06-09-2007, 06:23 AM
14.
A previously healthy 47-year-old woman comes to the emergency department because of a 36-hour history of nausea, vomiting, and abdominal pain that radiates to her back. Over the past 3 years, she has had intermittent episodes of cramping abdominal pain 1 to 2 hours after meals; the pain lasts for several hours and resolves spontaneously. She does not smoke and drinks one to two glasses of wine each evening. There is a family history of coronary artery disease and hypertension. Her temperature is 37 C (98.6 F), blood pressure is 100/60 mm Hg, pulse is 120/min, and respirations are 20/min. Abdominal examination shows moderate epigastric and right upper quadrant tenderness with no guarding or rebound; bowel sounds are decreased. Laboratory studies show:
Hematocrit 45%
Leukocyte count 9000/mm3 with a normal differential
Serum
Total bilirubin 1.5 mg/dL
Alkaline phosphatase 120 U/L
Aspartate aminotransferase (AST, GOT) 78 U/L
Amylase 365 U/L
Lipase 1223 U/L (N=1“160)
Triglycerides 300 mg/dL
Which of the following is the most likely diagnosis?
A
) Acute cholecystitis
B
) Alcoholic hepatitis
C
) Alcoholic pancreatitis
D
) Ascending cholangitis
E
) Gallstone pancreatitis
F
) Hepatitis A
G
) Pancreatic cancer
H
) Peptic ulcer disease
I
) Triglyceride-induced pancreatitis
A previously healthy 47-year-old woman comes to the emergency department because of a 36-hour history of nausea, vomiting, and abdominal pain that radiates to her back. Over the past 3 years, she has had intermittent episodes of cramping abdominal pain 1 to 2 hours after meals; the pain lasts for several hours and resolves spontaneously. She does not smoke and drinks one to two glasses of wine each evening. There is a family history of coronary artery disease and hypertension. Her temperature is 37 C (98.6 F), blood pressure is 100/60 mm Hg, pulse is 120/min, and respirations are 20/min. Abdominal examination shows moderate epigastric and right upper quadrant tenderness with no guarding or rebound; bowel sounds are decreased. Laboratory studies show:
Hematocrit 45%
Leukocyte count 9000/mm3 with a normal differential
Serum
Total bilirubin 1.5 mg/dL
Alkaline phosphatase 120 U/L
Aspartate aminotransferase (AST, GOT) 78 U/L
Amylase 365 U/L
Lipase 1223 U/L (N=1“160)
Triglycerides 300 mg/dL
Which of the following is the most likely diagnosis?
A
) Acute cholecystitis
B
) Alcoholic hepatitis
C
) Alcoholic pancreatitis
D
) Ascending cholangitis
E
) Gallstone pancreatitis
F
) Hepatitis A
G
) Pancreatic cancer
H
) Peptic ulcer disease
I
) Triglyceride-induced pancreatitis