Acute pancreatitis Quiz: Ace Your Exams

A 48-year-old man presents to the emergency department for evaluation of severe upper abdominal pain that radiates to the back for the past 8 hours. He rates the pain as 10/10 and states that it worsens when he is lying flat and improves with leaning forward. Past medical history is significant for hypertension controlled with amlodipine. The patient reports drinking 4-5 beers every weekend. BMI is 34 kg/m². Temperature is 37.8°C (100°F), blood pressure is 140/85 mmHg, pulse is 110/min, and respiratory rate is 18/min. On physical examination, multiple eruptive xanthomas are seen over his arms and legs. His abdomen is distended with tenderness and guarding in the epigastric region and associated hepatomegaly. Laboratory evaluation is significant for serum amylase of 800 U/L, serum lipase of 650 U/L, alanine transaminase (ALT) of 90 U/L and aspartate aminotransferase (AST) of 80 U/L. Which of the following is the most likely underlying etiology of this patient’s condition?