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Blood lipid levels
44%
19/43
CAGE questions and blood alcohol level
2%
1/43
CT scan of the abdomen
14%
6/43
Serum lipase
30%
13/43
Ultrasound
5%
2/43
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This patient is presenting with xanthomas and epigastric abdominal pain suggestive of pancreatitis. The most appropriate diagnostic test of the underlying etiology would be blood lipid levels.Pancreatitis typically presents with epigastric pain that radiates to the back in a patient with alcohol use disorder or a patient who has recently eaten a fatty meal. The diagnosis requires 2 of the following symptoms: epigastric pain that radiates to the back, amylase or lipase > 3 times upper limit of normal, or abnormalities on radiography. Hypertriglyceridemia is a cause of pancreatitis and is associated with xanthomas on physical exam. The diagnosis of hypertriglyceridemia can be confirmed with blood lipid levels. Treatment of pancreatitis is with NPO, fluid resuscitation, and lipid management such as with insulin if hypertriglyceridemia.Yang and McNabb-Baltar review the evidence regarding the diagnosis and treatment of patients with pancreatitis. They discuss how hypertriglyceridemia can cause pancreatitis. They recommend recognition of this entity to allow for proper treatment.Figure/Illustration A is a clinical image showing yellow deposits on the face (red circles) that are consistent with xanthomas. These findings are commonly seen in patients with hypertriglyceridemia. Incorrect Answers:Answer 2: CAGE questions and blood alcohol level could confirm a patient’s alcohol use disorder as the cause of their pancreatitis. Despite signs of alcohol use disorder in this patient, given the physical exam finding of xanthomas, hypertriglyceridemia is a more likely cause.Answer 3: CT scan of the abdomen could confirm the diagnosis of pancreatitis; however, the underlying cause of this patient’s hypertriglyceridemia would not be further elucidated by a CT scan. Answer 4: Serum lipase could further elucidate the diagnosis of pancreatitis; however, it would not work up the underlying cause of this patient’s pancreatitis (hypertriglyceridemia).Answer 5: Ultrasound could confirm the diagnosis of acute cholecystitis, which would present with right upper quadrant pain worsened by a meal with a positive Murphy finding on physical exam. Treatment is with bowel rest, resuscitation, antibiotics, and interval cholecystectomy.Bullet Summary:Hypertriglyceridemia is associated with xanthomas and pancreatitis and can be diagnosed with blood lipid levels.
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