Adamm - SOD and ERCP

[Guest guest]

Adam, Hi!

I am glad that your surgeon is trying hard to get to the bottom of

your illness.

I had SOD too either as a result of my acute pancreatitis attack or

from my subsequent GB surgery. Statistically, SOD is more

associated with laporascopic gallbladder surgery. Although it is

associated with AP, in my case, the acute pancreatitis occured

prior to the SOD. To diagnose SOD, the doctor has to do ERCP

with manometry. This measures the pressures of your sphincter

of Oddi. If it is higher than 40mgM then it is considered

abnormal and they will cut the sphincter. Usually they start with

just the biliary portion of it unless they have very high suspicions

that the pancreatic portion is also involved. Usually the biliary

sphincter is cut, the patient is observed for a few months and if

the pain persists, they will look then do the pancreatic part. One

thing to keep in mind, when you discuss the ERCP with your

surgeon, make it clear if he is going to do the whole ERCP

(which includes the pancreas) or only an ERC. Many, many if not

all physicians and surgeons use the acronym ERCP even when

they only intend to do what is called the ERC. This means that

only the biliary portion of your ductal system is looked at....which

gives a high likelihood of missing any pancreas problems. I say

this because this is what happened to me: the doc said he was

going to do an ERCP, ended up only doing the ERC and missed

my pancreas problem so I had to go back three weeks later, to

another doctor and have it all done over again! Needless to say,

I was not happy about the first doctor misleading me. There is a

very good article on-line about SOD published in the Journal of

the Pancreas, by Dr G Lehman - one of the best pancreas docs

in the country. You should be able to access this through a

google search. If not, I will try to find the link for you.

As far as ulcers...that is a standard line for any kind of digestive

disorders and it is fairly simple to rule out . Statistically, they are

one of the most common illnesses that people have when

complaining of abdominal or GI distress, so it is pertinent to just

rule it out. Doesn't mean that he is putting any probability on

it....just that it is something to look for. Kinda when your

computer doesn't work and the first thing they ask is if it is

plugged in. Not that they don't trust you to know when your

computer is broken...just that this is a statistically common

reason for computer " failure " .

As far as ANAs are concerned - depending on how the test was

run, what was going on in your life health wise when it was run, it

may not mean much. There is a good portion of the general

population that are positve ANA and it really means

nothing....patient age, activity, how the test was run, if you had a

cold or infection or other under the weather thing going on...all of

these can make you positive. Even things that you may be

exposed to (again, in my case I am positive because of my job,

most likely). So, until you can associate it with other things going

on in your body, the test is very, very non-specific.

Bilirubin level does have an association with bile flow. If your

common bile duct or other liver bile ducts are blocked you can

get abnormal readings. Bilirubin is the breakdown of heme

(blood) and abnormal levels can indicate liver function problems.

However, again in many healthy persons unconjugated bilirubin

can be slightly elevated (2 to 3mg / dL).

Basically, the tests that you indicated that the surgeon is

ordering for you should be comprehensive enough to get to the

bottom of things. The ERCP (the complete one, not just the

ERC) is the gold standard for ruling out or confirming pancreas

problems. However, keep in mind that it is not fail safe. Some

endoscopists believe that the combination of ERCP and

endoscopic ultrasound (EUS) is the state of the art standard now

for evaluating the pancreas. ERCP for looking at the ducts and

the EUS for evaluating the tissue of the pancreas (looking for

masses, calicifcations and other abnormalities involving the

tissue). And, even when both are used, issues involving cellular

and molecular functions can be missed. Some centers collect

fluid from the pancreas to evaluate its function but not many

places do this. Altogether, diagnosing pancreatic problems at

the early stage is a very difficult thing to do. Alot of times, it isn't

until many years have passed (sometimes a decade) before

changes are seen on ERCP that are diagnostic for a pancreas

problem. So, it is a very difficult, frustrating and controversial

road.

Hope this info helps a little and I wish you very good luck with all

the procedures!

Laurie