Diagnosing pancreatitis (either acute or chronic) should not be so difficult. You shouldn’t have to suffer while your doctor looks at you like a bull with a bad case of hemorrhoids (happened to me more than once). If you’re a doctor and reading this post and you get offended tough. Chances are you have a hard time diagnosing pancreatitis, whether acute or chronic, and because of that your patients suffer needlessly. I was in that category and I don’t forgive easily when someone causes me damage (which an inept doctor can do) nor do I easily forget for “To ERR is human, to FORGIVE divine. HOWEVER, neither is Marine Corps Policy.” – author unknown
I was dumbfounded when I read that approximately 210,000 people are diagnosed with pancreatitis yearly . 210,000! And then I can’t help but think or ask, based upon my personal experience “how many times did they have to visit the ER or doctor to obtain that diagnosis?” How many of those 210,000 are damaged needlessly and then develope chronic pancreatitis simply because they had doctors like I had? I have not been able to determine that number.
Acute Pancreatitis Diagnosis At Autopsy
How many people die without diagnosis where cause of death is found to be acute pancreatitis at autopsy?
In Germany (2000 – 2004) this was found to be true: “The reported incidence of acute pancreatitis diagnosed first at clinicopathologic autopsy ranges between 30% and 42%. To better describe outpatient fatalities due to acute pancreatitis that present as sudden, unexpected death, we retrospectively reviewed the autopsy files at the Institute of Legal Medicine, University of Hamburg, Germany, from 2000-2004. Individual cases were analyzed for sex, age, race, circumstances of death, social background of the deceased and previous medical history, seasonal occurrence of the disease, blood alcohol concentration at the time of death, body mass index, autopsy findings, histopathology, and etiology of acute pancreatitis. Among the 6178 autopsies carried out during the 5-year period evaluated, there were 27 cases of acute pancreatitis that presented as sudden, unexpected death. In all cases, the diagnosis was first made at autopsy.”
Glasgow is the largest city in Scotland. A review of all deaths from acute pancreatitis recorded at Glasgow Royal Infirmary between 1974 and 1984 identified 126 patients, 53 (42%) of whom had pancreatitis first diagnosed at necropsy (autopsy) .
One Turkish study describes and discusses the autopsy results for 12 sudden-death cases in which acute hemorrhagic pancreatitis was the cause of death. This study reviewed 3,305 autopsies performed between 1991 and 2001 at Turkey’s Council of Forensic Medicine. Of these, 12 cases (0.36 percent) involved sudden death due to acute hemorrhagic pancreatitis without symptoms .
I have NOT been able to locate statistics for the United States. If I am able to locate any data I’ll update this post.
WHY Is It So Difficult For Doctors When Diagnosing Pancreatitis?
Pancreatitis can be difficult to diagnose for several reasons which include:
1- Doctors have difficulty diagnosing pancreatitis because they just don’t listen. They are in to big a hurry to see their next patient, are thinking about their golf game or the hot nurse Hot Lips or simply doesn’t care because it isn’t him or her who is in agony.
2- Another reason is that they THINK they are omnipotent, know your body, its symptoms (what you are experiencing) a lot better than you do and if you beg to differ they simply chalk you up as a drug addict looking for a fix or a lonely hypochondriac in need of attention.
3 – Another reason is the medical profession has made it confusing and DANGEROUS (for the patient because time is of the essence to lessen damage) with different scoring criteria for both acute ( Ranson, APACHE II) and chronic pancreatitis. I would hazard to guess that most have never even heard of “minimal change chronic pancreatitis.” Even if they have there is still some criteria necessary for a diagnosis and …
Instead of using common sense, allowing that the patient is having recurrent AP and/or mild abdominal pain with nausea, vomiting, and other signs such as foul smelling, floating stools which indicate malabsorption due to a damaged pancreas that may not be producing enough digestive enzymes, that there is a REASON the patient is still sick they instead just roll it all off and tell the patient they are just peachy keen and nothing is wrong while the patient pukes on their shoes.
