Guest guest Posted May 26, 2004 Report Share Posted May 26, 2004 Hi , I am glad that what I wrote made sense. So many times the information tends to get so long but I try to make it understandable. The information that I share is from my year or so of searching databases and electronic medical libraries so that I could understand what was going on with my situation. It is nice that I can condense this to share with someone else. I also wanted to mention that the ampullary edema that you mentioned refers to the sphincter (sphincters are also called ampullas too). He is speculating that you may have swelling of the sphincter that is causing a blockage. If so, that could heal over time (as opposed to scarring - that will be permanent unless it is physically removed most likely). The values that you cited in one post for the ALT (?) is only slightly elevated and if that occured soon after your gallbladder surgery that is probably why he never mentioned it to you - it really was probably not too significant for you at the time. And while the level of elevations of AST / ALTs are not indicative of degree of tissue damage (permanent damage that is) it can be a diagnostic clue to certain conditions of hepatitis (any swelling of the liver is a type of hepatitis). Very high levels (high thousands, tens of thousands) usually mean some kind of toxic substance exposure (like bad mushrooms, something in the air or environment etc), moderately high (close to 1,000 and above) can be viral hepatitis and mid (hundreds) may be more alcoholic hepatitis, for example. And those that are only slightly above normal (lless than 2 times above normal) are usually not too clinically significant (tylenol use or alcohol drinking , body weight and even race can all elevate these less than twice normal). Usually when they are less than 2x above normal the docs ask you to stop all alcohol and medication use and repeat the tests in six weeks. If they are more than twice normal, then the doc will investigate for causes of hepatitis like autoimmune, alcoholic, hereditary, viral, toxicity, etc. And of course, the SOD! It sounds like you are on the right track, like you mentioned. The MRCP is usually done before an ERCP when the doctor is still in the diagnosing stage. If the MRCP shows a dilated duct, or a mass or strictures or anything anatomical then the ERCP will be next if it is something correctable by ERCP. If the MRCP is inconclusive, then the ERCP is done for the reasons you mentioned (manometry) and because it is still considered to be more sensitive to finding ductal abnormalities in the biliary or pancreas system. From what I have read, the docs like to start simple and move to the complex tests until something can be determined. So if he is suspecting retained gallstones for example, he will do an ultrasound, then maybe CT / MRI then go the ERCP. If the ultasound shows evidence of retained stones, then he may skip the MRCP and go directly to the ERCP because then the ERCP is not only diagnostic but therapeutic too (he can snatch the stones, for example). Have you read the article by Sherman about SOD in the online Journal of the Pancreas (www.jop.com I think)? It is an extremely good article and if you haven't seen it yet I can get you the link. There are also some really good liver enzyme articles that I can link you to too (or send as attachments if they are not linkable, I think). Let me know and I will forward the source of my information to you so you can see it first hand - in case I have misinterpreted something (if so, it is purely unintentionaly, but please remember that the information that I am passing along is just from my experiences and research - I have no special training in this; so don' t use what I say as infallible!!!!!! or completely reliable). It's a long, frustrating road that seems to only end in more frustration at times. But keep on it and hopefully in a few months you will have this all behind you! Laurie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 26, 2004 Report Share Posted May 26, 2004 Thank you so much Laurie....I truly DO appreciate all I can learn as I am one of those people that need to know all they possibly can and be an informed patient as it were. Yes!! I would love it if you could send along the links or any articles or ANYTHING that you think is pertinent. thanks again!! > Hi , > > I am glad that what I wrote made sense. So many times the > information tends to get so long but I try to make it > understandable. The information that I share is from my year or > so of searching databases and electronic medical libraries so > that I could understand what was going on with my situation. It is > nice that I can condense this to share with someone else. > > I also wanted to mention that the ampullary edema that you > mentioned refers to the sphincter (sphincters are also called > ampullas too). He is speculating that you may have swelling of > the sphincter that is causing a blockage. If so, that could heal > over time (as opposed to scarring - that will be permanent > unless it is physically removed most likely). The values that you > cited in one post for the ALT (?) is only slightly elevated and if that > occured soon after your gallbladder surgery that is probably why > he never mentioned it to you - it really was probably not too > significant for you at the time. And while the level of elevations of > AST / ALTs are not indicative of degree of tissue damage > (permanent damage that is) it can be a diagnostic clue to > certain conditions of hepatitis (any swelling of the liver is a type > of hepatitis). Very high levels (high thousands, tens of > thousands) usually mean some kind of toxic substance > exposure (like bad mushrooms, something in the air or > environment etc), moderately high (close to 1,000 and above) > can be viral hepatitis and mid (hundreds) may be more alcoholic > hepatitis, for example. And those that are only slightly above > normal (lless than 2 times above normal) are usually not too > clinically significant (tylenol use or alcohol drinking , body weight > and even race can all elevate these less than twice normal). > Usually when they are less than 2x above normal the docs ask > you to stop all alcohol and medication use and repeat the tests > in six weeks. If they are more than twice normal, then the doc will > investigate for causes of hepatitis like autoimmune, alcoholic, > hereditary, viral, toxicity, etc. And of course, the SOD! > > It sounds like you are on the right track, like you mentioned. The > MRCP is usually done before an ERCP when the doctor is still in > the diagnosing stage. If the MRCP shows a dilated duct, or a > mass or strictures or anything anatomical then the ERCP will be > next if it is something correctable by ERCP. If the MRCP is > inconclusive, then the ERCP is done for the reasons you > mentioned (manometry) and because it is still considered to be > more sensitive to finding ductal abnormalities in the biliary or > pancreas system. From what I have read, the docs like to start > simple and move to the complex tests until something can be > determined. So if he is suspecting retained gallstones for > example, he will do an ultrasound, then maybe CT / MRI then go > the ERCP. If the ultasound shows evidence of retained stones, > then he may skip the MRCP and go directly to the ERCP > because then the ERCP is not only diagnostic but therapeutic > too (he can snatch the stones, for example). > > Have you read the article by Sherman about SOD in the > online Journal of the Pancreas (www.jop.com I think)? It is an > extremely good article and if you haven't seen it yet I can get you > the link. There are also some really good liver enzyme articles > that I can link you to too (or send as attachments if they are not > linkable, I think). Let me know and I will forward the source of my > information to you so you can see it first hand - in case I have > misinterpreted something (if so, it is purely unintentionaly, but > please remember that the information that I am passing along is > just from my experiences and research - I have no special > training in this; so don' t use what I say as infallible!!!!!! or > completely reliable). It's a long, frustrating road that seems to > only end in more frustration at times. But keep on it and hopefully > in a few months you will have this all behind you! > > Laurie Quote Link to comment Share on other sites More sharing options...
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