PAINE PANCE Pearl – Gastrointestinal

47yo male presents to emergency department with a 3 day history of progressive abdominal pain, nausea, and vomiting.  He reports the pain the as a constant, boring pain that radiates to his back.  Eating seems to aggravate it and sitting up and leaning forward sometimes help.  He does report occasional alcohol use.  He reports subjective fever, but denies chills, recent illnesses, diarrhea, constipation, hematemesis, melena, or hematochezia.  Vital signs show BP-112/80, HR-118, RR-22, O2-100%, and temperature 39oC (102.2oF).  Physical exam reveals mild distension, generalized abdominal tenderness to deep palpation, absent bowel sounds, and the below finding:

figure-1-cullens-sign1

 

Laboratory studies are:

screen-shot-2016-10-12-at-8-02-57-amscreen-shot-2016-10-12-at-8-05-01-am

AST – 322U/L          ALT – 45U/L        ALP – 14U/L

LDH – 833U/L          GGT – 15U/L         Bilirubin – 1.9

Amylase – 209U/L

Lipase – 572U/L

Albumin – 3.5g/L

 

  1. What are the potential causes of this patient’s condition?
  2. What are 2 scoring systems used to predict severity?

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