Acute pancreatitis Quiz: Ace Your Exams
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A 43-year-old woman with a past medical history of gallstones presents to the emergency department with constant epigastric pain that radiates to the back with associated nausea and vomiting. She underwent an endoscopic retrograde cholangiopancreatography (ERCP) procedure 36 hours ago to remove a biliary stone. The patient has a 30-pack-year smoking history. BMI is 28 kg/m2. Temperature is 37.4°C (99.3°F), blood pressure is 105/68 mmHg, pulse is 92/min, respiratory rate is 20 per minute, and oxygen saturation is 96% on room air. The patient appears uncomfortable. The abdomen is tender in the epigastrium with guarding. Lungs are clear to auscultation bilaterally. Laboratory evaluation at admission shows the following findings listed below. CT scan of the abdomen reveals peripancreatic free fluid, fat stranding, and pancreatic edema. Which of the following factors is most indicative of a poor prognosis for this patient?
| Complete blood count (CBC) | Reference Range | |
| Leukocyte count | 17,000/mm3 | 4,500-11,000/mm3 |
| Hemoglobin | 14 g/dL | 12-16 g/dL |
| Platelet count | 450,000/mm3 | 150,000-400,000/mm3 |
| Serum chemistry | ||
| BUN | 19 mg/dL | 7-18 mg/dL |
| Creatinine | 1.4 mg/dL | 0.6-1.2 mg/dL |
| Serum Amylase | 2100 U/L | 25-125 U/L |
| Serum Lipase | 1400 U/L | 10-140 U/L |
| AST | 40 U/L | 8-40 U/L |
| ALT | 35 U/L | 8-40 U/L |
| Total Bilirubin | 1.0 mg/dL | 0.1-1 mg/dL |
| C-Reactive Protein | 100 mg/L | <0.3 mg/L |
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