strange question about a GI patient, please help!

core0 · Sep 27, 2007

Hey, all!! I am an ER RN and have a question regarding a patient. We had a patient in her 30s who was s/p lap choley due to chronic pancreatitis in the early 90s. She stated she had one episode of pancreatitis post op thn no problms at all, she stated.
This summer she started to be symptomatic again with pancreatitis. Amylase and lipase through the roof.. CT, the whole 9 yards.
My question, is that she is a nondrinker and not a druggie. Does a common bile duct stay in there on some patients, or what other causes could account for her symptoms? Like I said the labs are out the roof, but I was totally confused. Any input would be appreciated!
Anne, RNC

The common bile duct is not touched in a lap chole. The reason that it is removed it that the thought for unexplained pancreatitis is that there are small stones that lodge in the pancreatic duct and cause the pancreatitis. These are frequently not identified since the first thing the patient gets is an opiate which relaxes the ampulla allowing the stone to spill out. This symptoms usually resolve in a few days with this and no cause is found. Usually after 2 or more cases of unexplained pancreatitis GI recommends a chole.

The most common cause of pancreatitis is gallstones. Even in a patient S/P chole you can still develop gallstones. Usually in patients with gallbladder disease the common duct is enlarged and there are areas of stasis where stone can occur. Medication is also a common cause including HIV drugs, estrogens, diuretics and Chemotherapy drugs. Other causes include hypertriglyceridemia and pregnancy. Porphyria, genetic disorders and autoimmune disease are rare causes.

With your patient gallstones and medications would be the most likely. If all else fails it gets labeled idiopathic pancreatitis. Here is a short article on this:

http://www.medscape.com/viewarticle/529149

David Carpenter, PA-C