Case 7: Diagnostic Testing

Here are the initial lab results:

Can you now make a diagnosis of pancreatitis in this case?
As per the Atlanta Criteria, the diagnosis of pancreatitis requires the presence of 2 of the following 3 findings: 
Here’s what you might expect to see on diagnostic imaging
Sample CT findings in interstitial pancreatitis: The pancreas is outlined in white and the inflammatory changes in the peripancreatic fat are outlined in red. Red arrow: splenic vein; yellow arrow: portal vein.

Sample CT findings in necrotizing pancreatitis: Decreased enhancement of the distal body and tail compared to the more proximal portion of the pancreas with normal enhancement. NL: normal; Nec: necrosis; Inflamm: inflammatory changes.
No, additional testing is needed


What are the two most likely etiologies for this patient’s development of pancreatitis?
Correct! Our patient reports preceding abdominal pain triggered by fatty foods, and currently has elevated transaminases in the setting of pancreatitis. So, a biliary etiology is very likely. Gallstone pancreatitis is the most common cause of pancreatitis encompassing about 40% of all cases.
Less likely. Although alcohol is the second most common cause of pancreatitis (about 35% of all cases), he is denying recent binge in alcohol consumption.
Correct! Drug-induced pancreatitis accounts for about 2% of all cases of pancreatitis. He is taking two medications, 6-MP and valproate which have been associated with pancreatitis. Didanosine, azathioprine, sulfonamides, tetracycline, methyldopa, and furosemide are other medications which have been associated with pancreatitis.
Incorrect. While this can be a cause of pancreatitis, our patient’s calcium level is within normal limits. Generally, calcium levels > 14 mg/dl have been associated with development of pancreatitis.
Incorrect. While our patient’s triglycerides are elevated, triglycerides > 1000mg/dl are required to cause pancreatitis. Hypertriglyceridemia accounts for 1-4% of all cases of pancreatitis.

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Case 7 Index:
Physical Exam
Differential Diagnosis

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