my hypothesis - tweaked (?)

[Guest guest]

Hi !

You brought up some good points to add to the discussion. That

is the sphincterotomy aspect.....I think some of your points were

answered in other posts but I am going to throw in my two cents

worth too...forgive me if I am repeating what was said and I

acknowledge that these are not my original ideas (I do not wish

to plagerize).

Sphincterotomies and continuing spasms: I think it was pointed

out that the continuing spasms could be because the muscle

has become scarred or that the cut wasn't extended deep

enough. I also want to add that maybe only the biliary portion of

the muscle was cut too and not the pancreatic part so if the

pressure is affecting the pancreatic muscle group this could

explain the on-going SOD. Most docs use a two part aproach to

sphincterotomies for SOD. First they cut the biliary part in the

hopes that this alone will solve the problem, then they move on

to the pancreatic part if the patient doesn't improve in a few

months....or if there is significant relapse. They usually do this

because of the higher risk when messing with the pancreas. I

also think that the sphincter may be spasming because of the

role that it is forced into when the gallbladder is removed. It

seems that when the gall bladder is absent, that the common

bile duct takes over some of the GBs function. That is, it stores

bile and releases it in response to the food signals. That is why

it is very common to see dilated common bile ducts in persons

without GBs.....and the sphincter of Oddi acts as the gate keeper.

In fact, the " normal " diameter of a gallbladderless common bile

duct is adjusted to take into consideration this fact. So, as with

any muscle, the more work it does, the stronger it gets.....Which

could explain the spasms - and if it becomes overworked by

acting as a surrogate gallbladder.....this may induce the

spasms. I wouldn't be surprised to learn that the cut sphincter,

becomes completely functioning again...that is, closes to keep

out duodenal contents and opens when the juices flow. The cut, I

think, just allows it to open farther as long as scarring hasn't

taken place. I also think this is why there are so many changes

over time in pain levels and quality that a person feels.

And then you add in the anomaly of PD...which if anything, should

lessen the affect of SOD because most, if not all, of our

pancreas juice is not flowing through the SO. Intuitively, you

would want to say that we should be less affected by SOD, but I

have read that persons with PD have a higher association with

SOD....so what give's there? (but we are less likely to get

gallstone pancreatitis.....) But then the thought comes in...does

the fact that most of our pancreatic juice enters the duodenum

upstream of the common bile duct.....and hence interacts with

food before bile comes into the picture....does that phenomenom

have anything to do with PD pain....(which is off the subject of

SOD pain)......hmmmmm.....never thought of that before........

Laurie