A 23-year-old man is hospitalized with acute pancreatitis that resolves rapidly on fasting. He has suffered 2 similar episodes during the past 2 years. A gallbladder ultrasound obtained during a previous episode was normal. The patient has no other medical problems and takes no medications. He does not consume alcohol. Which of the following tests should be considered during the workup of this patient?

Question

A 23-year-old man is hospitalized with acute pancreatitis that resolves rapidly on fasting.  He has suffered 2 similar episodes during the past 2 years.  A gallbladder ultrasound obtained during a previous episode was normal.  The patient has no other medical problems and takes no medications.  He does not consume alcohol.  Which of the following tests should be considered during the workup of this patient?

Quizplus · Accepted Answer

Gallstones and alcohol use are the most common causes of acute pancreatitis. Gallstones typically affect middle-aged and older patients (particularly women) unless there is a predisposing condition (eg, young patients with sickle cell disease are at increased risk for bilirubin gallstones). This young male patient does not consume alcohol and is unlikely to have gallstones, especially considering the negative results of his prior ultrasound. Thus, one of the following less common causes of acute pancreatitis likely accounts for his condition: High levels of circulating triglycerides lead to increased production of free fatty acids within the pancreatic capillaries by pancreatic lipase. Normally, fatty acids exist in serum bound to albumin. However, if serum triglyceride levels rise to >1000 mg/dL, the concentration of free fatty acids exceeds the binding capacity of albumin and leads to direct injury to the pancreatic acinar cells. Thus, hypertriglyceridemia causes acute pancreatitis via direct tissue toxicity. (Choice A) Decreased serum ceruloplasmin and increased hepatic copper content are diagnostic of Wilson disease. Cirrhosis, central nervous system involvement, and Kayser-Fleischer rings are characteristic findings. Wilson disease does not predispose to acute pancreatitis. (Choice B) Increased serum cholesterol levels predispose to the development of systemic atherosclerosis, putting patients at increased risk for coronary artery disease, peripheral vascular disease, and stroke. In some cases, hypercholesterolemia may increase the risk of cholesterol gallstone formation, but this patient's negative gallbladder ultrasound makes this a less likely cause of his pancreatitis. (Choice C) High concentrations of serum ferritin are found in hemochromatosis. Hemochromatosis can cause cirrhosis, pancreatic fibrosis and subsequent diabetes, cardiomyopathy, and secondary hypogonadism. It does not cause acute pancreatitis. (Choice E) Hyperuricemia can lead to the formation of uric acid renal calculi and urate nephropathy. There is no association with acute pancreatitis. (Choice F) Increased concentrations of oxalate in the urine are associated with intestinal malabsorption syndromes (eg, Crohn disease). Calcium oxalate renal stones may form as a result. Hyperoxaluria is not associated with acute pancreatitis. Educational objective: Eighty percent of acute pancreatitis cases are caused by gallstones and chronic alcoholism. Less common causes account for the other 20%. Inherited or acquired hypertriglyceridemia can cause acute pancreatitis if the serum level of triglycerides exceeds 1000 mg/dL.

A 23-Year-Old Man Is Hospitalized with Acute Pancreatitis That Resolves