PRATIMA
SARKAR
Chronic Calcific Pancreatitis • ~40Y / Female
First Diagnosed
Year 2007
Pain Intensity
Grade 9/10
Clinical Status
Active Flare
Medical Alert Level
ACUTE
Consultation Key
"17+ Year History. PD Head progressed from 5.4mm to 7.5mm. Current presentation suggests severe acute-on-chronic pancreatitis flare."
Current Presentation / March 18, 2026
Pain & Agony
- • Excruciating chest and back pressure (9/10).
- • Severe spike in pain immediately after food intake.
- • Unable to sit or lie in a straight posture.
Systemic Infection
- • High-grade fever with persistent shivering.
- • Severe migraine-type headache.
- • Extreme physical weakness & persistent cough.
Sleep & Activity
- • Severe pain-induced insomnia (poor sleep).
- • Sensation of heavy pressure in upper torso.
- • Bowel movements currently reported as normal.
Clinical History
Detailed Investigation Timeline (2007 - 2025)
PD Head 2023
5.4mm
PD Head 2025
7.5mm
Initial symptoms of esophageal obstruction (food getting stuck) and chronic gastric discomfort identified nearly two decades ago.
Investigation: MRI/MRCP (04-10-23)
Acute on Chronic Pancreatitis with Ductal Strictures.
- • Pancreas: Enlarged with diffuse edema (hyperintense signal).
- • Pancreatic Duct: Dilated to 5.4 mm with side branch dilation.
- • Strictures: Two short segment strictures in head & neck regions.
- • Inflammation: Extensive peripancreatic fat stranding & fluid pockets.
- • Biliary: CBD dilated to 8.5 mm with early biliary dilatation.
- • Effusion: Mild bilateral pleural effusions detected.
- • Portal Vein: Normal flow and caliber.
- • Gallbladder: Normal wall thickness, no stones/calculi.
- • Spleen: Normal size and signal intensity.
- • Kidneys: Normal outline and enhancement.
- • Ascites: No evidence of any free fluid.
Advice by Dr. Rupjyoti Talukdar: If pain persists, evaluate for ERCP and Pancreatic Duct Stenting.
AIG Hospitals - Post Therapy Review
- • Pancreas: Tiny parenchymal calcifications detected.
- • PD: Dilated in head & neck region (upto 4mm).
- • Liver: Grade I fatty changes noted.
- • CBD: Prominent (6.7mm) with distal tapering.
- • Edema: No peripancreatic edema or fluid collection.
- • Liver Size: Normal at 140 mm.
- • Gallbladder: Well distended, no calculi.
- • Kidney/Spleen: Normal size, shape, and echotexture.
- • Pleural: No pleural effusion on this date.
Dr. Akash Jaiswal (Investigation: MRCP 14-07-25)
PD Diameter Spikes to 7.5mm
PD Head Diameter
7.5 mm
+2.1mm Growth from 2023
Liver Span
156 mm
Diagnosed: Hepatomegaly
- • Pancreas: Mildly bulky at tail region (25mm AP).
- • Pancreatic Duct: Head 7.5mm, Body 5mm, Tail 2.5mm.
- • Liver: Enlarged to 156 mm with Hepatomegaly.
- • CBD: Dilated up to 8 mm.
- • Gallbladder: Distended, no filling defect.
- • Other Organs: Visualized bowel loops and kidneys appear normal.
- • Impression: No immediate focal tumor/mass detected.
Dr. Akash Jaiswal Recommendation:
"Further evaluation by ERCP is suggested if necessary on clinical grounds. Rule out acute-on-chronic pancreatitis."
Verified Normals
- GB: No stones or sludge.
- Kidneys: Functioning Normally.
- No Malignant Tumor / Mass.
- Portal Vein: Intact caliber.
Urgent Pathology
- Serum Amylase & Lipase
- CBC / CRP / LFT
- Blood Glucose Profile
Current Protocol
Latest Active Therapy (March 2026)
Current Daily Medication
Creon 25000 MG
TID (With Meals)
Antoxipan Tab
BD (After Meals)
Pantocid 40 MG
BD (Before Meals)
Lactifiber Powder
OD (Bedtime)
Clinical Advice
Immediate evaluation for ERCP + PD Stenting is mandatory as PD Head dilation reached 7.5 mm.
Active exacerbation flare requires systemic management (IV fluid + analgesic control).
Dietary Alert
ZERO FAT PROTOCOL: No oils, ghee, or butter. Triggers instant ductal pressure spikes.
LIQUIDS ONLY: Focus on coconut water & clear diluted broths during active pain episodes.