Question

A 39-year-old male presents to the emergency department with acute abdominal pain and anorexia for two days. The patient has an extensive history of alcoholism with a hospitalization four months ago after being brought in by the police department for intoxication. On physical exam vital signs are T 99.0 F, BP 100/68 mmHg, HR 135 bpm, RR 20 rpm, and O2 Sat 100%. Abdominal exam is notable for exquisite tenderness to palpation over the epigastrium and the following finding (Figure A). Therapy for this patient should consist of which of the following?

a. Endoscopic retrograde cholangiopancreatography (ERCP)
b. IV fluid hydration, analgesia, and intensive care management
c. Treat with chlordiazepoxide and intensive care management
d. Esophagogastroduodenoscopy (EGD) with variceal banding
e. Percutaneous transhepatic cholangiography (PTC)

Answer 1

The therapy for the patient should consist of IV fluid hydration, analgesia, and intensive care management.

Step-by-step explanation:

The therapy for this patient should consist of IV fluid hydration, analgesia, and intensive care management. Based on the patient's presentation with acute abdominal pain and anorexia, along with the history of alcoholism, a likely diagnosis is acute pancreatitis. This is supported by the physical exam findings of tenderness to palpation over the epigastrium. The high heart rate and low blood pressure indicate signs of shock, which require intensive care management. Providing intravenous fluids for hydration and analgesia for pain relief would be appropriate initial therapy in this scenario.