Case 7: Diagnostic Testing

Correct! 
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.

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.