OpenHealth Q&A

Concerns Over Pancreatic Cysts: A Patient's Journey

I'm a 29-year-old woman who has been navigating health challenges for roughly 12 years. Nearly two years ago, I visited the emergency room due to severe abdominal pain, where they discovered a cyst measuring 3.7 cm on the head of my pancreas. Following this, I consulted with a gastrointestinal surgeon who performed an endoscopic retrograde cholangiopancreatography (ERCP) and a fine needle aspiration biopsy, the results of which were negative. That's promising news, right? However, during a follow-up scan six months later, the radiologist provided some disquieting observations: 1. A cystic mass measuring 2.0 x 1.7 cm in the pancreas head, characterized by multiple enhancing internal septations, raising red flags for a possible cystic pancreatic neoplasm. 2. Multiple cystic lesions measuring at least 4-5 mm were noted extending from the main pancreatic duct into the body and tail of the pancreas. These lesions are nonspecific and might suggest the presence of side branch intraductal papillary mucinous neoplasms. 3. A referral to a pancreatic specialist for a thorough evaluation is recommended. Upon returning to the GI surgeon for a follow-up after the scan, I left the appointment feeling uneasy. While he had previously mentioned that the cyst could potentially lead to pain, he contradicted that claim at our latest meeting. He dismissed the radiologist's findings, stating that while some physicians regard those interpretations as sacrosanct, he personally does not. He asserted that biopsies of this nature can be inaccurate, justifying his decision to delay a follow-up MRI for another year. When my husband inquired about the possibility of an earlier scan at six months, the surgeon deemed it unnecessary and a misallocation of resources. Ouch! Moving on, my primary care physician was infuriated from my visit, expressing disbelief that the surgeon hadn’t taken my condition more seriously. She explained that it’s imperative I see a pancreatic specialist. I have a phone consultation scheduled with the Mayo Clinic in May. In the meantime, I would greatly appreciate any insights, suggestions, or comments, as this entire situation is quite unnerving—particularly when it concerns my pancreas. At present, I am grappling with the following symptoms: - Sharp pains in my upper abdomen that occur independently of my dietary choices, persisting even when I don't eat. - Persistent bloating that begins around 11:00 AM daily, regardless of food or fluid intake. - Extreme discomfort when lying down, especially on my back. - Thankfully, I haven’t experienced significant weight loss, but I also haven't been able to gain any, which is unusual for someone who has struggled with weight gain for the last decade despite being an active athlete. - I face significant constipation that can be maddening, or conversely, an overwhelming urge to stay in the bathroom. - My stool appears in a variety of unusual colors and consistencies, including dark brown, near black, orange, clay-like, and tan, and it's rarely solid—when it is, it's quite surprising. - While my appetite isn’t completely absent, certain foods no longer seem appealing, particularly red meat, which now makes me feel nauseous at the mere thought of it. - I experience constant fatigue and daily body aches. Background and potentially significant factors include: - I have undergone both endoscopy and colonoscopy in the past, with nothing abnormal observed. - Alcohol consumption has never posed a problem for me, as I keep my intake to a minimum; however, early signs of fatty liver disease have emerged. Notably, the elasticity measurement revealed normal results. - All other organs examined in the scan, particularly my gallbladder and spleen, appear normal. - A recent brain scan identified Chiari malformation; while I experience various neurological symptoms, they don't seem directly related to my current issues. - Occasionally, I notice slight yellowing of my eyes that fades quickly, accompanied by persistent redness. An eye examination yielded normal results aside from my poor vision. - Initially diagnosed with Celiac disease, subsequent tests and biopsies ruled this out. - I had previously been classified as pre-diabetic, but I no longer fall within that range. - My primary care physician diagnosed me with PCOS due to past difficulties with weight loss, although my situation has changed. - I was involved in a car accident about a year and a half ago, with the GI specialist speculating that it could have caused my pancreatic cyst, as I had not experienced abdominal pain prior to the accident. - Recently, I suspect I underwent a miscarriage (I had a positive pregnancy test followed by monitored decreasing hormone levels) and experienced over a month of bleeding. After a brief two-week pause, I had what seemed like my period, which included the passage of a large dark or tan lump and heavy bleeding for another five days. This follows a previous miscarriage from 2.5 years ago. I'm currently on the following medications: Metformin 500 mg daily (which I started taking well before the cyst diagnosis) and Adderall 25 mg daily, with an additional 5 mg as needed in the afternoon (initiated after the cyst discovery). I sincerely appreciate your time and any assistance you can provide!

Answers (1)

3/19/2025, 8:01:28 PM

OpenHealth AI

I understand that you are feeling quite anxious about your pancreatic cyst and the symptoms you are experiencing. It’s completely natural to seek clarity and support given the complexity of your situation. Here’s a summary of your situation and recommendations moving forward.

Main Points:

1. Pancreatic Cyst Findings: Your recent imaging indicates changes in the cystic mass, which may require further evaluation.
2. Symptoms: Ongoing abdominal pain, bloating, unusual stool, and discomfort necessitate careful tracking and further assessment.
3. Next Steps: Prioritize your upcoming consultation with the pancreatic specialist while managing your symptoms in the interim.

Explanation:

The cysts in your pancreas have been labeled with characteristics that can indicate a range of conditions, some benign and others that may require closer monitoring or intervention. It’s reassuring that your biopsy results were negative, but the radiologist’s findings and your persistent symptoms should not be overlooked.

The symptoms you describe—including abdominal pain, bloating, changes in your stool, and discomfort—may be linked to pancreatic issues or other gastrointestinal concerns. The sharp abdominal pain, in particular, can sometimes indicate an issue that warrants further evaluation. The variability in your stool color and consistency suggests possible disturbances in digestion or absorption, which may also be related to your pancreas.

Next Steps:

1. Keep Your Scheduled Appointment: Your upcoming consultation with the pancreatic specialist at Mayo Clinic is crucial. Prepare a list of your symptoms, questions, and any test results for this appointment.

2. Monitor Symptoms: Keep a diary of your symptoms, particularly food intake, pain episodes, and stool characteristics. Note any changes to your condition or symptoms that worsen.

3. Manage Pain and Discomfort at Home:

   • Dietary Adjustments:
     • Consider a bland diet that avoids greasy, heavy, and spicy foods. Eating smaller, more frequent meals can sometimes help.
     • Stay hydrated, particularly if you are experiencing constipation. Include high-fiber foods and consider a gentle laxative option for constipation, as needed.
   • Pain Relief: Over-the-counter pain relief (like acetaminophen) can help alleviate discomfort, but avoid NSAIDs (like ibuprofen) frequently as they may irritate the stomach.

4. Follow Up on Symptoms: Be vigilant for any worsening signs, such as significant changes in pain, abdominal swelling, jaundice (yellowing of skin or eyes), or drastic changes in stool color that persist.

5. Seek a Second Opinion: If you feel uncomfortable with the current management plan or if the pain continues, don’t hesitate to ask another gastroenterologist for their perspective, especially if you have health insurance that allows for this.

Your health journey has been challenging, and it's important to continue advocating for yourself. The upcoming specialist visit will provide you with more targeted recommendations and reassurance regarding any necessary steps to take moving forward. Take care, and focus on managing your symptoms while preparing for your consultation.