Pancreatitis

Chapter 34 Pancreatitis




Clinical Case Problem 1: 50-Year-Old Man with a History of Severe Abdominal Pain


A 50-year-old man with a 20-year history of heavy drinking comes to your emergency department with his wife complaining of severe abdominal pain. The pain began 4   days ago and has been getting progressively worse. The pain has been so severe that the patient has been crying at night. Despite this severe pain, the patient managed to make it to his local bar last evening and straggled home at 3   AM. He has also been nauseous and vomited a few times yesterday. The pain is described as constant, sometimes burning in nature, and seems to go to the back. The patient has not eaten for the past 4   days.


On examination, you observe a stoic, overweight man who looks much older than his stated age; he looks pale and slightly diaphoretic. As you examine him, you clearly smell alcohol on his breath. The patient’s blood pressure is 90/70   mm Hg, respirations are 20 breaths/minute, and pulse is 100 beats/minute. Examination of his heart and lungs is normal except for mild tachycardia. He has a marked tenderness in the epigastric region along with guarding. The bowel sounds are slightly diminished. There is also a sensation of fullness present in the epigastric area. No other abnormalities are present.



Select the best answer to the following questions




1. The differential diagnosis at this point would be


a. acute gastritis

b. acute pancreatitis

c. perforated peptic ulcer

d. acute cholecystitis

e. all of the above

2. All of the following tests should be ordered next except


a. complete blood count with differential

b. serum amylase and lipase level

c. computed tomography (CT) scan of the abdomen with contrast

d. comprehensive metabolic panel

e. arterial blood gases

3. Which of the radiologic imaging techniques is the most sensitive in diagnosis of acute pancreatitis and pancreatic pseudocyst?


a. transabdominal ultrasonography

b. contrast-enhanced CT of the abdomen

c. magnetic resonance cholangiopancreatography

d. plain radiograph (abdominal series)

e. endoscopic ultrasonography

4. Patients with acute pancreatitis sometimes present with bruising around the umbilicus and flank area. This is due to


a. trauma to the abdomen

b. ruptured spleen

c. retroperitoneal bleeding

d. superior mesenteric artery erosion

e. disseminated intravascular coagulation

5. Fullness in the epigastric region and a palpable mass in this patient are most likely due to


a. pancreatic pseudocyst formation

b. palpable gallbladder

c. enlarged spleen

d. enlarged liver

e. abdominal wall hematoma

6. What is (are) the essential diagnostic feature(s) of the condition of the patient described here?


a. abrupt onset of epigastric pain with radiation to the back

b. nausea and vomiting

c. elevated serum amylase

d. all of the above

e. none of the above

7. The treatment of this condition must include all of the following except


a. eliminate oral intake for the first 48 hours

b. aggressive fluid replacement

c. calcium replacement

d. pain control

e. intravenous H2 receptor blockers

8. Which of the following statements about the disease discussed is (are) true?


a. many cases of this disease are associated with gallstones

b. strong evidence suggests a link between this disease and alcohol

c. the chronic condition of this disease is more likely to be associated with alcohol abuse rather than with biliary tract disease

d. all of the above

e. none of the above

9. In approximately two thirds of patients with this disease, a plain film of the abdomen is abnormal. Which of the following abnormalities is this plain film most likely to show?


a. a “sentinel loop”

b. the “colon cutoff sign”

c. air under the diaphragm

d. distention in both the small bowel and the large bowel

e. feces throughout the colon

10. Complications of the condition described here include all of the following except


a. ascites

Related posts:

  1. Alcohol
  2. Colorectal Cancer and Other Colonic Disorders
  3. Sexual Dysfunction
  4. Illustrated Review

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Pancreatitis

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