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Alcoholism
6%
5/86
Scorpion sting
5%
4/86
Biliary tract obstruction
13%
11/86
Hypertriglyceridemia
73%
63/86
Hypercalcemia
2%
2/86
Select Answer to see Preferred Response
This patient is experiencing an episode of acute pancreatitis. Hypertriglyceridemia should be very high on the differential when a patient denies alcohol use, there is no evidence of cholelithiasis, and has xanthomas on physical examination. Acute pancreatitis is a life threatening disease that is caused by leaking pancreatic enzymes that autodigest the pancreas. Over 70% of cases are caused by alcoholism and gallstones. If patients do not have gallstones or a history of alcohol use, other causes must be explored. Acute pancreatitis can be caused by medications, hypertriglyceridemia, hypercalcemia, recent ERCP, trauma, infection, and even scorpion stings. If patients have xanthomas or xanthelasmas, it is likely that they have hypertriglyceridemia, which may be the cause of their acute pancreatitis. Patients often present with severe epigastric pain and elevated amylase and lipase. Acute treatment includes IV fluids, bowel rest, and nasogastric decompression. Figure A demonstrates eruptive xanthomas which, when seen, should be associated with high triglyceride levels. Illustration A is an overview image of how gallstones can block the common bile duct and cause inflammation of the pancreas. Illustration B depicts an axial CT in a patient with acute exudative pancreatitis showing extensive fluid collections surrounding the pancreas. Incorrect Answers: Answers 1-3, 5: Although each of these are able to cause acute pancreatitis, hypertriglyceridemia is the most likely cause in the above vignette.
4.6
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