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56 CASE 56


A 38-year-old man comes to the emergency department complaining of an abrupt, severe epigastric pain.


The patient is a known alcoholic who has been seen in the emergency department for several fights and accidents related to inebriation. Today he is brought in because of an attack of pain in his epigastric region after an afternoon drinking binge. The patient describes his pain as radiating to his back, and he feels nauseated. The patient recently vomited, and he is sweating profusely.



PHYSICAL EXAMINATION



VS: T 39°C, P 98/min, R 17/min, BP 95/70 mm Hg

PE: The patient’s pain worsens with walking and lying supine. His pain lessens if he sits up or leans forward. On palpation, his upper abdomen is tender, without guarding, rigidity, or rebound. His abdomen is distended. He exhibits overall weakness, pallor, and cool, clammy skin. The patient also has mild jaundice.


LABORATORY TESTS



Blood Values
Calcium: 8 mg/dL (normal: 8.4-10.2 mg/dL)

Glucose: 130 mg/dL (normal < 120 mg/dL)

Blood urea nitrogen (BUN): 40 mg/dL (normal: 7-18 mg/dL)

Bilirubin total: 4.2 mg/dL (normal: 0.1-1.0 mg/dL)

Serum Alkaline Phosphatase
Serum amylase: 400 U/L (normal: 25-125 U/L)

Serum lipase: 220 U/L (normal: 20-70 U/L)

White blood cells: Leukocytosis of 10,000/uL

Urinalysis: Proteinuria +2 (normal: 0), granular casts

Abdominal radiograph: Gallstones and a “sentinel loop” (a segment of air-filled left upper quadrant of small intestine)

CT: Enlarged pancreas
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Jul 4, 2016 | Posted by in PHYSIOLOGY | Comments Off on 56

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