SAQ 428 – Gastroenterology – acute pancreatitis with obstructive LFTs
Model Answer
Gastroenterology – acute pancreatitis with obstructive LFTs.
a. Diagnosis
- Acute pancreatitis, most likely gallstone or obstructive biliary pancreatitis.
b. Likely causes
| Cause | Supporting evidence |
|---|---|
| Gallstones or transient common bile duct obstruction | Female patient with pancreatitis plus cholestatic liver tests: raised ALP, GGT, and bilirubin. |
| Alcohol-related pancreatitis, if supported by history | Common cause in this age group, but the provided tests more strongly support a biliary cause. |
| Other causes to consider if history supports them | Hypertriglyceridaemia, drugs, ERCP, trauma, or hypercalcaemia. |
c. Complications
- Local pancreatic necrosis, abscess, or pseudocyst.
- Systemic inflammatory response, sepsis, shock, or multiorgan failure.
- Respiratory failure/ARDS.
- Renal failure.
- Hypocalcaemia or significant metabolic disturbance.
- Biliary obstruction or cholangitis if the stone remains obstructing.
d. Prognostic features
- Age and comorbidities.
- Shock, hypoxia, organ failure, or high early warning score on arrival.
- Biochemical severity markers such as high urea or rising urea, renal impairment, high glucose, high LDH, high AST, low calcium, or base deficit.
- Inflammatory severity such as high WCC or CRP, particularly CRP >150 mg/L at 48 hours.
- Imaging evidence of pancreatic necrosis or severe local complication when obtained.
- Severity scores such as APACHE II or Ranson criteria, using the required admission and later variables.
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