Pancreas EUS, severe resp dx

56-year-old lady with recurrent pancreatitispage2image3512703968


  • ‘Grumbling’ chronic pancreatitis over last 3 years
  • Monthly symptoms and hospital presentations
  • Lipase and LFT’s elevated
  • Previous cholecystectomy


  • Severe COPD and asthma- 26 pack year smoking history
  • Severe mixed obstructive and restrictive defect on formal spirometry: FEV1/FVC = 0.71/1.66, Bronchodilator reversibility. TLCO 69%
  • Multiple admissions with infective exacerbations of COPD
  • Mild OSA
  • NYHA Class 3 dyspnoea, walks 200-300m on flat
  • Attended JHH for EUS pancreas a few weeks ago, waking from RNC to JHH door to gain entry to hospital and was dyspnoeic. A passing Dr noticed her respiratory distress and stopped to help her, called the gastroenterologist and the procedure was cancelled.


Opportunities for optimisation

  • Discussed with regular respiratory physician, optimised from respiratory perspective, but suggests there may be room to improve dyspnoea with diuretics.
  • Recent admission with infective exacerbation of COPD, she responded to a small dose of furosemide.
  • BNP during admission = 982.
  • Post-discharge, Sestamibi and TTE were normal.
  • Awaiting appointment with cardiologist

Proceed to surgery?page3image3534029344

  • Patient at her baseline best, states that the dyspnoea she was experiencing was normal for her.
  • Cardiology opinion useful in the long-termpage3image3534006016
  • Cardiac investigations reassuringpage3image3534008784
  • No benefit to repeating BNP, unlikely to change anaesthetic managementpage3image3534016496
  • Needs to be assessed for fluid status on DOSpage3image3534041680


  • Proceed to surgery
  • Discuss at cardiology MDT