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 42-year-old man comes to the physician because of severe epigastric pain for a week. The pain is constant and he describes it as 6 out of 10 in intensity. The pain radiates to his back and is worse after meals. He has had several episodes of nausea and vomiting during this period. He has taken ibuprofen for multiple similar episodes of pain during the past 6 months. He also has had a 5.4-kg (12-lb) weight loss over the past 4 months. He has a 12-year history of drinking 3 to 4 pints of rum daily. He has been hospitalized three times for severe abdominal pain in the past 3 years. He appears ill. His temperature is 37°C (98.6°F), pulse is 87/min, and blood pressure is 110/70 mm Hg. There is severe epigastric tenderness to palpation. Bowel sounds are normal. Cardiopulmonary examination shows no abnormalities. Laboratory studies show: Hemoglobin 13.6 g/dL Leukocyte count 7,800/mm3 Serum Glucose 106 mg/dL Creatinine 1.1 mg/dL Amylase 150 U/L A CT of the abdomen is shown. Which of the following is the most appropriate long-term management for this patient?
APancreatic enzyme therapy
BWhipple procedure
CEndoscopic stent placement
DCeliac ganglion block
EGluten-free diet
A 29-year-old woman presents with a 2-hour history of sudden onset of severe mid-epigastric pain. The pain radiates to the back, and is not relieved by over-the-counter antacids. The patient also complains of profuse vomiting. The patient’s medical history is negative for similar symptoms. She consumes 3–4 alcoholic drinks daily. The blood pressure is 80/40 mm Hg and the heart rate is 105/min. Examination of the lungs reveals bibasilar crackles. Abdominal examination reveals diffuse tenderness involving the entire abdomen, marked guarding, rigidity, and reduced bowel sounds. The chest X-ray is normal. However, the abdominal CT scan reveals peritoneal fluid collection and diffuse pancreatic enlargement. The laboratory findings include: Aspartate aminotransferase 63 IU/L Alkaline phosphatase 204 IU/L Alanine aminotransferase 32 IU/L Serum amylase 500 IU/L (Normal: 25-125 IU/L) Serum lipase 1,140 IU/L (Normal: 0-160 IU/L) Serum calcium 2 mmol/L Which of the following cellular changes are most likely, based on the clinical and laboratory findings?
ALiquefactive necrosis
BDry gangrene
CCaseous necrosis
DCoagulative necrosis
EFat necrosis
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