Pancreatitis...with no pain?

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

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?

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maybe it is a chronic pancreatitis?

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

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

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

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

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

CT with contrast of the abdomen and ultrasound of the abdomen. Her presenting complaint was a 16 lb weight gain and 6 inch increase in abdominal girth in 1 week. No fever.

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CT with contrast of the abdomen and ultrasound of the abdomen. Her presenting complaint was a 16 lb weight gain and 6 inch increase in abdominal girth in 1 week. No fever.

I would be worried about cancer here. Thats another place where you see increased lipase. Any jaundice?

David Carpenter, PA-C

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Specializes in LTC, home health, critical care, pulmonary nursing.
I would be worried about cancer here. Thats another place where you see increased lipase. Any jaundice?

David Carpenter, PA-C

In a 25 y/o?

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Specializes in CTICU.

25yo's get cancer all the time, unfortunately.

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CT with contrast of the abdomen and ultrasound of the abdomen. Her presenting complaint was a 16 lb weight gain and 6 inch increase in abdominal girth in 1 week. No fever.

I know you may not be able to tell us, but do you know what findings on the imaging specifically made them decide it was pancreatitis? I agree with core0, the picture is quite worrisome for malignancy.

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25yo's get cancer all the time, unfortunately.

If she's nice and has several adorable kids it approaches 100% unfortunately:(.

David Carpenter, PA-C

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25yo's get cancer all the time, unfortunately.

I dont think at all that 25 yo's get the cancer ALL the time,actually according to statistics they are a low risk patients,just like they dont develop cataract that often or other conditions related getting older,advanced age is a major risk factor,and also although it happends rare pancreatititis develop from uknown cause and is not related to abuse of alcohol.With that said I agree that this looks like an unlucky case of pancreatic cancer...hopefully for this young person life I'm wrong.

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I dont think at all that 25 yo's get the cancer ALL the time,actually according to statistics they are a low risk patients,just like they dont develop cataract that often or other conditions related getting older,advanced age is a major risk factor,and also although it happends rare pancreatititis develop from uknown cause and is not related to abuse of alcohol.With that said I agree that this looks like an unlucky case of pancreatic cancer...hopefully for this young person life I'm wrong.

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. If I remember the incidence of pancreatic cancer in that age group is something on the order of 1 per 1 million. But other cancers are prominent in that age group. These are also rare but when present tend to be devastating.

David Carpenter, PA-C

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