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Suggest Treatment For Acute Pancreatitis

Posted on Fri, 2 May 2014

Question: Hello doctor, My father aged 61 years , today had 5-6 times vomiting Followed by severe pain in upper part of stomach so we had to rush him to the hospital where he is now diagnosed with acute pancreatitis and we are told the cause is due to gall bladder and advised for an ERCP procedure with gall bladder removal through laparoscopy .kindly advice of the treatment is recommended and if yes what would the approximate total cost for both procedures in a multispeciality hospital in Bangalore Also I was trying to understand the ultrasound report observation the reports says for gall bladder -moderately distended ,no evidence of calculli ,thickness normal.wat does this mean does the gall bladder really has stones and need ERCP procedure and removal of gall bladder ? Kindly advice

Answered by Dr. T Chandrakant (1 hour later)

Brief Answer: Looks normal GB Detailed Answer: Hi XXXXXXX Based on the history you have provided about your Father, and Medical History of Hypertension and Diabetes. The first thing I would like to know how is his Blood pressure and Blood Sugar Level. Both should be really under control for the best outcome of the Pancreatitis or whatever we shall find on subsequent evaluation. Was this diagnosed and confirmed by ultrasound / CT or MRI of abdomen and blood reports of serum amylase and Lipase? Or just by clinical suspicion? By the reports you have posted . The gall bladder (GB) looks normal- normal thickness, 'NO' stones (calculi); The distension is usually due to the patient is kept nil orally or may be due to edema of the pancreas, which USG should have reported. From this the gall bladder looks normal and Have they commented on CBD= common bile duct- as normal caliber or dilated or having stone/ obstruction? With the present report there looks to be no need of gall bladder removal. ERCP can be for diagnostic and / or therapeutic value for removal of stones in the CBD or pancreatic duct if present. I would suggest: please request for second opinion of another expert before you say yes to any procedure, See that the blood pressure and diabetes are absolutely under control, Patient's medical condition to be stable. You may please request for MRCP= Magnetic resonance cholangiopancreatography . This will give you and the Doctors the best idea. Please feel free to ask for any further clarification and please post other reports ( as noted above) for me to help and guide you further. Wishing your Father an early and complete recovery. The best center can be decided later if need be.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. T Chandrakant (14 minutes later)

Thanks a lot doctor for your response.the last BP recorded was around 150/90 and 265 random blood sugar. On the second opinion how do I approach the hospital management to give me the reports and allow me for second opinion ?

Answered by Dr. T Chandrakant (8 minutes later)

Brief Answer: Talk to the Hospital Owner or Authority Detailed Answer: The BP looks OK , but Sugar is pretty high. I hope your Father is on Insulin. Talk to the Hospital Owner or Authority and insist you would like to have another/ Second opinion. You have all the right to do so as this is a serious condition. Most of the times they may not refuse. If they are refusing, tell them that you would like to shift the patient to another Hospital. This is a reasonable Practice in India. I think they will do the needful.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. T Chandrakant (16 minutes later)

Thanks once again .doctor would you mind giving me your contact number as it would be of great help to get us the correct and comprehensive advice

Answered by Dr. T Chandrakant (10 minutes later)

Brief Answer: Moderator please. Detailed Answer: Thanks for your appreciation, XXXXXXX I really do not know if I can give my number. If this is a Practice our Moderator would be of a definite help to both of us to give phone numbers. Anyway You can always contact me on this great site. Please follow , what I have tried to guide you and everything will be fine. Wishing Your Father once again an early, fast and complete recovery. Dr T Chandrakant.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. T Chandrakant (16 minutes later)

Is ERCP recommended ? It is scheduled for tomorrow noon where doc said he would use some stent to remove the gall stones .

Answered by Dr. T Chandrakant (14 minutes later)

Brief Answer: Please go ahead with ERCP Detailed Answer: I think there must be some stone/s impacted in the CBD= common bile duct which carry the bile into the duodenum( small bowel) after joining the pancreatic duct. this impacted stone/s can cause and are a known cause of Pancreatitis. Putting in a stent also help the relieve the back-pressure in both the ducts and helps early recovery. I think please go ahead with ERCP. There must have been some signs seen in the reports.

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Above answer was peer-reviewed by : Dr. Yogesh D