4- Many doctors have difficulty diagnosing anything unless it slaps them in the face (CT scan showing horrendous damage due to necrotizing pancreatitis or cysts the size of watermelons). Horrendous damage, internal bleeding and/or organ failure help them arrive at a diagnosis of pancreatitis but if you don’t have those types of complications yet, and trust me on this, you don’t want those easy to read signs but …
You have moderate to severe gastrointestinal symptoms and have yet to have a doctor give you a correct, common sense diagnosis make sure you persevere in finding an Internal Medicine doctor or a Gastroenterologist who received his/her degree from somewhere other than a Cracker Jack box, is able to recall what they learned in medical school and use common sense along with the modern diagnostic tools. I know I am asking a lot because …
Finding a good doctor with great diagnostic skills is like locating a huge placer gold deposit but …
Here’s the point of the whole diagnosing pancreatitis deal:
As far as I can find the ONLY condition with the tell-tale signs of SEVERE abdominal pain radiating to the back, with nausea and vomiting is acute pancreatitis. Go ahead Google this phrase without the quotation marks: “severe abdominal pain radiating to back, nausea, vomiting” and the first condition that pops up is what?
If you use the WebMD Symptom Checker (which does NOT ask all the right questions such as pain radiating to back) pancreatitis comes in number 4 and gallstones gets top billing but at least pancreatitis is a potential suspect. So if someone can take a couple of minutes and plug some info into a symptom checker, use a key word search phrase on Google that contains the exact symptoms and come up with pancreatitis why can’t a doctor do the same IF they have doubts or need some help in pointing their brain in the right direction? Ego or the “dumber than barber hair” syndrome?
The patient “leaning forward” is another clue (mentioned in most descriptions of acute pancreatitis symptoms). For some reason leaning forward helps to ease the pain (I’m laughing cuz it doesn’t help much) a tad or maybe it’s a “knee-jerk” reaction with acute pancreatitis patients with severe pain because when it did happen with me I did it EVERY time yet …
Could any one of the ER physicians put the clues together?
They were ALL dumber than a bag of barber hair. Anyway back to …
When the Hippocratic oath states: “to abstain from doing harm” why would any physician with a brain sit on his/her thumbs waiting for some scoring criteria, especially if the patient presents with text-book symptoms including elevated amylase and lipase? Time is of the essence to prevent more pancreas damage and …
IF the physician has enough on the ball to recognize the symptoms of acute pancreatitis, with p-amylase, lipase and trypsin (if available) testing giving the confirmation of acute pancreatitis within hours of onset along with the patients declaration of symptoms, I find it totally ludicrous to wait 48 for scoring criteria before addressing the inflammation but then …
ER physicians do NOT address the inflammation properly anyway. The ONLY thing they do initially that is worth spit is to make the patient go NPO (nothing by mouth). Instead of addressing the inflammation with an anti-inflammatory such as Ibuprofen they give the patient morphine or some morphine derivative which can actually cause MORE inflammation in the pancreas but …
At least you’d know that you had a decent physician for him or her to even get that far! I was in the ER seven, SEVEN (7) times with my worst acute attacks before being diagnosed (outside the ER). Not ONE ER physician had brains enough to check my amylase and lipase levels after four hours of onset. They did ONE blood test (CBC) in all 7 case interviews and NOTHING else as far as I know. Since I was there and coherent I do know.
One time I was given a shot of demerol (meperidine) for pain. It did NOTHING which should have been a HUGE clue which indicated the need for additional testing but what did the doctor say? “Come back if your condition becomes worse.” IF I hadn’t have felt like death warmed over that would have been funny and …
What’s even more disgusting is that 5 of those ER visits were to the same ER! They should have had a patient file, which if anyone would have had the brains to look, may have given a clue that there was definitely something wrong that needed more attention other than another CBC.
If you have been diagnosed I hope you had a better experience in regards to your ER physician diagnosing pancreatitis than me and …
I wish you good luck in your recovery and healing process.
1 – Pancreatitis – NIDDK scientists and other experts.
The NIDDK would like to thank:
David C. Whitcomb, M.D., University of Pittsburgh
2 – Acute pancreatitis presenting as sudden, unexpected death: an autopsy-based study of 27 cases.
Tsokos M1, Braun C. 1Institute of Legal Medicine and Forensic Sciences, Berlin, Germany. firstname.lastname@example.org
3 – Fatal acute pancreatitis
C WILSON, C W IMRIE, AND D C CARTER
From the Division and University Department of Surgery, Royal Infirmary, Glasgow
4 – Diagnostic Dilemma of Sudden Deaths Due to Acute Hemorrhagic Pancreatitis
Author(s): Ali R. Tumer M.D. ; Cenap Dener M.D.
Journal: Journal of Forensic Sciences Volume:52 Issue:1 Dated:January 2007 Pages:180 to 182
Date Published: 01/2007