dr confused
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A 44-year-old white female presents with the chief complaints of severe epigastric pain radiating to the back, associated with nausea and vomiting. She is non-alcoholic, has no past medical problems, and takes no medication. Her vitals are: BP: 110/70 mm Hg, PR: 100/min, Temperature: 38.3C(101.1F). On examination, there is no icterus or hepatosplenomegaly; heart and lungs are clear to auscultation without abnormalities. Her chest X-ray is normal. Her laboratory reports shows: WBC count: 15,000/cmm, Hb: 11.0 mg/dl, Bilirubin: 1.0 mg/dl, Amylase: 2100 IU/L, Lipase: 7800 IU/l, AST: 130 IU/L, ALT: 80 IU/L, alkaline phosphatase: 170 IU/L, and normal lipid profile. What should be the next best investigation in this patient?
A. CT scan abdomen.
B. HIDA scan.
C. Ultrasonogram of the abdomen.
D. X-ray abdomen.
E. ERCP
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| kpmle2
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A. CT scan abdomen
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| dr confused
Forum Senior
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thats why i posted this q
look at the explanation from UW
This woman has a classic presentation of acute pancreatitis. This is characterized by epigastric pain radiating to the back, associated with fever and vomiting, increased WBC count, lipase and amylase levels.
The two most common causes of acute pancreatitis are alcohol and gallstones. This patient is not alcoholic; she has no major illnesses, takes no medications, and has a normal lipid profile. Therefore gallstones are the most likely cause. In this setting, an ultrasonogram (USG) of the abdomen would provide the best information on the presence/ absence of gallstones. (Choice C)
Choice A: CT scan is obviously better than USG to identify pancreatic edema, necrosis, and cysts but is relatively insensitive for gallstones. Acute pancreatitis is a clinical diagnosis (history and biochemical) and usually does not require CT abdomen to diagnose. However, CT abdomen is indicated in patients with a white count of >20,000 and when the suspicion for necrotizing pancreatitis is high
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| kpmle2
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thanks a lot dr confused. Its a nice Q.
if the pt was alcoholic then it would have been CT right.
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| sherry39
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no.,if patient would be alcoholic.,it would still be USG abdomen...coz ct is basically to see things not visible with usg and in traumas/carcinomas.,to know extent of disease
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| shenyc
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yes,I choose C!
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