Question

A 44 year old female presents with epigastric abdominal pain, nausea, and vomiting. Her symptoms began after eating fried chicken and ice cream at a carnival two nights ago, and have progressively worsened. Physical examination shows an obese, afebrile female, with pulse 110 and blood pressure 96/60. There is mild, diffuse tenderness to palpation throughout the abdomen and worst at the epigastrium. Bowel sounds are absent, and there is no rebound tenderness or guarding. Laboratory evaluation shows the following: WBC 12,000/mm3; Hct 49%; AST 18; ALT 25; Lipase 320; Total bilirubin 2.0. Right upper quadrant ultrasound reveals numerous gallstones, but no gallbladder wall thickening or pericholecystic fluid collection. Which of the following is the most likely diagnosis in this patient?

A. Acute pancreatitis
B. Biliary colic
C. Cholecystitis
D. Choledocholithiasis
E. Ovarian torsion

Answer 1

The patient most likely has acute pancreatitis, supported by her symptoms, lab results with elevated lipase, and presence of gallstones on ultrasound without signs of gallbladder inflammation or blockage of the bile duct. Acute pancreatitis is often associated with gallstones and requires treatment focused on relieving pancreatic inflammation and addressing the underlying cause.

Step-by-step explanation:

Diagnosis of Epigastric Abdominal Pain and Associated Symptoms

The clinical presentation of a 44-year-old female with epigastric abdominal pain, nausea, and vomiting that started after consuming fried food suggests a possible acute gastrointestinal issue. Considering her vital signs, laboratory evaluation with elevated white blood cell count (WBC), hematocrit (Hct), lipase, and bilirubin, along with the finding of gallstones without gallbladder wall thickening or pericholecystic fluid on ultrasound, the most likely diagnosis is acute pancreatitis. This diagnosis is supported by the significantly elevated lipase level, indicative of pancreatic inflammation.

Gallstones can lead to pancreatic inflammation when they block the outflow of pancreatic fluid, causing pain and other symptoms such as jaundice, as bile pigments like bilirubin build up in the blood. Management of acute pancreatitis includes addressing the underlying cause, such as removing gallstones if they are obstructing the bile or pancreatic ducts.

A crucial part of assessing abdominal pain is differentiating between various potential causes, such as cholecystitis or choledocholithiasis, by correlating clinical signs, laboratory findings, and imaging results.