Dilated pancreatic duct: Should I get a second opinion?

Thank you. I can tell that my symptoms are worsening as I have not lost an additional 7 lbs in just a week. The pain in my upper abdomen has increased and now I am having chronic diarrhea which may be related to a magnesium supplement I have begun taking for leg cramps. I have asked my doctor to order some additional lab work as the gastroenterologist advised me I was anemia and needed an iron supplement. My PCP told me not to take iron as it can sometimes cause diarrhea. Because I have been feeling so weak I have taken 2 slow release iron tabs in the past couple of days, but because of this diarrhea I have stopped with the iron. I am still recovering from the interstim surgery of one week ago, and admittedly not taking it as easy as I should be. I have asked for a second opinion. In fact, my gastroenterologist suggested I get one. Another Sutter Medical practice has a no second opinion policy, so my only recourse is going to San Francisco, which is a possibility. Needless to say, my stress level is high. I have not even watched the video for my new interstim device which has to be charged weekly for 30 minutes. The Medtronic representative tells me, "I explained everything to you in the recovery room after your surgery." I don't even remember seeing him at all. Oy vey, always something.

Thank you, Yes, I am in the process of getting a second opinion from a physician in San Francisco who is currently doing a study on patients with my condition. I understand patients these days really have to advocate more for themselves than they used to. Sometimes it can be quite taxing.

@frances007, I agree with @astaingegerdm that you have a right to have the results of your tests and possible diagnosis explained to you in layman terms. Not only will that put your mind at ease, it will help you and doctors to work together as a team. It's good to ask questions.

I moved your posts to this existing discussion:
– Dilated pancreatic duct: Should I get a second opinion?: https://connect.mayoclinic.org/discussion/dilated-pancreatic-duct/

I did this so that you can connect with @doxie2 who is going through a similar situation right now. Frances, have you considered getting a second opinion?

Here is the most recent CT scan. Perhaps I am overthinking these issues; however, I'm not a doctor and at this point unable to rely on my treating physicians to explain anything to me, other than the fact they want more studies.

TECHNIQUE: Transverse and sagittal transabdominal sonograms of the upper abdomen, aorta and IVC were performed in conjunction with color Doppler.

FINDINGS:
Liver: 16.4 cm liver is homogeneous without focal mass. There is persistent moderate intrahepatic biliary ductal dilatation

CBD: Measures 11 mm without obvious choledocholithiasis or biliary ductal mass. Common bile duct measures 13 mm in December 2020.

Gallbladder: Nondistended without stone, inflammation, or tenderness

Spleen: Homogeneous, without focal mass or enlargement. Spleen is 8.0 cm in length.

Pancreas: Visualized portions of the pancreas are grossly unremarkable except for moderate dilatation of the main pancreatic duct to 2.3 mm without obvious pancreatic mass, intraductal nodule or stone.

Kidneys: Right kidney measures 9.0 x 3.9 x 3.4 cm with 7 mm cortex, while the left is 8.9 x 3.6 x 5.2 cm with 14 mm cortex. There is no definite hydronephrosis, abnormal soft tissue mass, or stone in either kidney.

Miscellaneous: Aorta, inferior vena cava, and main portal vein are normal in caliber and direction of flow. There is no definite ascites or significant pleural effusion.

Thank you for asking. 2 years ago I began complaining of upper abdominal pain and loss of appetite that had been ongoing for about 8 months. I also mentioned to him that I had a lot of itching, which my doctor thought was a reaction to the Bentyl I take for IBS. My PCP dismissed my complaints and said it was acid reflux. During COVID-19 I went to urgent care for a COVID-19 test and mentioned to the physician the upper ab pain. By the grace of god, he ordered an ultrasound that revealed a dilated liver duct. My PCP called and said he had good news and bad news. The findings were not good, but they were going to monitor my problem. During the past 2 years I have had so many diagnostic tests that I have lost count. The most recent ultrasound revealed dilation of both my liver and pancreatic duct, which in my mind tells me the problem is not getting any better. My gastroenterologist discussed scoping with me, reminding me there was a 50% success rate and that the MCRP would be the best way to determine what was going on. He said he could not rule out a mass, even though I have had 2 CT scans. As I have mentioned, I have an interstim device to help me urinate; in order to have the MRI I had surgery a week ago to remove and replace this device with one that will now allow the MRI which is being scheduled. I take Norco for pain and that helps. I recently tapered off Methadone because the gastroenterologist said there was a correlation between opiates and dilation of bile/pancreatic ducts. I suffer from chronic pain as a result of a very bad car accident 9 years ago. I have been on opiates a very long time, starting with fentynal patches, and then changing to methadone because of the Medicare "donut hole." I recently found a doctor in San Francisco who is doing a study related to my condition, and asked my PCP for a referral, which I will secure. It has been a slow, painful and frustrating process. I asked my PCP for a referral to a different gastoenterologist, but he would not give me one. I recently changed to a new PCP and will obtain a referral to a new doctor as I want a fresh set of eyes to look at my condition. While I have always been on the low side as far as weight, having lost over 15 pounds since March of this year concerns me. I have no appetite, take phenergan for frequent nausea and now beginning to feel much weaker than I have ever felt. I am very active, but now seem to be slowing down. My PCP mentioned to me a few days ago that I had a low red blood cell count, but did not want me to take an iron supplement, contradicting what the stomach doctor suggested. In any event, I will move forward with the testing and obtain new referrals etc. I thank you for your concern. I recently exchanged messages with my OB/GYN who said she wished that doctors could go back to "slow medicine" focusing more on the individual, as that is what patients want. I do not see that happening at Sutter Medical Foundation where I have been a patient for over 30 years.

@frances007 - May I ask what symptoms you had leading to the diagnosis of dilated bile duct 2 years ago?
It sounds as if you suffer from a lot of pain- of course you want to know what’s going on!
Having an MRCP sounds like a good start. I just don’t understand how your doctor could get angry at you want answers.
If you don’t feel comfortable with your doctor it might be a good idea to get a second opinion as soon as possible. Try to find a doctor at a university medical center.
You don’t want to waste time now- please let us know about your testing!

2 years ago I was diagnosed with a dilation of my main liver bile duct. My doctors chose a "wait and see" approach. About 6 months ago another CT scan was done, showing dilation of my pancreatic duct. My gastroenterologist did not want to perform ECRP because of the risks involved. I have undergone many diagnostic tests. I recently had surgery to remove and replace an Interstim device that will now allow me to have the MCRP which is being scheduled. I have lost 19 pounds since March 2022. I have challenged my doctor on his approach, but this only angered him. Naturally I am concerned about the weight loss, upper abdominal pain and nausea for which I take Phenergan on a daily basis. I have had so many diagnostic tests that I have lost count. I remain hopeful that the MCRP will give the doctor the answers he needs to approach my problem. I am not jaundiced and my liver enzyme values are normal, but I know that sometimes this is possible. Has anyone had a similar experience?

Doxie, I agree with @hopeful33250. It sounds like you have questions that your doctor should answer.

Hello, test was ordered originally because I had pain
I was sent for an ultrasound and they saw a dilation then I was sent for an MRCP
then anEUS then another MRCP almost a year to the day from the first one .

Hello@hopeful33250, it started with pain in upper right quadrant probably pancreatitis, had ultrasound sound then MRCP then sent for a EUS, I guess that wanted it repeated in a year to see if there were any changes plus I am still having occasional pain. I am also on meds for reflux.