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Suggest treatment for acute pancreatitis

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Posted on Mon, 1 Jun 2015
Question: hi, i have acute pancreatitis and they said Abdominal USS: Appearances would be compatible with cholecystitis in the appropriate clinical setting.The CBD is dilated,what does it mean?

Triphasic CT,slightly increases volume of peripancreatic fluid within the small bowel mesenetery.
Do i have to do operation for my gallstone? and how long i have to be in the fluid diet?
doctor
Answered by Dr. T Chandrakant (1 hour later)
Brief Answer:
Obstruction to CBD, yes surgery for gall bladder needed.

Detailed Answer:
Hi.
Thanks for your query and proper history.

Read and understood that you are suffering from Acute Pancreatitis and have questions related to the following points, which I will try my best to make simplified:

Abd USG: Appearances would be compatible with cholecystitis in the appropriate clinical setting.The CBD is dilated,what does it mean?

Appearances would be compatible with cholecystitis in the appropriate clinical setting: Means that there is evidence of inflammation of the gall bladder (Cholecystitis); Whether stones are present in the gall bladder or the bile ducts is not mentioned by you.
One of the causes of Pancreatitis is Gall Bladder stones slipping into the bile duct and getting imacted at the sphincter of Oddi which also drains the pancreatic duct. This impacted stone cases back pressure in the pancreatic duct casing the pancreatitis.
Hence it is imperative that the gall bladder be removed so that further stones are not formed and pancreatitis not be repeated.

The CBD is dilated,what does it mean?
> As just explained above the obstruction to the outflow of bile from the bile duct (CBD=Common Bile Duct as we say) in the small intestine (duodenum) will create back-pressure and resultant dilatation.
This means that there is an obstruction to the outflow.

Triphasic CT:slightly increases volume of peripancreatic fluid within the small bowel mesenetery.
Do i have to do operation for my gallstone? and how long i have to be in the fluid diet?

*Slightly increases volume of peripancreatic fluid within the small bowel mesenetery.>> this is body's reaction to the disease, by secretin fluid to dilute the ill-effects of the disease.

*Do i have to do operation for my gallstone?
> Surely yes, the reason as explained above.

* and how long i have to be in the fluid diet?
> This is solely dependent upon the condition, response to the treatment and the sequel. Really difficult to comment upon.

I hope this answers all your queries.
Please feel free to ask further relevant queries if you need to or if you feel that there is a gap of communication.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. T Chandrakant (4 hours later)
hi Dr, thank you for your reply, the cause for this has not been identified,MRCP/ECRP may aid further assessment if clinically indicated, do u think i need an endoscopy? i'm seeing my surgeon next week i just need an early answer to prepare myself for it. On discharge:
FBC 147/11.70/376
uec 139/4.1/31/3.9/63
lftS bILI 5, alt 40,ALP 132,GGT 367 Alb 35 CRP 190

Can you explain it to me please what the number means? and

Bloods
LIPASE 3770
doctor
Answered by Dr. T Chandrakant (3 hours later)
Brief Answer:
ERCP at the earliest

Detailed Answer:
Hi.
Thanks for your feedback.

ERCP is the most important diagnostic and many times the therapeutic endoscopic test and must be done at the earliest, of course as decided by the TEAM of Doctors treating you.
Sphincteroplasty done during this procedure helps to remove the stone or sludge responsible for CBD dilation and drains pancreatic duct too helping fast recovery.
It will help to find the cause and also remove it as a treatment.

Lipase is too high, and diagnostic of Pancreatitis.

FBC 147/11.70/376
uec 139/4.1/31/3.9/63
Can not decipher unless the report with normal range for that particular lab is there.

lftS bILI 5, alt 40,ALP 132,GGT 367 Alb 35 CRP 190 >>
This looks to be LFT= Liver function tests.
Bilirubin is 5- high
Alt- normal
ALP may be AST - high
GGT and CRP are also high.
Albumin- Alb may be 3.5

Humble request to you: please post the original reports as some misunderstanding in names or values can have different implications.

Prepare yourself for ERCP and MRCP is definitely a good tool for good diagnosis.
With the advent of the newer techniques, machines the understanding the disease, follow-up and outcome have all well improved.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (8 hours later)
Hi Dr,

Please find attached my original reports

Thanks

Widya
doctor
Answered by Dr. T Chandrakant (1 hour later)
Brief Answer:
Please post fresh photographs.

Detailed Answer:
Please take a proper photograph from above the paper.
The reports you have posted are photographed in such a way that upper portion is not readable.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (3 hours later)
hi Dr, please find another 2 reports, I hope you can read it this time
doctor
Answered by Dr. T Chandrakant (3 hours later)
Brief Answer:
Most of the points already covered as above.

Detailed Answer:
Oh, thanks. Could save and applied software and could read very well.
(mobile - cells phones are nasty - PC works well)

The first report is summary and it shows you were quite serious on admission:
-Acute Pancreatitis
-Cholecystitis
-Hypoxia - needed oxygen
-Tachycardia and
-Hypokalemia

The other paper tells about your reports:
- FBC Means full blood count 147/11.70/376 looks to be encrypted.
- UEC means Urea electrolytes and creatinine
Sodium, potassium 139/4.1/31/3.9/63
** important for us is to know - Potassium which was less (Hypokalemia as noted above) was 3.4 is 4.1 on discharge and normal.

LFT- Liver function tests:
Bilirubin increased from 2.3 to 5
ALT was 508 and reduced to 40- very good and normal
ALP raised from 92 to 132
GGT reduced from 954 to 367 - good sign
Albumin reduced from 4.5 to 3.5

Abdominal USS and rest of the things already discussed in the first answer, please refer to and please let me know if there is anything which you would like to know.

