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I've been experiencing nausa, bloating, left flank pain and pain under my left rib cage. I've had an upper GI and it was normal besides "Mild slovakine (?) of esophagus lining" and a colonoscopy which appeared normal. I haven't gotten the biopsies results yet but based on the innitial findings I'm sure it'll be normal.
I had a few blood tests one of which was Lipase with 88 IU.L. According to the lab 88 is out of range but according to google 88 doesn't seem that high. Clearly, I don't have acute pancreatitis but I'm wondering if this elevation could mean anything.
Does anyone know about lipase levels and whether left upper stomach pain indicate anything? Any clues or advice would be great.
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Lipase levels are to check for pacreatitis; normal is below 160 Unite per Liter.
Epigastric or generalised abdominal tenderness, often with rigidity is one of the signs; with low concentration of oxygen in blood;
Serum amylase three or more times normal is the traditional way of diagnosing acute pancreatitis. However, lipase levels are more sensitive and more specific.
FBC, U&E, glucose and C-reactive protein (CRP) indicate prognosis
Raised bilirubin and/or serum aminotransferase suggest gallstones.
Hypocalcaemia is relatively common.
They only testes lipase, CRP which was only slightly elevated and celiac which I tested negative for.
You need to state your lab's reference range please since they do vary depending on method! They vary big times. Your 88 U/L are out of range you say, but by how much?
There should be amylase as well and unfortunately those enzyme levels are often non-specific. Your symptoms should make sense together with blood results and go from there.
They shall repeat those enzymes though.
All the best!
Thanks for the reply!
My lab range says 13-60 IU/L, so its 28 over, which honestly I have no idea is a lot or a little.
They didn't do an amylase test only a CRP which was just slightly elevated and they tested for Celiac which I didn't have.
Do you know if my symptoms of left quadrant pain and elevated enzymes match? About four years ago I went to the GI doctor and I remember I hd slightly elevated lipase panel and they said it was probably from an acute pancretitis attack but they didn't do any follow up. So I'm wondering if the issue could possibly be with that.
Thanks again for your advice!
Thank you! Great!
So 'just' slightly elevated.
Now, if you had no symptoms one would say that is your individual normal level. (the referance range covers just 95% of normal people, some are bit below and some are bit above and fully healthy, but the Gauss math evaluation of as to what is normal with that method is a 95% calculation. Just noting as 'btw' Lipase can stay elevated if a decreased clearance in blood makes levels artificially higher.
But you have symptoms. Chronic pancreatitis could be the case and many other (list below).
The only statistic I can provide you with is, that less than three times the upper limit of normal concerning lipase and/or amylase level (so lipase up to 180IU in your case),
often do not find any pathology in pancreas.
Since investigation is expensive, docs often refrain from further pancreas imaging with mildly elevated levels unless symptoms prompt it or time of ongoing repeated elevations, (but mind you I love imaging as a peace of mind, too. I have to pay privately for each MRI anyway and still a battle to get it) as also the worse thing: malignancy in pancreas is usually not found with these mild elevated levels according to statistics..
Elevations if not your personal norm value
can be from pancreas problems (chronic pancreatitis)
salviary gland inflammation
(celiac disease -ruled out you said)
(peptic ulcer disease - ruled out)
don't think it's bowel obstruction as it would become very acute pain.
In blood test as a basic liver enzymes and kidney parameters and electrolytes should always be ordered (and are not expensive).
Pancreas and gall juices use the same end duct to get into duodenum. If sludge or a stone partially obstructs the flow, it can cause a backlog and inflammation.
Some people with small intestine bacteria overgrowth (treated with e.g. Rifaximin) had elevated lipase levels.
Hm....the field is huge, but mayb you can start with something somewhere.
Some people say that chlorophil added to their water a couple times a day helped the pancreas. Eating low fat, high carb diet, low sugar. Mainly green veggies, carbs from yams and not simple carbs (sugars).
It is not highly elevated, but I fully understand your concerns.
You might try some diet suggestions for yourself
and provide doc with some further testing suggestions, what he/she thought of it.
You might want to read through here too:
All all the best!
Thanks for your thorough response, I really appreciate it. You definitely sparked some curiousity when you said salvairy gland inflammation as I have sjogrens syndrome. I know it's rare to have GI complications with sjogrens but perhaps this should be explored furhter especially the association with chronic pancreatitis. I should probably get records from my old GI to see if it helps at all.
One more question for you when you say further pancreas imaging does that mean there are more specific imaging tests for the pancrease other than a CT scan of the ab with contrast?
A normal CT scan doesn't exclude chronic pancreatitis, though advanced chronic pancreatitis will be seen in CT.
It get's expensive for the system (and docs have to justify indication) or for yourself AND some investigations have risks due to complications that can arise when poking scopes into places inside body.
Here the list:
Ultrasound (the normal non invasive trans abdominal/ through skin)
MR cholangiopancreatography (MRCP, investigating biliary obstruction - fully non invasive, great tool!)
endoscopic retrograde cholangiopancreatography
(This ERCP is invasive. I would always ask why not MRCP was good enough if ERCP was offered. ERCP allows eye visual evaluation of duct tissue and can see small tumors, that go undetected by CT or MRI, but it needs an indication for it.)
endoscopic ultrasound (bit invasive)
small bowel follow through (doesn't hurt)
hepatobiliary scan (HIDA)
As far as I read a CT and MRCP should be combined together re pancreas because both methods have great advantages but also disadvantages, nothing is 100% in imaging.
Now with Sjorgrens syndrome I think the pancreatic and biliary duct needs to be assessed if in doubt it seems and
MRCP or ERCP are the way to go for a 'pancreatogram'.
Autoimmune exocrinopathy come up in Sjorgens syndrome mentioning some pancreas enzymes being elevated.
BUT here comes the good news:
tennis star Venus Williams shares this autoimmune disease with you and since we have some tiny autoimmune battle (but not Sjogren's) ourselves, were adviced by doc to google her diet.
Diet can do a lot to you, especially in autoimmune diseases, and therefore make symptoms better.
(A vegan diet apparently)
Maybe worth a look and google into it for your own health to do something actively? Docs can't do that. The 'leafy greens', there is something good about it.
(Not for me since iodine is high in greens and my thyroid goes overboard, but in general)
So if your thyroid is good and not autonomic with iodine (is rare), why not give it a try.
All the best!
If you want to read in detail and see how complex the imaging is and why 'one CT' is not 'all done and dusted'. I really would ask for MRCP and get on a special diet as it takes time to take effect.
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