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What causes repetitive pancreatitis attack?

Answered by
Dr. Happykumar Kagathara

Gastroenterologist, Surgical

Practicing since :2006

Answered : 434 Questions

Posted on Sun, 12 Mar 2017 in Digestion and Bowels
Question: Hi ,

My wife is having repetitive pancreatitis attack .
She has gallstone of 6.9 MM .Doctor is saying these attacks are coming due to gallstone.
She got this problem after 3 to 4 months c-sec delivery (25-nov-2014) at that time doctor gave some gas medicine and it did not come for 6 months . but after some time she was getting these attacks again but settle down in 4 5 hours .

In 19-Aug 2016 she got these attack again this time we admit her in hospital
Answered by Dr. Happykumar Kagathara 2 hours later
Brief Answer:
Gall stone related pancreatitis.

Detailed Answer:
I can understand your concern for your wife's health.
1) She has active episode of pancreatitis at present and surgery for gall stone is not recommended at this stage. Let pancreatitis resolve with medications then doctor can plan for surgery later.
2) Pancreatitis can occur by two ways in such conditions; either directly due to small gall stone, fragment of which pass into bile duct and block pancreatic duct and pancreatitis develop. Another reason for development of pancreatitis is ERCP test done to remove/confirm bile duct stone. This test itself can cause pancreatitis.
3) Ideally, she must be treated with medical treatment for this pancreatitis episode. Once pancreatitis resolve then ERCP must be done to rule out/confirm stone in bile duct which causes repeated episodes of pancreatitis.
4) After this, repeat USG abdomen must be done to rule out/confirm gall stone and if present, surgery would be required.

Hope I answered your query. If you have any further doubts, I would be happy to help you.
Have a nice day!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Happykumar Kagathara 18 minutes later

Thanks Doctor for your reply
"fragment of which pass into bile duct and block pancreatic duct and pancreatitis develop."
For this reason only we have done the mrcp test .which was clear, there is no stone in the bile duct

Now the biggest concern is fever which is coming frequently .
Doctor is saying this is due to pancreatitis which creates side effect.
two three days before she was having loose motion ,and vomiting (some yellow liquid was coming) which has been cured now.

Another concern is water in lungs : is it due to pancreatitis ? , they have done one time tapping and remove the 360 ml water .and done the test of the water no infection found .

i just want to about fever and water in lungs when we can expect to get rid of this ?
Answered by Dr. Happykumar Kagathara 6 minutes later
Brief Answer:
Pancreatitis related effusion and fever

Detailed Answer:
ERCP is far better than MRCP for such small sludges/fragments.
Yes, fever, water in lungs can develop due to pancreatitis.
For both of these, you need to continue medical treatment only. Inflammatory reaction in body due to pancreatitis cause swelling in leg, water in lungs and high protein diet is beneficial in such conditions.
If she can not tolerate oral diet then discuss with your doctor about possibility of Parenteral Nutrition.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Happykumar Kagathara 4 hours later
Thanks Doctor for your advice

I have one doubt regarding increase of WBC count
she is having following History

07-Feb-2017 : 15600
11-Feb-2017 :12700
13-Feb-2017 : 11400
16-Feb-2017 18600
I have doubt how this WBC count can be increased suddenly .
Answered by Dr. Happykumar Kagathara 12 hours later
Brief Answer:
Due to infection or inflammation

Detailed Answer:
I apologize for late reply.
Increased WBC count suggest infection or inflammation in body. Pancreatitis with inflammation in surrounding area is responsible for this.
Above answer was peer-reviewed by : Dr. Remy Koshy
Follow up: Dr. Happykumar Kagathara 35 hours later
Hellow Doctor

thanks for reply

I am worried about her fever which is increased in after noon around 12 clock and remains 100.4 till we give calpol after that fever goes and next day comes again around same time .

this fever start from 11-Feb-2017 .and in the beginning it was coming three time
Do you have any idea when this fever coming from last 7th day.d .She is on antibiotics (meromac 1 gm ) three times a days.Is there any specific antibiotics for this treatment .

Todays her wbc count was 16300 which was 18600 on 16-feb-2017
Please guide
Answered by Dr. Happykumar Kagathara 16 hours later
Brief Answer:
inflammation associated fever

Detailed Answer:
I apologize for late reply.
1) In this scenario, fever is due to inflammation around pancreas and also due to body's own defence mechanism against spread of inflammation.
2) Antibiotic has very limited role here to prevent infection only.
3) WBC count is now on decreasing pattern and fever spikes are also mild type, these suggests that inflammation has started resolving. Still it will take 7-10 days to reach almost normal parameters.
Above answer was peer-reviewed by : Dr. Vaishalee Punj

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