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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for pancreatitis, cholelithiasis, severe back ache and vomiting after childbirth

Answered by
Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 16512 Questions

Posted on Thu, 10 Sep 2015 in Digestion and Bowels
Question: My bother's daughter (26 years) recently (22 days back) delivered (normal) pre matured baby (250 days). Child had low plate count (around 1 lak) and kept in incubator and now OK. Four days back Mother had severe back ache, vomits and kept on drip for two days in local hospital. After they had US scan and told that she is having pancreatitis and advised to move bigger hospital. Yester day was admitted in bigger hospital and kept in ICU and had CT SCan. The impression is
Bulky Shows heterodense enhansement peripancreatic mesenteri fat stranding
peri pancreatic collections noted, collections in lesser sac, perinephric sub hepatic perisplenic extending to iliac regions pelvis peripancreatic fat inflamation noted. Thickened gerota's fascia.Thickened vasarecta,mesentary subcentimetre mesentric,pre paraaoratic, aortocaval,retrocaval.iliac, iliac lymphadenopathy noted. F/S/O acute pancreatitis with modified CT deverity index of 6/10 S/O moderate pancreatitis cholelthiasis
Is there any need to take ant super speciality Hospital ? What is her health condition
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
Better to shift to super-specialty center.

Detailed Answer:
Thanks for your query and an elucidate history and the CT report.
All the findings are of Acute pancreatitis. This is one disease which can take any form anytime and is a highly unpredictable one as far as the progress is concerned.
In additions she has a reason of pancreatitis, the cholelithiasis (gall stones). The slipped stone getting impacted into the common bile duct just before duodenum is one of the most important reasons. (might have passed as CBD is not dilated- but already ave caused the problem o get initiated)

Hence the best way is to get her shifted to the super-specialty center. There in all the possible best treatment options are available and can be undertaken if need be.

Please remember she will need Cholecystectomy at a later date at an appropriate time.

The health condition can be talked about only after a proper clinical evaluation, examination and by knowing the vital and the reports: it is combined understanding of all the things together.

I hope this answer helps, 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
Follow up: Dr. T Chandrakant 8 minutes later
Whether report indicate any infection in addition to inflamation. Whether the cause of pancreatitis can be zeroed down to gall stones or any possibility of any other reason exist.
Answered by Dr. T Chandrakant 36 minutes later
Brief Answer:
unless proved otherwise.

Detailed Answer:
Infection or inflammation can not be differentiated on CT scan.
WBC cont too can increase in both the conditions.
Since the gallstones are present, this is to be taken as a cause of pancreatitis unless proved otherwise.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. T Chandrakant 56 minutes later
Sorry for troubling you again. Last one. She is now in ICU at Multi specialty hospital at XXXXXXX They are just informing that she may recover after 10 days. No detailed briefing. we can shift her to super specialty at chennai/Hyderabad. is it necessary or advisable at this stage. What information should we ask specifically from Hospital to take decision.
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
As discussed

Detailed Answer:
Nothing to say sorry about, I shall be happy to assist you to the fullest.
Read and understood the concerns.
I would advise you to talk to the Doctor/Consultant in-charge, know the exact position the patient is in, ask whether she needs shifting to a super-specialty hospital. And most important is the question about shifting- whether by road or by air or so.
Hyderabad's Asian Institute of Gastroenterology is a premier institute, get the phone numbers and see if the Consultants like Dr XXXXXXX are available or not.

Another option:
To know exactly who is treating her.
Is he a Gastroenterologist of repute or not?
Also ask if you can have another (second-opinion) opinion of XXXXXXX Gastroenterologist in Vijaywada and you have to specifically discuss the position of the patient she in in at the moment.

It is true that recovery takes time in such problems, and the future course unpredictable.

I hope the child is taken care of well also.

Please feel to ask any questions in your mind, I shall be happy to assist you the most.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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Hi Doctor(s),

I need a favour from you. My wife hospitalized since November 2010 till February 2011 due to Acute Pancreatitis. Also doctors diagonized that she is having a severe heart problem. I am explaining the whole history of the hospitalization of the patient, just i would like to know opinion / suggestion on the patient's situation.

