Question of the Week # 422

422) A 54-year-old man with history of Diabetes Mellitus and End-Stage Renal Disease is evaluated in your office during a follow up visit after undergoing hemo-dialysis in the morning. He has been dependent on Hemo-Dialysis  for past four years and undergoes dialysis thrice a week. He reports recurrent epigastric abdominal pain that is burning in quality which is relieved by taking over the counter antacids. He denies any pain at this time. He denies any nausea or vomiting. He has no history of alcohol use or smoking. On examination, he is afebrile and vitals are stable. Abdominal examination is benign. Laboratory investigations are as follows:

WBC  8.0K/µL

Hemoglobin 10.5gm%

Serum amylase 200 IU/L ( N =  25 to 160 U/L)

Serum Lipase 150 IU/L (Normal = 25 to 80U/L)

AST  30 IU/L

ALT 40 IU/L

Total bilirubin 0.6gm%

Alkaline Phosphatase 80IU/L .

Which of the following is indicated in this patient at this time?

A) Ultrasound of the Gall Bladder

B) Nothing by mouth and IV hydration

C) No further investigations or treatment

D) Endoscopic Retrograde Cholangio Pancreatography

E) CT scan of the Abdomen

21 Responses

  1. a

  2. C) No further investigations or treatment?? Since he is asymptomatic?(Although high(not too much) Serum Amylase and Lipase suggest a/c pancreatits)

    • I meant his serum amylase and lipase are not high enough to suggest acute pancreatitis(Not B or E).Alk Phos is normal (Not D).AST & ALT are only slightly above normal and no symptoms of cholecystitis /biliary cholic(Not A).But what do the slightly abnormal lab results suggest though??

      • We are having an extensive discussion on this @ http://facebook.com/archerreview

      • Lipase and Amylase are abnormal , what do they suggest?

      • Chronic Pancreatitis since they are not too high

      • That’s a wealth of information thank u!

  3. B.

  4. His alk phos is very high. Shouldn’t he be at lease NPO with I’ve hydration.

  5. E

  6. E-Ct scan of abdomen.Chronic pancretitis??

  7. d

  8. c

  9. B

  10. a

  11. c

  12. Us of gb

  13. c?

  14. diabetic patient with chronic pancreatitis, warrants ct scan of the abdomen, to do nothing with recurrent epigastric pain would be negligent and very high amylase is seen in acute pancreatitis but not in chronic pancreatitis.

  15. PANCREATIC ENZYMES — Marked elevations of amylase and lipase are frequently used to help diagnose pancreatitis in patients without renal failure (see “Clinical manifestations and diagnosis of acute pancreatitis”). However, serum concentrations of pancreatic amylase and lipase are elevated in patients with end-stage renal disease (ESRD) in the absence of acute pancreatitis [12-22]. The highest levels of amylase and lipase are noted in hemodialysis patients, but marked elevations can also be seen in patients with chronic renal failure and in those undergoing peritoneal dialysis. A threefold to fivefold increase in amylase and lipase levels is most commonly observed, but the absolute values do not exceed three times the upper limit of normal. The degree of elevation is roughly proportional to the degree of renal dysfunction.

  16. c

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