A 42-year-old woman is brought to the emergency department because of a 5-day history of epigastric pain, fever, nausea, and malaise. Five weeks ago she had acute biliary pancreatitis and was treated with endoscopic retrograde cholangiopancreatography and subsequent cholecystectomy. Her maternal grandfather died of pancreatic cancer. She does not smoke. She drinks 1–2 beers daily. Her temperature is 38.7°C (101.7°F), respirations are 18/min, pulse is 120/min, and blood pressure is 100/70 mm Hg. Abdominal examination shows epigastric tenderness and three well-healed laparoscopy scars. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 10 g/dL Leukocyte count 15,800/mm3 Serum Na+ 140 mEq/L Cl− 103 mEq/L K+ 4.5 mEq/L HCO3- 25 mEq/L Urea nitrogen 18 mg/dL Creatinine 1.0 mg/dL Alkaline phosphatase 70 U/L Aspartate aminotransferase (AST, GOT) 22 U/L Alanine aminotransferase (ALT, GPT) 19 U/L γ-Glutamyltransferase (GGT) 55 U/L (N = 5–50) Bilirubin 1 mg/dl Glucose 105 mg/dL Amylase 220 U/L Lipase 365 U/L (N = 14–280) Abdominal ultrasound shows a complex cystic fluid collection with irregular walls and septations in the pancreas. Which of the following is the most likely diagnosis?
APancreatic cancer
BAcute cholangitis
CPancreatic abscess
DPancreatic pseudocyst
EERCP-induced pancreatitis
A 29-year-old female is hospitalized 1 day after an endoscopic retrograde cholangiopancreatography (ERCP) because of vomiting, weakness, and severe abdominal pain. Physical examination findings include abdominal tenderness and diminished bowel sounds. A CT scan demonstrates fluid around the pancreas. Serum levels of which of the following are likely to be low in this patient?
AAmylase
BTriglycerides
CCalcium
DGlucose
ELipase
A 43-year-old man is brought to the emergency department because of severe epigastric pain and vomiting for 6 hours. The pain radiates to his back and he describes it as 9 out of 10 in intensity. He has had 3–4 episodes of vomiting during this period. He admits to consuming over 13 alcoholic beverages the previous night. There is no personal or family history of serious illness and he takes no medications. He is 177 cm (5 ft 10 in) tall and weighs 55 kg (121 lb); BMI is 17.6 kg/m2. He appears uncomfortable. His temperature is 37.5°C (99.5°F), pulse is 97/min, and blood pressure is 128/78 mm Hg. Abdominal examination shows severe epigastric tenderness to palpation. Bowel sounds are hypoactive. The remainder of the physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 13.5 g/dL Hematocrit 62% Leukocyte count 13,800/mm3 Serum Na+ 134 mEq/L K+ 3.6 mEq/L Cl- 98 mEq/L Calcium 8.3 mg/dL Glucose 180 mg/dL Creatinine 0.9 mg/dL Amylase 150 U/L Lipase 347 U/L (N = 14–280) Total bilirubin 0.8 mg/dL Alkaline phosphatase 66 U/L AST 19 U/L ALT 18 U/L LDH 360 U/L Which of the following laboratory studies is the best prognostic indicator for this patient's condition?
AAST/ALT ratio
BAlkaline phosphatase
CTotal bilirubin
DLipase
EHematocrit
+ 7 more in the PDF
Browse all chapters