The patient: the body wasted, left abdominal pain, abdominal distension, diarrhea for more than a year, gastroenterology examination did not find anything, blood amylase 57, urine amylase 553, CT examination of the pancreatic body slightly large, no clear abnormal density shadow, surrounding fat gap is still clear, consider pancreatitis. Before the examination of the pancreas was treated as gastroenteritis, no significant effect. Can this confirm the diagnosis of chronic pancreatitis? What medicine should I take to get better? Ding Zhen, Department of Gastroenterology, Wuhan Union Medical College Hospital
Ding Zhen, Department of Gastroenterology, Wuhan Union Medical College Hospital.
Not yet diagnosed
We need to do MRCP to check the pancreatic duct, and I don’t know if the CT is enhanced.
Patient: I don’t know if the CT is enhanced, I’ll send it to you.
Patient: I have new information to upload
Ding Zhen, Department of Gastroenterology, Wuhan Union Medical College Hospital.
The picture is not very clear, the CT is a plain scan, it looks like the pancreas is in good condition, from the report results also look like this, and amylase is not very valuable for the diagnosis of chronic pancreatitis, so I think the diagnosis of pancreatitis is not based on enough. If you are not sure, you can add an enhanced CT of the pancreas and MRCP of the pancreas to rule out pancreatitis.
Can you describe the symptoms in detail, such as how much weight loss over a long period of time, the number of times of diarrhea, the nature of the stool, the time, location and nature of abdominal pain episodes, etc.?
Patient: Thank you, Dr. Ding, I didn’t see your reply when I went on a business trip some time ago, I have been weighing about 108 pounds for a long time, my appetite is not high, I don’t have a sense of hunger, I feel bloated after eating, I don’t want to drink, my abdominal pain is sometimes in my abdomen, when I have severe pain in my abdomen I have diarrhea, most of the time my stool is dark green; sometimes I feel bloating and pain in my left rib cage, the doctor on my side used to diagnose it as gastritis and colitis, but now it is pancreatitis. I don’t know how to treat it, but it’s pancreatitis.
Wuhan Union Medical College Hospital, Department of Gastroenterology, Ding Zhen.
The early diagnosis of chronic pancreatitis is clinically difficult because the typical clinical and imaging manifestations appear late.
The main feature of chronic pancreatitis diarrhea is steatorrhea, which is a large amount of fat in the stool, in addition to the late stage is usually accompanied by diabetes. I think chronic pancreatitis is not enough basis according to your description, we can treat it as functional gastrointestinal disease such as IBS, we can give digestive enzymes, intestinal flora regulating drugs and Desutex for pain relief.
Patient: Thank you, Dr. Ding.