History of the Patient:

In  01-11-2010,  the patient was ( with symptoms: abdomen pain,back pain and vomiting) admitted in Bollineni Superspeciality Hospital, Nellore, AP. There we realized that she is suffering from severe "Acute Pancreatitis, Cholelithiasis".  Immediately shifted to Vijaya Heart Foundation hospital, Chennai. Treated 27 days with various expensive antibiotics, but no use. Infection not able to controlled. She suffered from constant fever due to infection fluid collections in the abdomen formed in the form of packets.
We demanded to discharge her on 27th day and shifted her to "Asian Institute of Gastroenterology" (AIG) hospital, Hyderabad. Medical treatment started on the admitted day itself by giving so many expensive anti-biotics. CT scan radiologist kept 2 tubes into the stomach at left side to drain the fluid collections, but right side they are not able to put the tubes as the organs are there and also fluid collections are very thick. After 3 weeks doctors planned to do major surgery as right side collections are not draining and due to this she is suffering from constant high fever. As per Cardiologist opinion, they kept the surgery on hold as she is have another issue in the heart. Heart left ventricle's ejecting factor(EF) recorded to 27% only which is severe dysfunction and high risk of giving anesthesia while surgery. After that they tried to improve the functionality, but in the span of just 2 weeks by giving medicines, it improved to 30%.
Due to this, doctors changed the opinion of surgery for the time being. CT Scan radiologist hardly tried and kept another 2 tubes into stomach through the right side of the abdomen.That way the draining is started in right side also.  Every day giving her expensive anti-biotic medicines to control the infection, doing fluid culture tests, blood tests to check Albumin, hemoglobin % and also Liver Functional Test, not to spread across the other organs. At the same time trying to improve the heart functionality, controlling the blood sugar by giving the Insulin in a daily basis. Likewise CT scan radiologist kept total 6 tubes into abdomen in both sides to drain all the infection fluid.
The root cause for all these: "formation of stones in the gall bladder, travelled through the bile duct and stuck at the Pancreas head". Doctors want to remove the gallbladder after few months of bed rest as again the existing small stones might travel. Frequent reviews and checkups after discharge (on 27-Feb-11 ) from AIG hospital. All Tubes removed from abdomen and found 'no collections' by CT review.
Planned to do open Cholecystectomy surgery at AIG on 20th May'11. But Cardiologist given the opinion as "High risk for surgery" as she is having the "Dilated Cardiomyopathy" (Severe dysfunction with 32% LV ejecting factor). Anesthesiologist  saying that on giving the anesthesia, they are not sure how the heart will respond while surgery. Went to Vijaya Heart Foundation (VHF) hospital, Chennai. VHF Cardiologist given opinion as "Fit for high risk surgery" by taking 2D ECHO. 
Doctor in AIG hospital told to come back after 30 to 45 days for Cholecystectomy surgery and should take 10 to 20% risk on the surgery inaddition to precautions. As she is diabetic, and presently she is having 347 points in random blood test, consulted Endocrinologist to control blood sugar. Now sugar is under process to control.
Present In-take Medicines (For heart issue):
Name                          Dosage  
Aldactone 25mg tab: 1 - 0 - 1
Lasix 20 mg    tablet  : 1 - 0 - 0
Carnisure 500 tablet  : 1 - 0 - 1 (Stopped now)
Coversyl 2mg tablet  : 1 - 0 - 0
Ivabradibe 5mg        : 1 - 0 - 1
For Pancreas issue:
Creon 25000  capsules: 1 - 1 - 1
Request you to provide your valuable opinion / suggestions / medications (to control Dilated Cardiomyopathy) to overcome or reduce the risk factor in a short period of time and to become fit for surgery with a minimal risk factor.
Please prescribe / suggest, if any using medicines required to change for quick improvement of heart. Because those above listed medicines (for heart) are using from middle of December 2010 to till date. But improvement is not observing much and not that much effective.
Awaiting for your reply.
Thanks a lot.
Siva Prasad K V