Pancreatitis...with no pain?

Nurses General Nursing

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I always thought that pancreatitis came along with horrible pain. This lady was laughing and chatting with her friend, and kept insisting she had no pain. Anyone ever seen anything like this?

Specializes in tele, stepdown/PCU, med/surg.

the weight gain seems strange though for justpancreatitis.

Specializes in LTC, skilled nursing, Med-Surg.
Then how is the diagnosis made? Is this elevated Lipase and Amylase or do you have radiographic evidence. If its just an elevated lipase then there are a lot of other things that can elevate it medications among them. More frustrating are the cases where there is raging pancreatitis on imaging (along with pain) and normal amylase and lipase.

David Carpenter, PA-C

I know this post is a few weeks old, but I just wanted to add my humble input as a nursing student and non-alcoholic pancreatitis sufferer. I agree with what has been said about how everyone responds differently to pain, and not everyone will admit if he/she is in pain. The aforementioned patient (quite a baffling situation, i might add) in the original post could just be in denial or wanted to joke or act cheerful to cover up any pain or anxiety she might have been feeling. I know I do laugh and joke a lot myself -- sometimes the joking is to mask the pain -- and sometimes I just need a good laugh, to try and keep my spirits up. That old saying "laughter is the best medicine" is true for a lot of things. Anyway, I know for me, pancreatitis is extremely painful. I have had recurrent attacks of pancreatitis for several years and now it's turning chronic, so I have pain every day. I do know many other pancreatitis suffers from support groups, and a few have very little pain or just mild pain.

David, I agree with you that the cases of raging pancreatitis with terrible pain, that actually show up on the imaging tests, but not the blood work -- are very frustrating, for the doctors, PA's and NP's, nurses and of course the patients, too. Equally frustrating is when someone presents with severe upper abdominal pain, nausea and/or vomiting, and elevated lipase and amylase-- but regular imaging tests like CT and ultrasound, are inconclusive. :( Then, more extensive, invasive (and expensive) procedures like an ERCP and an EUS are usually done to get an in-depth look at what's going on in the pancreas and biliary tree. That's the stage I'm at -- awaiting an ERCP.

For the scenario in the original post, I wonder if pancreas divisum has been ruled out?

Anyhoo, thanks for letting me add my input. I hope everyone is well! God bless those who suffer from either acute or chronic pancreatitis, and God bless their caregivers... it is hard on everyone. :heartbeat :nurse:

Specializes in Home Care, Primary care NP, QI, Nsg Adm.

It would interesting to see her labs. Is she eating? Any other physical complaints?

I've never seen a 'pain-free' pancreatitis. No answer about the jaundice.

Any tenderness on palpation?

Very interesting. Plz provide us with f/u.

Saifudin, CRNP

i too am thinking a metastatic gi cancer...

and lovehospital, while we are statistically aware of cancer occurrences, when you work w/clusters of those afflicted, it is always too many.

leslie

Specializes in LTC, home health, critical care, pulmonary nursing.

If it was CA, I would think the abdominal CT and ultrasound would have indicated something. Anyway, at her follow up, the abdominal distension had resolved and she was almost back to her pre pancreatitis weight. On ABT, lipase was normal, liver enzymes were a bit elevated, but rechecked a week after she finished the ABT and they were normal. Such an odd presentation. Usually the pts with pancreatitis are on the light every hour begging for morphine.

Specializes in Oncology.
Its true that 25 y/o don't get cancer all the time. But if you work at a tertiary center it feels like it.

Yes, yes it does.

Specializes in NICU, Post-partum.
Nope...pt is in her mid 20s, no hx of it, doesn't drink at all.

Sounds like she probably "diagnosed" herself.

Specializes in LTC, home health, critical care, pulmonary nursing.
Sounds like she probably "diagnosed" herself.

No, the ER physician diagnosed her. She seemed surprised when he said "You have pancreatitis."

Sounds like she probably "diagnosed" herself.

HI, I can understand why you guys would think that, you probably see people who self diagnosed alot. However, not everyone follows the norm. I have abnormal presentations most of the time and it takes them a while to figure out what is wrong, even specialists in certian areas will be surprized sometimes.

for me :

Asthma - no wheezing AT ALL just a tramendous amount of coughing, the doc tried to see if it was something else then saw my symptoms flair, and be relieved by albuteral and that told him that indeed it was asthma

hiatal hernia - vomiting and lost of it for a while and a loss of hunger, that was it. at first told i had a virus then it was acid reflux it wasnt till i got to a gi doc, had a upper gi study (where you swallow barium and they watch it move thorugh you), stomach emptying study, and then finally an endoscopy they finally figured out what was wrong with the endoscopy

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