Question

A 41 year old male patient comes to the clinic with complaints of midback pain. Upon examination, the NP notices that the patient is guarding and has tenderness over the epigastric area. Cullen's sign is positive. This may be indicate of:

a. Acute pancreatitis
b. Acute diverticulitis
c. Acute cholecysitis
d. Acute appendicitis

Answer 1

The presence of Cullen's sign and epigastric tenderness in a patient with midback pain may indicate acute pancreatitis, which is associated with severe abdominal and back pain often caused by gallstones or chronic alcohol use.

Step-by-step explanation:

The patient's positive Cullen's sign, along with the presentation of guarding and tenderness over the epigastric area, may be indicative of acute pancreatitis. Cullen's sign, which is the appearance of bruising around the umbilicus, is a symptom often associated with severe pancreatitis that suggests intra-abdominal bleeding. Pancreatitis is characterized by inflammation of the pancreas, which can lead to intense pain that may radiate to the back, and is commonly caused by gallstones, chronic alcohol use, among other factors. Treatment would involve managing the pain and addressing the underlying cause, such as removing gallstones observed via diagnostic tools like an abdominal ultrasound.