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Acute Pancreatitis 3

Acute pancreatitis
pathophysiology

Question

Vignette: A 25-year-old man presents to the emergency department with complaints of severe abdominal pain, nausea, and vomiting. He reports that he recently started drinking alcohol heavily. On physical examination, his temperature is 101.3°F, blood pressure is 130/80 mmHg, pulse rate is 100/min, and respiratory rate is 22/min. His abdomen is tender to palpation, especially in the upper quadrants. Laboratory tests show an elevated amylase and lipase. An abdominal CT scan shows inflammation and swelling of the pancreas. Which of the following mechanisms is most likely responsible for his condition?

Choices

A. Auto-digestion of the pancreatic parenchyma

B. Gallstone obstruction of the common bile duct

C. Infection by hepatitis C virus

D. Malignant transformation of the pancreatic cells

E. Metabolic acidosis due to diabetic ketoacidosis

Answer

A. Auto-digestion of the pancreatic parenchyma

Explanation

The patient's symptoms, laboratory findings, and CT scan results are consistent with acute pancreatitis, which is often caused by heavy alcohol use or gallstones. The mechanism behind acute pancreatitis is premature activation of pancreatic enzymes, leading to auto-digestion of the pancreatic parenchyma. This results in inflammation and necrosis of the pancreas. Gallstone obstruction of the common bile duct (Choice B) can also lead to acute pancreatitis, but this patient does not have symptoms of biliary colic (i.e., right upper quadrant pain after eating a fatty meal), jaundice, or abnormal liver function tests. Infection by hepatitis C virus (Choice C) primarily affects the liver and typically presents with jaundice, fatigue, and abnormal liver function tests. Malignant transformation of the pancreatic cells (Choice D) would not present acutely with these symptoms, and metabolic acidosis due to diabetic ketoacidosis (Choice E) would present with hyperglycemia and a high anion gap metabolic acidosis, neither of which is mentioned in the vignette.

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