A 74-year-old man is admitted to the hospital after an acute onset of epigastric pain, which has been unrelenting for 6 hours. He has tachycardia, at a rate of 114 beats per minute; his blood pressure is 140/90 mm Hg, respiratory rate 24 breaths per minute, temperature 37.6°C, and oxygen saturation 92% while he is breathing ambient air. His serum amylase level is 1270 U per liter (normal range, 19 to 86), and his lipase level is 6430 U per liter (normal range, 7 to 59); these levels are consistent with a diagnosis of acute pancreatitis. Other laboratory results at admission include a hematocrit of 47%, white-cell count of 18,000 per cubic millimeter, calcium level of 7.8 mg per deciliter (2.0 mmol per liter), alanine aminotransferase level of 295 IU per liter, aspartate aminotransferase level of 221 IU per liter, alkaline phosphatase level of 217 IU per liter, bilirubin level of 0.9 mg per deciliter (15.4 μmol per liter), glucose level of 240 mg per deciliter (13.3 mmol per liter), blood urea nitrogen level of 47 mg per deciliter (16.8 mmol per liter), and creatinine level of 1.3 mg per deciliter (114.9 μmol per liter). Abdominal ultrasonography reveals gallbladder stones; the common bile duct is 6 mm in diameter, and no intraductal stones are identified. The pancreatitis, which is presumed to have a biliary cause, is predicted to be severe. The consulting gastroenterologist initially favors ongoing supportive therapy but will consider selective endoscopic retrograde cholangiopancreatography (ERCP), depending on the patient's clinical course.
ASJC Scopus subject areas