A patient with chronic hepatitis C with esophageal varices had a computed tomography (CT) scan with contrast. The scan showed advanced cirrhosis and a pancreas that is diffusely fatty. He has diabetes in good control, and is obese. Will the fatty pancreas cause chronic right-to-middle upper-abdomen pain? The patient has normal liver function tests and normal lipase and amylase levels as well. — Deb Krembs, MS, APNP-C, Madison, Wis. 

Did you check fecal elastase to see if the patient has pancreatic insufficiency? The pain is hard to tease out, whether it is from the cirrhosis or possibly from chronic pancreatitis. Having this person see a pancreatitis specialist may help, as would an endoscopic ultrasound. Is he a compensated cirrhotic? Did he ever have a bout of acute pancreatitis?

You didn’t mention the cause of the cirrhosis, if fatty liver, the pain could be from that, but again, it is difficult to determine. — Sharon Dudley-Brown, PhD, FNP-BC, co-director, gastroenterology and hepatology, Nurse Practitioner Fellowship Program, Johns Hopkins University Schools of Medicine & Nursing, Baltimore (192-3)

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