MEDizzy - A 45-year-old woman with a known history of cholelithiasis

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A 45-year-old woman with a known history of cholelithiasis is admitted to the hospital with severe mid-epigastric pain, fever of 38.5°C, tachycardia of 110 bpm, and blood pressure of 100/50 mmHg. Her examination shows a diffusely tender abdomen with guarding. Radiographs show an abdominal ileus with no free air. Laboratories are notable for a hemoglobin of 15 g/dL and elevations of amylase and lipase. Which of the following statements regarding this patient’s likely diagnosis is true?

ExplanationIn combination with a consistent clinical story and radiographic findings, serum amylase, and lipase values threefold or more above normal virtually clinch the diagnosis of acute pancreatitis. Gut perforation, ischemia, and infarction should be excluded. Serum lipase is the preferred test and has a higher specificity than serum amylase. There is no correlation between the severity of pancreatitis and the degree of serum lipase and amylase elevations. After 3–7 days, even with continuing evidence of pancreatitis, total serum amylase values tend to return to normal. However, pancreatic isoamylase and lipase levels may remain elevated for 7–14 days. Elevation of serum amylase is not specific for acute pancreatitis; notably, patients with metabolic academia (e.g., diabetic ketoacidosis) may have a spurious elevation of serum amylase without pancreatitis. Hypocalcemia occurs in approximately 25% of cases of acute pancreatitis, whereas hypercalcemia is not a feature.