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[omegared]

hi guys,

 

thanks for the heads up. Been tracking my own medical history since I've been hospitalized twice this year due to pancreatitis and gastritis, so here are my questions:

 

1) my current episode started with severe diarrhea that provided the AGE diagnosis but it developed to my usual gastritis. A doctor friend says this is normal but it was the first time I experienced this combination. Question is whether this really occurs regularly or not?

 

2) my bloodworks had always shown high levels of lipase. Is it possible that this becomes "normal" for me or should I always lower it to normal levels?

 

3) are there studies wherein repeated bouts with pancreatitis resulted to pancreatic cancer? Like, how likely would a few bouts result to cancer and what would be the number that constitute these few bouts?

 

I'm a little paranoid so please do help me out lol thanks

Elevated lipase in multiple episodes is bad news, something is going on. Acute pancreatitis is relatively common, majority will go away with bowel rest and pain meds, most are with alcohol or stones, there are also a lot with no readily identified cause, most are one time deal.

Chronically elevated lipase can be a sign of chronic pancreatitis, which increases your tisk for pancreatic cancer. The cause should be investigated as the long term outcome is not very good. It can lead to malabsorption, diabetes and yes, cancer is a possibility.

2 very difficult cases I have seen to illustrate this difficulty, one had good outcome the other although not fatal was debilitating.

 

A 20ish guy keeps coming back to the ER, always with elevated lipase and lots of abdominal pain. Multiple ERCP's eventually had his gallbladder taken out, he keeps coming back with stays between a week to 2 weeks, usualy on narcotics, always with lots of pain, elevated lipase and nausea and vomiting. I eventually gave up on him as drug seeker. Sent him to 2 prestigious teaching hospitals, they repeat our tests, MRI, ERCP, serology markers, they came up with the same diagnosis. He disappeared for a while, I thought he overdosed. I saw him in ER 3 years later. He was there for a different problem. He has not had pancreatitis for over a couple of years, he was diagnosed with autoimmune pancreatitis, put on low dose prednisone and has a "normal" life.

 

Obvioulsly I felt guilty about thinking he was just a "drug seeker".

 

Second case:

[omegared]

This is a very nice healthy Veteran that comes for regular check up. All his tests were good, he is in good shape for late 60's. He had a bout of abdominal pain, I eventually diagnosed him with acute pancreatitis. He did good went home but on discharge lipase was still high normal. I decided to follow up labwork at the office and his lipase will go up and down, never going over 120, without symptoms. MRI, serologies and nothing. He eventually had ERCP to look for mass or anatomic abnormality, an abnormal duct morphology was a possibility. First ERCP was negative, second was negative, third was negative. His lipase is either a little high or normal, he has not had any pain all these time. 3-4 years later he became diabetic, a year later he needed to take pacreatic enzymes for digesting food, his lipase remained elevated. His Xrays has started to show calcifications, he later lost so much weight and I eventually diagnosed him with pancreatic cancer, I sent him to hospice about 7 years after I first saw his elevated lipase.

 

Both cases are not common but illustrate need to be dilligent in looking for a cause, it's never normal.

[ibirp]

i think there should be a new thread for Sports Injuries

[ermita rojo]

This is a very nice healthy Veteran that comes for regular check up. All his tests were good, he is in good shape for late 60's. He had a bout of abdominal pain, I eventually diagnosed him with acute pancreatitis. He did good went home but on discharge lipase was still high normal. I decided to follow up labwork at the office and his lipase will go up and down, never going over 120, without symptoms. MRI, serologies and nothing. He eventually had ERCP to look for mass or anatomic abnormality, an abnormal duct morphology was a possibility. First ERCP was negative, second was negative, third was negative. His lipase is either a little high or normal, he has not had any pain all these time. 3-4 years later he became diabetic, a year later he needed to take pacreatic enzymes for digesting food, his lipase remained elevated. His Xrays has started to show calcifications, he later lost so much weight and I eventually diagnosed him with pancreatic cancer, I sent him to hospice about 7 years after I first saw his elevated lipase.

 

Both cases are not common but illustrate need to be dilligent in looking for a cause, it's never normal.

 

 

no MRCP done before? CA 19-9?

[omegared]

Multiple MRCP's, maybe 4 or 5, CA markers, all normal.

[ermita rojo]

Multiple MRCP's, maybe 4 or 5, CA markers, all normal.

 

 

ok. for a while i thought i read ERCPs were done, and not MRCPs.

 

 

makes a difference

[omegared]

Yes and yes, 4-5 MRCP's over the years, 3 ERCP's that I know. He was seen in other practice past 3-4 years before I found him again in my service.

