A 52-year-old male was admitted to the hospital complaining of severe epigastric pain with
radiation to his back. The pain started on the day before admission and was associated with
nausea and vomiting. On examination he was found to be dehydrated and to have only mild
epigastric midline tenderness and guarding. He denied a recent alcohol debauch. Because of
previous symptoms, the patient had undergone an ultrasound of the gallbladder, the results of
which were normal.
The diagnosis of pancreatitis was certain in light of the elevation of both the serum and urine
amylase levels and also of the serum lipase level. Alcohol and gallstones are the two most
common causes of pancreatitis; however, the patient denied drinking alcohol, and previous
ultrasound of the gallbladder excluded gallstones. Because cancer of the pancreas also can
cause distal pancreatic inflammation, tumor had to be ruled out as a cause of this pancreatic
episode. Ultrasonography, which is occasionally inaccurate for pathologic pancreatic
conditions, indicated an enlarged head of the pancreas that could be compatible with a tumor.
However, CT scanning and ERCP results eliminated the possibility of cancer.
The patient was treated with nasogastric (NG) suction and IV infusions until his
gastrointestinal function returned to normal. His pancreatitis was subsequently found to be
drug induced (by hydrochlorothiazide). The drug was stopped, and he had no further
Critical Thinking Questions
Case Studies 2
Copyright 2014 by Mosby, Inc., an imprint of Elsevier Inc.
1. Why was it important to question this patient about binge drinking?
2. What advantage is achieved by obtaining urine amylase levels in addition to serum
A 52-year-old male was admitted to the hospital complaining of severe epigastric pain with radiation to his back.