ZyraDoc #51 - September 21, 2026

A 52-year-old male with a history of gallstone disease presents with severe, constant epigastric abdominal pain that radiates straight through to his back, accompanied by persistent nausea and repeated bilious emesis.

Physical examination reveals marked epigastric tenderness with voluntary guarding, abdominal distension, reduced bowel sounds, and mild scleral icterus.

Laboratory evaluation demonstrates a serum lipase level of 1,250 U/L (more than 3 times the upper limit of normal) and an elevated C-reactive protein level, confirming acute pancreatitis.

Case Summary

Clinical Focus:

The diagnosis is Acute Pancreatitis.

Aetiology/Cause:

Gallstones (biliary pancreatitis) causing transient or persistent impaction at the ampulla of Vater, accounting for ~40% of cases.
Chronic heavy alcohol consumption triggering acinar cell digestive enzyme activation and ductal protein plugging (~30% of cases).
Other causes: Hypertriglyceridemia (>1000 mg/dL), post-ERCP, hypercalcemia, medications (e.g., azathioprine, loop diuretics), trauma, and autoimmune pancreatitis.

Clinical Features:

Sudden onset of persistent, severe epigastric abdominal pain classic for radiating directly to the back, partially relieved by leaning forward.
Persistent nausea, emesis, anorexia, and progressive abdominal distension secondary to reflex paralytic ileus.
Abdominal physical signs: epigastric tenderness, guarding, and rarely retroperitoneal hemorrhagic signs (Cullen's sign—periumbilical ecchymosis; Grey Turner's sign—flank ecchymosis).
Systemic manifestations: fever, tachycardia, tachypnea, hypotension, and scleral icterus (if choledocholithiasis present).

Diagnosis and Investigations:

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