[nouseforaname]

Hi,

 

Just want to ask something about tubercolosis. 2 years ago, i had a bad cough. There are spots of blood in my cough. Then i went for a checkup and the doctor said the blood that i saw was from my throat because of the roughness and the cough was because of mycoplasma. I was treated with medicine back then, and it went away. Now, i have been coughing bad again. My throat was the one triggering the cough. It's very itchy. It's been 3 weeks since i started coughing again. Yesterday, i went to the doctor and got an xray. Now my problem is this,the xray technician told me that i had a healed tb scar probably for 2 years now. I am shocked because i was never been diagnosed and i don't have any symptoms...now i am very worried. Am i still going to have a tubercolosis even if it's already healed? And is it possible that the TB healed itself? Please help me. Thanks.

[miggyE]

chances are, you had PTB previously as a child. childhood PTB is quite common in this country, and is usually treated early. its just that it is often referred to as Koch's Infection or Primary Complex, and this is why most people don't realize that this is a childhood form of PTB.

 

PTB rarely heals by itself and usually spreads over time. and, no, regular antibiotics don't work on PTB. only a few do, and you have to take them as a group over a period of months.

 

to be safe, bring the Xray to a Pulmonologist and get yourself a true consult. not to demean the xray techs here, but i would rather you see a true MD.

 

and, bilib ako ha! Xray Tech na marunong magsabi kung ilang taon na ang healed scar! i wonder what the markers are to determine age of the scar tissue without having to do a biopsy? once scar tissue forms, it is usually permanent.

[nouseforaname]

Ganun ba? Is it possible na since nagkamycoplasma ako dun ko sya nakuha? Magpapasecond opinion ako, very worried lang ako na if ever tb scar nga yun, hindi na ako makakapagtrabaho. Next week magpapasputum test ako. Hindi rin masabi ng doktor kung tb scar yun kaya sabi magpatest pa daw ako. Totally curable ba sya? Sana nga hindi TB scar yun. Tinest ako for infection, cbc ok naman naman ang result. Maraming salamat sa response! Will it be reactivated again?

[omegared]

Ganun ba? Is it possible na since nagkamycoplasma ako dun ko sya nakuha? Magpapasecond opinion ako, very worried lang ako na if ever tb scar nga yun, hindi na ako makakapagtrabaho. Next week magpapasputum test ako. Hindi rin masabi ng doktor kung tb scar yun kaya sabi magpatest pa daw ako. Totally curable ba sya? Sana nga hindi TB scar yun. Tinest ako for infection, cbc ok naman naman ang result. Maraming salamat sa response! Will it be reactivated again?

[omegared]

Let's keep it simple. Nagpa physical ka for work, X ray mo may shadow sa apex, there's a presumptive diagnosis of PTB dahil sa high incidence ng TB sa Pilipinas.

1. Wala ka pang TB, pag sputum mo may stained na bacteria, wala ka pa ring TB malamang lang, pagmerong culture na, may TB ka, then may TB ka.

2. Unfortunately over 30 days bago mafinalize ang culture so for practical purposes, if the sputum is positive for acid fast bacili, you will be presumed to have PTB until proven otherwise and should be treated. Paglabas ng culture, kahit negative, dahil nakakalhati ka na ng treatment ipapatapos na lang sa yo yun.

3. If you have an old Xray to compare, at pareho ang hitsura ng shadow, I will wait for acid fast to be positive, pagnegative, follow up Xray ka na lang. I will not treat, some will do PPD, pero dahil high risk ka because it's endemic, if negative, it will be presumed that it was a false negative anergic reaction. If the shadow has not changed and negative sputum mo, at negative PPD mo, at asymptomatic ka, I will not treat, although majority of docs will treat.

Now, kung may RNA, DNA probe or Quantiferon tests na available, it will be easier to decide.

But Im the more dont treat doc and wait than treat unless it's life threathening illness that cannot wait. If asymtomatic, I dont see urgency to treat at this point.

[nouseforaname]

Let's keep it simple. Nagpa physical ka for work, X ray mo may shadow sa apex, there's a presumptive diagnosis of PTB dahil sa high incidence ng TB sa Pilipinas.

1. Wala ka pang TB, pag sputum mo may stained na bacteria, wala ka pa ring TB malamang lang, pagmerong culture na, may TB ka, then may TB ka.

2. Unfortunately over 30 days bago mafinalize ang culture so for practical purposes, if the sputum is positive for acid fast bacili, you will be presumed to have PTB until proven otherwise and should be treated. Paglabas ng culture, kahit negative, dahil nakakalhati ka na ng treatment ipapatapos na lang sa yo yun.

3. If you have an old Xray to compare, at pareho ang hitsura ng shadow, I will wait for acid fast to be positive, pagnegative, follow up Xray ka na lang. I will not treat, some will do PPD, pero dahil high risk ka because it's endemic, if negative, it will be presumed that it was a false negative anergic reaction. If the shadow has not changed and negative sputum mo, at negative PPD mo, at asymptomatic ka, I will not treat, although majority of docs will treat.

Now, kung may RNA, DNA probe or Quantiferon tests na available, it will be easier to decide.

But Im the more dont treat doc and wait than treat unless it's life threathening illness that cannot wait. If asymtomatic, I dont see urgency to treat at this point.

alright. maraming salamat po! natakot lang kasi ako

[bigsam]

high blood pressure is a bitch!