The most important fact is that you need an ERCP for the earliest diagnosis as well as therapy, cholecystectomy (gall bladder removal and concentrate on getting the things properly at an appropriate time than looking at the reports.Since you would not know the significance of each and may cause you more and unnecessary confusion and stress, which adversely affects your health and outcome of the treatment.

I hope you agree with me.
I also noted your reports showing that you have:
Cerebral Palsy, Hemiplegia, right sided weakness, Equinus deformity of right foot, seizure, depression with psychotic features for which you were admitted on 10/01/15 and also have OSA.
Please take of this part of diseases too.


I hope this answer helps you to get a proper diagnosis, and get a proper further treatment. Please feel free to ask for more or if you need further clarifications or if you feel there is a gap of communication.
You may please rate this answer before closure of the discussion and can certainly contact me on the bellow link in future, whenever you may need me.
http://bit.ly/askdrtchandrakant

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (53 minutes later)
is there any food or drinks ivcan take at the moment because I can't take any solid food my tummy always sore😢
doctor
Answered by Dr. T Chandrakant (53 minutes later)
Brief Answer:
Try water with Electral, strained water of boiled rice and pulses.

Detailed Answer:
you were admitted for 12 days as per the Discharge paper and asked to take Metoclopramide
Please take Metoclopramide at 8 hourly interval to suppress the nausea and vomiting. If this works you may tolerate water and other liquids like fruit juices and strained rice and dal (pulses) water after boiling it.

If this too is not tolerated, I am worried, you need an admission for fluid and electrolyte maintenance. You already had hypokalemia on admission.

Dehydration has to be avoided at at any cost.
One of the reports say ''trying to conceive'' Are you on some hormonal tablets too?
You should be well hydrated to avoid further complications which can occur very fast in post-pancreatitis scenario like DVT and all.

Try these liquids and let me know please whether tolerated or not.

In fact stop taking anything solid at the moment. And insist for admission if you can not tolerate fluids too and ask for blood investigations and intravenous therapy.
Review ultrasonography is also important to see the progress of the whole disease process and whether sequel or complications like pseudocyst have occurred or not.






Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (19 minutes later)
Dear Dr,

I tried the liquid supplements from hospital but my tummy still sore, i went back to hospital 3 days ago because i can't tolerate drink n food but they sent me home, they said it was only gastro. i'm thinking goin to another hospital on Monday because here on the weekends i don't think they do the procedure on the weekends


Is there anything i can do to reduce the pain?

sorry i forgot to mentioned it i'm not on any hormonal pills.
doctor
Answered by Dr. T Chandrakant (34 minutes later)
Brief Answer:
Buscopan for pain - Admission if required after clinical evaluation.

Detailed Answer:
Whether Gastro or no gastro, if the patient is not tolerating anything orally, needs to be admitted to maintain the hydration and electrolyte balance. This is very important.
It is good to know that you are not on any hormonal pills.

You may please go to any other hospitals to check for the vitals as you had tachycardia (high pulse rate) last time with hypokalemia and can develop again if you can no tolerate anything orally and continue on loose stools and/or vomiting.
The motto at the moment is to avoid any further complications.
Procedure can wait as no body would do it as you say on weekends. There mat be a Doctor who can be more helpful, who knows.

Medicines like Buscopan (Hyoscine butylbromide) may help a bit.
Narcotic analgesic are the best but you need a valid prescription and some Doctors prefer not to give for the fear of spasm of sphincter of Oddi guarding the CBD and Pancreatic duct, although there are no such reports; yet this is the personal choice of a particular Doctor.

So getting admitted for proper water and electrolyte balance and to have symptomatic relief with various medicines is of utmost importance.

I hope this answer helps you.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Suggest treatment for acute pancreatitis

Brief Answer: Obstruction to CBD, yes surgery for gall bladder needed. Detailed Answer: Hi. Thanks for your query and proper history. Read and understood that you are suffering from Acute Pancreatitis and have questions related to the following points, which I will try my best to make simplified: Abd USG: Appearances would be compatible with cholecystitis in the appropriate clinical setting.The CBD is dilated,what does it mean? Appearances would be compatible with cholecystitis in the appropriate clinical setting: Means that there is evidence of inflammation of the gall bladder (Cholecystitis); Whether stones are present in the gall bladder or the bile ducts is not mentioned by you. One of the causes of Pancreatitis is Gall Bladder stones slipping into the bile duct and getting imacted at the sphincter of Oddi which also drains the pancreatic duct. This impacted stone cases back pressure in the pancreatic duct casing the pancreatitis. Hence it is imperative that the gall bladder be removed so that further stones are not formed and pancreatitis not be repeated. The CBD is dilated,what does it mean? > As just explained above the obstruction to the outflow of bile from the bile duct (CBD=Common Bile Duct as we say) in the small intestine (duodenum) will create back-pressure and resultant dilatation. This means that there is an obstruction to the outflow. Triphasic CT:slightly increases volume of peripancreatic fluid within the small bowel mesenetery. Do i have to do operation for my gallstone? and how long i have to be in the fluid diet? *Slightly increases volume of peripancreatic fluid within the small bowel mesenetery.>> this is body's reaction to the disease, by secretin fluid to dilute the ill-effects of the disease. *Do i have to do operation for my gallstone? > Surely yes, the reason as explained above. * and how long i have to be in the fluid diet? > This is solely dependent upon the condition, response to the treatment and the sequel. Really difficult to comment upon. I hope this answers all your queries. Please feel free to ask further relevant queries if you need to or if you feel that there is a gap of communication.