blockage or not?

[Guest guest]

Other than going to my pain doc to see the nurse and get my precscriptions,

today was the only day I've been out of the house since getting discharged from

the hospital on July 23rd. Well, not counting my two ER visits, one on Sunday,

July 25th, and then one Wednesday, July 28th.

I left the Mayo Clinic with the impression that they had found at least part of

the cause for my continuing attacks of pancreatitis, which ultimately led to my

diagnosis of chronic pancreatitis. I understood them to say that the CT scan

showed a blockage of some sort at the 'ampulla of vater'. I also understood

them to say that they were unable to get to this area via ERCP so they couldn't

tell me whether the blockage was a tumor, scar tissue, or what it is.

However, after calling my local GI/Hep's office on Friday I am totall confused

on what they did/did not find at Mayo. I was under the impression that they

definitely found either a tumor, scar tissue, or some sort of blockage around

the amupualla of vater. Mayo alos suggested that I may not have autoimmune

hepatitis (AIH) at all and that the damage to my live might just be caused by

repeat attacks of acute panc. Regardless of whether I have AIH or not the Hep

at Mayo suggested stopping meds for AIH (imuran and predisone) and monitoring my

liver enzymes. I saw my local GI/Hep do on Friday, July 2nd. He said he saw no

harm in stopping the meds for AIH and seeing what happens. So, I have now been

off imuran and prednisone for a month. The first two week blood check one of my

liver enzymes was up to 95 (just over 3 times normal), the other one was about

60 something (or about 2 times normal). My GI/Hep's advice was to wait and see

what the next few labs show. When I asked him about the CT scan at MAYO and the

last CT scan done at Crestwood (the Hospital in Huntsville that he goes to)

showing a 'prominent ampulla' that needed to be investigated further. He really

didn't give me a an answer. I asked him if if was a tumor or even scar tissue,

couldn't it be removed surgerically without having to mess with my actual

pancreas. He told me he wanted to just adress one thing at a time and that he

first wanted to see what happens with me off my meds for the AIH. At the time I

was satisfied with that answer. However, since then, I've been in the hospital

once and to the ER 3 or 4 times. I called his nurse Friday and told her that

this was ridiculous and that I wanted to know if something could be done about

whatever it is they saw on the ct scan that they incicated as 'prominent

ampulla', which all the doctors said it meant there's either a tumor, scar

tissue, or some other sort of partial blockage at the ampulla of vater.

Well, then the nurse called me back, she said my GI/Hep doc said that the ERCP

showed there was no blockage at the ampulla of vater. The way that I am reading

the ERCP report, I don't think they were actually able to get to the ampulla of

vater via ERCP because of my gastric bypass. My discharge summary from Mayo

clearly states

Summary Diagnoses:

" #1 Partial biliary obstruction "

Admissions Problems:

" #1incomplete biliary obstruction, here for ERCP "

" She has a history of an incomplete biliary obstruction with secondary biliary

fibrosis "

It goes on to state

" She had a norma cholangiogram but faled her pancreatogram. "

Past Medical/Surgical Problems:

" Chronic incomplete biliary obstruction with secondary biliray fibrosis. "

Problem Oriented Hospital Course (IOP):

" #1 Incomplete biliary obstruction, status post ERCP "

One page of the quack GI's (Dr. Lara) sumary notes states:

" CT Scan showed intra and extra-hepatic duct diation. The pancreatitic duct was

slightly prominent, also. A prominent ampulla was suspected. In the left upper

quadrant a loop of intetine that appeared to be an intussusception was noted.

There has been no previous mention of an ampullary adenoma, thus it is difficult

to interpret the significance of the finding n the recent CT scan (the one done

at Mayo - however, the other GI I saw, Dr. Topazian, said he saw the prominent

ampulla on the ct films from home and that it had definitely increased in sized

during the time period between the ct scan at home and the ct scan at Mayo.).

The CT Scan report from the CT scan done at Mayo mentions

" dilatation of the intrahepatic bile ducts and of the common duct and there is

slight dilation of the pancreatitic duct. The major finding concerning me today

is what appears to be a mount of soft tissueprojecting into the secodn portion

of the duodenum right at the junction of the ducts with the secodn protion fo

the duodenum. To me, this looks like a very prominent ampulla. I know it might

be difficult to get a look at the ampulla, but I think it would be worthwile if

it was possible to do so. In the left upper quadrant, there is a loop of

intestine that looks like an intussusception. "

The ERCP report states:

" The minor and major papillae were identified. Free bile drainage was present.

The biliary duct could be accessed and cholangiography demonstrated a mildly

dilated biliary tree with no stones or strictures. Drainage of bile was

generous. Prolonged efforts at pancreatitic cannulationwith a variably flexed

sphincterotome and an angled glidewire fialed to image or identify that duct.

Glucagon was eventually admministered, as we abandoned hopes of performing

manometry, but entry into the pancreas could still not be accomplished. "

I know this is long but it anyone can shed some light on it, it would be greatly

appreciated.

thanks,

[Guest guest]

Hi ,

In my opinion, I vote for blockage - the intermittent or parital kind

like what was described by one of the doctors writing the report.

I base my novice conclusions on this part of the report:

" The major finding concerning me today is what appears to be a

mound of soft tissue projecting into the secodn portion of the

duodenum right at the junction of the ducts with the secodn

protion fo the duodenum. To me, this looks like a very prominent

ampulla. I know it might be difficult to get a look at the ampulla,

but I think it would be worthwile if it was possible to do so. "

I think that this summary makes it clear that this abnormality is

something that is contributing to your illness and should be

looked at more closely. If this is partially obstructing your duct, it

clearly could be the cause of your pain and pancreatitis attacks. I

am surprised that they are not making plans to do more

here....but, like your one doc said....one thing at a time I

guess...although if you are getting attacks so close together that

make you go to the ER, I would think that this would warrant a

more aggressive look-see at this mass / inflammation, etc........

I am also wondering why they are not pursueing the

intussusception which I thought was something that could

become concerning - potential for bowel obstruction / perforation

(?)....and to find a cause.....

Well, just my thoughts, not sure if they help much though.

Laurie