my regular GYN checkup four days ago and my lipase was 585. I had much imaging last year and all was normal except finally on a endoscopic ultrasound some small stones were seen in my gallbladder so I had my gallbladder removed in November. My liver function tests are occasionally a bit high but they are normal now. All other labs are normal. I know you cannot diagnose by email, but any advice or thoughts please? I have a GI appointment but not for several days. Thank you.
Posted Thu, 11 Apr 2013 in Women's Health
Answered by Dr. Abhijit Deshmukh 7 hours later

Thank you for the query XXXXXX,

You seem to have had biliary pancreatitis last April needing a cholecystectomy.

Well the current pain with markedly raised lipase (it has to be three times the upper normal limit in that report) suggests an acute exacerbation. The cause of acute exacerbation needs to be identified and treated accordingly.

My suggestions is that you need to visit the ER if your appointment with gastroenterologist is late.
- you need to look for residual stones in common bile duct since you had them in gall bladder earlier. Endoscopic Ultrasound (EUS) or Magnetic Resonance Cholangiopancreatogram (MRCP) is in order.
- In their absence, we need to look for other causes like raised triglycerides or calcium levels.
- Also need to look for a persistent pseudocyst and underlying chronic pancreatitis in view of recurrent pain.

Hope this answers your query. Let me know if you need clarifications.

Wish you a speedy recovery.

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