Alcoholic Pancreatitis 1

Question

Vignette: A 45-year-old man presents to the emergency department with severe abdominal pain and vomiting. He has a history of chronic alcoholism. On physical examination, his abdomen is distended and tender to palpation. A CT scan reveals an inflamed pancreas and multiple fluid-filled sacs in the pancreas. His serum amylase and lipase levels are significantly elevated.

Question: What is the most likely pathophysiological mechanism for the observed findings in this patient?

Choices

A. Autodigestion of the pancreatic tissue

B. Gastric acid reflux into the pancreas

C. Gallstone obstruction of the common bile duct

D. Ischemic necrosis of the pancreatic tissue

E. Metastatic spread of gastric carcinoma

Answer

A. Autodigestion of the pancreatic tissue

Explanation

This patient's presentation and imaging findings are consistent with acute pancreatitis, a condition commonly associated with alcohol abuse and gallstones. In alcohol-induced pancreatitis, ethanol stimulates the pancreas to produce digestive enzymes, which are activated prematurely within the pancreas instead of the small intestine. This leads to autodigestion of the pancreatic tissue, resulting in inflammation, necrosis, and formation of pseudocysts (fluid-filled sacs). The elevated serum levels of pancreatic enzymes (amylase and lipase) further support this diagnosis. Other choices, such as gastric acid reflux into the pancreas (Choice B), gallstone obstruction of the common bile duct (Choice C), ischemic necrosis of the pancreatic tissue (Choice D), and metastatic spread of gastric carcinoma (Choice E), can cause pancreatic pathology but are less likely given the patient's history and presentation.