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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Hi, I am a 31yr old female who never smokes

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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2199 Questions

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Posted on Mon, 24 Dec 2018 in Liver and Gall Bladder
Question: Hi,

I am a 31yr old female who never smokes and occasionally drinks. I recently had an EUS due to mild RUQ and LUQ pain. The EUS noted mild hyperecholc strands in the head and gneu of the pancreas and I was told I had an enlarged large colon(although that wasn't included on the report). I suffer from chronic constapation. I was given a plexus celic shot to assist with the pain but I can't really tell a difference. I guess my question is do I have mild chronic pancreatitis? I've read in some places a small amount of hyperecholc stands could be normal? I've had amalyse and lipse levels checked and they are always normal. There's not a time that sticks out where an acute attack has occurred? The pain is never greater than a 3.Could the pain be related to The enlarged colon since the celic block didn't really have an impact?
doctor
Answered by Dr. Ramesh Kumar 47 minutes later
Brief Answer:
Your EUS report is clinically normal.

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and reports and here is my advice.

Answer 1-
Hyperechoic abnormalities on doing EUS does not necessarily mean that there is a presence of chronic pancreatitis. However to know if these hyperechoic strands are true or not a fine-reticular pattern is useful and is seen with the help of a CT. Only when the pattern is reticular we consider chronic pancreatitis as a differencial.

Secondly, as all enzymes are normal again it can't be pancreatitis.
Lastly, as you said you are a patient of constipation. Constipation causes stagnation of food. This stagnated food gets fermented in intestines which releases a lot of toxic gas and leads to the formation of toxic bacterial and yeast colonies. This will lead to inflammation in the wall of gut hence causing pain.

Pain in pancreatitis would never be at a level of 3/10. So, possibly you're being over-diagnosed. Initially, the root cause should be treated.

2) Pain is not related to enlarged colon rather its related to inflammation caused by toxic colonies of yeast and bacteria's where basic tests like stool routine microscopy culture and sensitivity should be done.

Waiting for your reply.
Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Ramesh Kumar 19 minutes later
Thank you for your detailed response. Could this be a sign of chronic pancreatits? I've read once it's chronic your levels can go back to normal. I had a CT prior to the EUS which showed a completely normal looking pancreas. I am the one who pushed for the EUS for fear of pancreatitis (that's when the hyperercholc strands were found). The only thing mentioned on the CT that I received prior to the EUS was a moderate amount of stool impactation. I also have a prior history of being diagnosed with IBS.
doctor
Answered by Dr. Ramesh Kumar 17 minutes later
Brief Answer:
CT-scan is superior to ultrasound.

Detailed Answer:
Hello again,

For me, it's not pancreatitis. Even the CT is reported normal.
Your problem seems to be related to constipation. Once treated it would be relieved.
Lastly, as the name suggests chronic pancreatitis = pancreas +titis=pancreas inflammation.
How can CT be normal, isn't it?

Rule of medical science is common thing first. So initially, please treat your primary problem and get well soon...

In case you need some information for treating constipation just revert back.

It's not pancreatitis my dear.
Get well soon!


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ramesh Kumar 1 hour later
Well that's a relief but I thought an endoscopic ultra sound was a better standard for diagnosing pancreatitis then a CT since they are actually going inside the pancreas?
doctor
Answered by Dr. Ramesh Kumar 6 minutes later
Brief Answer:
Follow up.

Detailed Answer:
Hi there,

Sensitivity and specificity are two terms used in medical science. Some tests are more sensitive but less specific while other is vice versa. This is a very big topic and difficult to explain.

However, I would just assure you that it's not pancreatitis.
Enjoy life, take care of your IBS and constipation and get well soon.
If CT and Enzymes are normal all good.

CT uses 360 degree X-rays while Ultrasound uses ultrasonic waves. Penetration of X rays with slices in 360 degrees is better then Ultrasonic waves.

As said earlier very long topic.
It's not pancreatitis.

Hope I was helpful.
Follow-ups are welcome.
Get well soon!


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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