A 54-year-old alcoholic man is admitted to the emergency room with an 8-hour history of severe epigastric pain. He reports that the pain radiates to his back and is more intense when he lies down. Physical examination reveals tachycardia, hypotension, and low-grade fever consistent with the early stage of shock. Which of the following serum measurements would be most useful in providing a diagnosis of his condition?

Question

Quizplus · Accepted Answer

The patient's symptoms and history are suggestive of acute pancreatitis, and serum amylase is a key diagnostic marker for this condition. Elevated levels of amylase are commonly seen in acute pancreatitis. The hallmark of acute pancreatitis is abdominal pain that is initially localized to the epigastrium and later becomes diffuse. It typically radiates to the back and is frequently more intense in the supine position. Other common symptoms and signs include nausea, vomiting, and tachycardia. If the pancreatitis is severe, hypotension can occur due to extravasation of blood and fluids into peritoneal spaces and shock may ensue. Measurement of both pancreatic amylase and lipase enzyme levels are useful in the diagnosis of acute pancreatitis. Amylase levels rise early in the course of the disease, while elevation of lipase levels may not occur until 24 hours after onset of illness. Although false positives and false negatives do occur, an elevated amylase level in conjunction with a consistent pattern of acute epigastric/abdominal pain is considered evidence of acute pancreatitis if other acute surgical conditions have been ruled out.

A 54-Year-Old Alcoholic Man Is Admitted to the Emergency Room