32-Year-Old-Woman With Abdominal Pain

Laboratory values on admission included the following (reference ranges provided parenthetically): hemoglobin, 16.0 g/dL (13.5-17.5 g/dL); hematocrit, 50% (38.8%-50.0%); white blood cell count, 10.8 x 109/L (3.5-10.5 x 109/L); platelet count, 316 x 109/L (150-450 x 109/L); alanine aminotransferase (ALT), 601 U/L (755 U/L); sodium, 141 mmol/L (135-145 mmol/L); potassium, 3.7 mmol/L (3.6-4.8 mmol/L); serum urea nitrogen (BUN), 10 mg/dL (8-24 mg/dL); creatinine, 0.8 mg/dL (0.9-1.4 mg/dL); aspartate aminotransferase (AST), 409 U/L (8-48 U/L); albumin, 3.9 g/ dL (3.5-5.0 g/dL); total bilirubin, 6.2 mg/dL (0.1-1.2 mg/dL); direct bilirubin, 3.3 mg/dL (0.1-0.4 mg/dL); alkaline phosphatase, 126 U/L (45-115 U/L); and lipase, 9360 U/L (760 U/L). No focal consolidations or pleural effusions were noted on chest radiography. 1.Which one of the following is the most appropriate step in establishing the diagnosis of acute pancreatitis? a. No further diagnostic studies are indicated b. Serum amylase measurement c. Serum triglyceride measurement d. Computed tomography (CT) of the abdomen e. Abdominal ultrasonography The diagnosis of acute pancreatitis can be established if at least 2 of the following 3 criteria are met: abdominal imaging with characteristic findings suggestive of acute pancreatitis, lipase or amylase level greater than 3 times the upper limit of normal, and abdominal pain characteristic of the disease (epigastric pain, commonly radiating to the back).1 There is no need for further diagnostic modalities because the patient has met 2 of the 3 criteria needed to establish a diagnosis of acute pancreatitis. Computed tomography of the abdomen should be reserved for patients in whom...