The good doctor just stopped by

As a quick summary, Mary is in pain but different than what she felt before ERCP #3, the bilary system is not functioning all that well, the new stent may or may not be helping or perhaps even hurting and the Stanford pathologists gave the same answer about the new ERCP#3 brushings as the Good Sam pathologists did for #1 and #2--inconclusive. Pancreatitis is off the table because the blood tests this AM DQ'd it.

So here is the plan:

1. An x-ray to see if the fluorescopy materials are still in the gall bladder. These were from ERCP #1 and #2 over two weeks ago. Will be done today. If the xray fluorescent material is still there, then her GB is not draining and may be enlarged causing stress and pain. Or, the fluorescent material could be causing a GB infection.
2. (Late Edit) A high resolution CT scan of the affected area. To be done today.
3. An MRCP which uses MRI technology to image the Cholingio (i.e., bile duct work and associated parts). Today if at all possible and highly likely. This is the best non-invasive imaging technique available. Because its MRI based, it doesn't need the fluo materials which are not as effective if the cystic duct is blocked, for example. In Mary's case, the cystic duct is blocked so the MRCP should give the image of the critical area they cannot get with the techniques used so far.
4. Admit Mary to Stanford. Today for sure.
5. Introduce Mary to the surgical team. Today. I didn't catch the surgeon's name but when I do I'll post his/her Stanford URL.
6. Reserve the available ERCP slot for Friday afternoon if the stent needs to be replaced. Reservation made. If surgery isn't scheduled until Monday or Tues, and the stent is suspect, they may install a new one so she can make it thru the weekend--as an inpatient.
7. Obtain the path results on the biopsy from ERCP#3. Monday or Tuesday.
8. Prep Mary for surgery. TBD but in 3 to 4 days. The doc said being an inpatient will accelerate the decision for surgery to a few days vs the few weeks it takes as an outpatient.

The bottom line is that the pace is picking up. They've done blood tests and ultrasounds this AM already and are planning the x-ray and MRCP this afternoon. The blood tests DQ'd pancreatitis. The ultrasound shows a possibly enlarged gall bladder. It did not show the top of the stent so that leads to a suspicion that has moved.

Mary is resting comfortably. The fentanyl and nausea meds are keeping the pain away and are, as she puts it, making her "loopy".

That's all for now.

Pat