 

starting 5 years ago, i became very active and started healthy eating. since then i have lost 70lbs (from 250 to 180lbs).. i don't smoke, drink, i avoid processed food, i avoid fried foods, i do a lot of cardio (bike, run, swim) and weights.. but still i have high bp, 130/110.. now i have to take maintenance meds.

[lolxes]

high blood pressure is a bitch!

 

starting 5 years ago, i became very active and started healthy eating. since then i have lost 70lbs (from 250 to 180lbs).. i don't smoke, drink, i avoid processed food, i avoid fried foods, i do a lot of cardio (bike, run, swim) and weights.. but still i have high bp, 130/110.. now i have to take maintenance meds.

maybe may history ang family mo for that

[miggyE]

i agree with archerrin123, whats your family history? how about your cholesterol levels?

 

although both do not give the whole picture, it could help point an MD in the right direction.

[bigsam]

i haven't checked my cholesterol level.. but i assume it's OK.. i had a medical check up for employment abroad. i dont know if that included cholesterol check.

 

BUT family history is the main factor for me.

[omegared]

If you are less than 40 years old, there is 10% chance that there is a reason for having high blood pressure and some of these can be fixed, if you are over 40, there is 99% chance that your hypertension is called essential, basically you are born with it.

[Genesis_MD]

Diagnosis of PTB may not always be based on chest xray nor sputum smear. Clinically, based on signs and symptoms one may be diagnosed by a competent physician without any test, hence, may be started on full course treatment.(Bacteriologically-confirmed vs Clinically-diagnosed)

[omegared]

Diagnosis of PTB may not always be based on chest xray nor sputum smear. Clinically, based on signs and symptoms one may be diagnosed by a competent physician without any test, hence, may be started on full course treatment.(Bacteriologically-confirmed vs Clinically-diagnosed)

What's your advice for Bigsam?

[Genesis_MD]

What's your advice for Bigsam?

Regarding what sir? BP control or cholesterol?

Edited March 10, 2016 by Genesis_MD

[omegared]

Regarding what sir? BP control or cholesterol?

Sorry Sir, si nouseforaname pala about his PTB question. It may help me with future cases. TIA.

[Genesis_MD]

Hi,

 

Just want to ask something about tubercolosis. 2 years ago, i had a bad cough. There are spots of blood in my cough. Then i went for a checkup and the doctor said the blood that i saw was from my throat because of the roughness and the cough was because of mycoplasma. I was treated with medicine back then, and it went away. Now, i have been coughing bad again. My throat was the one triggering the cough. It's very itchy. It's been 3 weeks since i started coughing again. Yesterday, i went to the doctor and got an xray. Now my problem is this,the xray technician told me that i had a healed tb scar probably for 2 years now. I am shocked because i was never been diagnosed and i don't have any symptoms...now i am very worried. Am i still going to have a tubercolosis even if it's already healed? And is it possible that the TB healed itself? Please help me. Thanks.

Overall, it is estimated that up to 10% of infected persons will eventually develop active TB in their lifetime half of them during the first 18 months after infection. The risk is much higher among HIV-infected persons. Reinfection of a previously infected individual, which is common in areas with high rates of TB transmission, may also favor the development of disease. Edited March 12, 2016 by Genesis_MD

[Genesis_MD]

Overall, it is estimated that up to 10% of infected persons will eventually develop active TB in their lifetime half of them during the first 18 months after infection. The risk is much higher among HIV-infected persons. Reinfection of a previously infected individual, which is common in areas with high rates of TB transmission, may also favor the development of disease.

Kapag na expose sa person na may infectious form of TB, about 10% of healthy adults will have infection, dun naman sa mga presently infected about 10% lang ang magkaron ng active disease, sila yun kailangan mag undergo ng treatment, usually 6 months pero depende pa din kung complicated case. Then yun about 90% na walang active disease, sila yun na expose, na infect pero walang symptom, sila yun pwede mag positive sa ppd skin test or quantiferon (IGRAs), sila yun may latent TB infection, sa case nila we doctors may or may not treat to prevent na maging active disease yun latent TB infection nila, pero yun treatment nila iba sa active tb disease. Kung nag treat at cured na yun previous TB disease, yes, pwede ulit magkaron ng reinfection. Kapag TB reinfection iba na din ang treatment. Kaya its very important to consult a pulmonolgist, to have a right diagnosis and proper treatment.

 

BTW, im not a pulmonologist, iba po ang subspecialty ko. ☺

[flashman]

Can anyone recommend a good gastroenterologist in st. Lukes or capitol medical center? Laging sumasakit sikmura after drinking coffee. Minsan kapag after kumain or iinom ng tubig. Masakit parang burning sensation sa ilalim lang ng dibdib. I'am Suspecting ulcer or gerd ba yun? Dati nawawala after a day or two pero napapadalas na ngayon lalo na after consuming alcohol.

 

Thanks.

Edited March 13, 2016 by 314