MEDizzy - A 44-year-old, obese woman presents to the emergency

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Acute Abdominal Pain

A 44-year-old, obese woman presents to the emergency department with a history of acute onset of severe epigastric pain radiating toward the back. The pain began several hours after dinner. The patient has no significant past medical history and denies any previous surgery. She takes no medications. On examination, the patient has marked epigastric tenderness with guarding and hypoactive bowel sounds. Her vital signs are: heart rate, 110 beats/min; blood pressure, 120/50 mm Hg; respiration, 28/min; temperature, 38.0°C. Amylase level is 2500 units. Which of the following is the most likely cause of this patient's pain?

ExplanationA. The history, physical examination, and elevated amylase are all consistent with pancreatitis. Gallstones and alcohol account for 90% of the cases of pancreatitis in the United States. A high amylase level (over 1000) suggests gallstones over alcohol abuse. Age in the 40s, being female, and obesity are also risk factors for gallstones. Hyperparathyroidism and hyperlipidemia are rare causes of pancreatitis. A ruptured peptic ulcer could present in a similar manner but the elevated amylase suggests pancreatitis. A history of epigastric discomfort or antacid use would also suggest ulcer disease.