Question

A 45-year-old man with a history of biliary colic presents with one-day of intractable nausea, vomiting, and abdominal pain radiating to the back. Temperature is 99.7 deg F (37.6 deg C), blood pressure is 102/78 mmHg, pulse is 112/min, and respirations are 22/min. On abdominal exam, he has involuntary guarding and tenderness to palpation in the right upper quadrant and epigastric regions. Laboratory studies show white blood cell count 18,200/uL, alkaline phosphatase 650 U/L, total bilirubin 2.5 mg/dL, amylase 500 U/L, and lipase 1160 U/L. Which of the patient's laboratory findings is associated with increased mortality?

a. White blood cell count
b. Alkaline phosphatase
c. Total bilirubin
d. Amylase
e. Lipase

Answer 1

The laboratory finding associated with increased mortality in this patient with symptoms suggestive of pancreatitis is the lipase level, which is significantly elevated at 1160 U/L. So the correct answer is option (E).

Step-by-step explanation:

A 45-year-old man with a history of biliary colic is presenting with symptoms and laboratory findings suggestive of pancreatitis, possibly due to gallstone disease. Among the lab findings provided, the laboratory value associated with increased mortality in the context of pancreatitis is the lipase level. Elevated levels of amylase and lipase are indicative of pancreatic inflammation, whereas an elevated white blood cell count suggests infection or inflammation.

The increase in total bilirubin may indicate jaundice or biliary obstruction, and the elevated alkaline phosphatase (ALP) is commonly associated with biliary tract disease. However, it is the extremely elevated lipase level (1160 U/L) that is particularly concerning and more specific to pancreatitis, which can be associated with increased mortality in severe cases.