Gastroenterology
Case 33: A Patient with Epigastric Pain and Vomiting
CASE
A 64‐year‐old woman is admitted to hospital with severe epigastric pain and vomiting. The pain was of sudden onset coming on an hour after eating. The pain radiates through to her back and had only just improved with intravenous morphine given in the casualty department. She is hypertensive on treatment with an ACE inhibitor and a thiazide diuretic. She had been investigated previously 2 years ago for abdominal pain.
On examination she is in obvious pain. Her temperature is 38.2°C. She is tachycardic with a pulse of 120 beats/min and a BP of 90/60 mmHg. She is tachypnoeic with a respiratory rate of 25 breaths/min. Abdominal examination reveals marked tenderness in the upper abdomen associated with guarding.
Blood tests showed:
Hb 11.4 g/dL WCC 22.4 × 109/L Platelets 110 × 109/L CRP 250 mg/L Glucose 9.8 mmol/L Arterial pH 7.30 PO2 7.4 kPa PCO2 3.2 kPa HCO3 19 mmol/L Na 38 mmol/L K 5.6 mmol/L Corrected Ca 1.95 mmol/L Urea 12.4 mmol/L Creatinine 120 µmol/L Albumin 32 g/L Bilirubin 35 µmol/L ALP 146 U/L AST 120 U/L Amylase 3560 U/L
Chest X‐ray is normal.
QUESTION 1
Your score this session: 0 of 0
What further tests are necessary to confirm a diagnosis of acute pancreatitis?