| Author | 12 Posts |
dr_jojo
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A previously healthy 47-year-old woman comes to the emergency department because of a 36-hour history of nausea, vomiting, and abdominal pain that radiates to her back. Over the past 3 years, she has had intermittent episodes of cramping abdominal pain 1 to 2 hours after meals; the pain lasts for several hours and resolves spontaneously. She does not smoke and drinks one to two glasses of wine each evening. There is a family history of coronary artery disease and hypertension. Her temperature is 37 C (98.6 F), blood pressure is 100/60 mm Hg, pulse is 120/min, and respirations are 20/min. Abdominal examination shows moderate epigastric and right upper quadrant tenderness with no guarding or rebound; bowel sounds are decreased. Laboratory studies show:
Hematocrit 45%
Leukocyte count 9000/mm3 with a normal differential
Serum
Total bilirubin 1.5 mg/dL
Alkaline phosphatase 120 U/L
Aspartate aminotransferase (AST, GOT) 78 U/L
Amylase 365 U/L
Lipase 1223 U/L (N=1–160)
Triglycerides 300 mg/dL
Which of the following is the most likely diagnosis?
A
) Acute cholecystitis
B
) Alcoholic hepatitis
C
) Alcoholic pancreatitis
D
) Ascending cholangitis
E
) Gallstone pancreatitis
F
) Hepatitis A
G
) Pancreatic cancer
H
) Peptic ulcer disease
I
) Triglyceride-induced pancreatitis
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| dr_jojo
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Obstructive pancreatitis
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| robin082006
Forum Hero
Topics: 471
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E
) Gallstone pancreatitis
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| dr in trouble
Forum Guru
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E
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| amkhit
Forum Newbie
Topics: 4
Posts: 30
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The prsent scenario with acute pain radiatingto the back and vomiting with tachycardia and abnormally high Lipase and Amylase definitely suggests pancreatitis. Its Gallstone Pancreatitis . theres a history of recurrent resolving epigastric pain in a fertile female
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| r_albayunen
Forum Senior
Topics: 0
Posts: 218
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anyone .. is the clue in gallstone pancreatitis is the typical epi pain rad back with an additional RUQ pain??? so as to whenever i see that clinical scenario think of it??
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| ashfaque
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E
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| Justice
Forum Fanatic
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Posts: 1,955
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I think a clue to a gallstone pancreatitis is Alkaline phosphatase 120 U/L - biliary obstruction... However, this is quite a weak clue since the Pt is completely asymptomatic for cholecystitis
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| r_albayunen
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Actually a high Alkaline P. is high is any obstructive jaundice benign or malignant .. i was thinking pancreatic ca at first but i realize the enzymes where high so r/out .. her alcohol history is not that sig and they just showed the AST not the ALT so r/out, Trig are high >150 but point is i think: she has been reflecting a biliary colic for the past 3 yrs accomp by eating .. this stones logged on the pancreatic duct and caused the acute pancreatitis!
suggestions...
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| nadiabarati
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why not alcohol pancreatitis? Just mechanical obstruction causes increased ALP? the scenario is so silent for cholecystitis besides that meal and pain can be because of peptic ulcer!
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| usmle12
Forum Senior
Topics: 19
Posts: 194
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well alcohlic pancreatitis is associated with heavy drinking not just a glass of wine or 2...plus the she is female n 2nd common cause of pancreatitis is galstones...and also she has vague history of recurent pains...
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| ram3
Forum Guru
Topics: 47
Posts: 510
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The answer is gallstone pancreatitis
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