This is a case of a 40-year-old man who is a binge drinker. These are not just the people who indulge in huge quantities on a weekend. Binge drinking is defined as drinking twice the recommended limit in any one sitting. He developed severe abdominal pain which radiated through to the back. The pain had started suddenly, 15 hours before admission to the hospital. He had no previous history of gastrointestinal disease. On examination, the patient was mildly shocked and his abdomen was tender in the epigastric region with slight guarding. There was no evidence of either intestinal obstruction or perforation of a viscus on radiographic examination. Blood was taken for urgent biochemical investigation.
| 10 mmol/L
| 90 mmol/L
| 2.10 mmol/L
| 30 g/L
| 12 mmol/L
| 5000 U/L --- Normal Range: 60-180 U/L
The diagnosis of acute pancreatitis is based on the clinical history, evidence of inflammation is known usually by computerized tomography (CT scan) and the finding of a high serum (or sometimes urinary) amylase activity. It is effectively a diagnosis of exclusion: the finding of a very high serum amylase activity is very suggestive but is not on its own diagnostic, as many other conditions can cause elevated activity. It is necessary to consider all the available evidence, and to exclude other causes of an acute abdomen. In this case, the history is suggestive of pancreatitis and the clinical findings, although non-specific, are consistent with this diagnosis. The radiological findings militate against, but do not exclude, intestinal obstruction and perforation, two important differential diagnoses.
The slightly raised urea, with normal creatinine, can be explained by renal hypoperfusion due to shock. Loss of protein-rich exudate into the peritoneal cavity frequently causes a fall in plasma albumin concentration and contributes to the hypocalcaemia that is often...
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