Question

a 37 - year - old alcoholic patient presents with colicky epigastric pain and is bent over in a fetal position. physical exam reveals a temperature of 101 and blood pressure of 103/70. what is your working diagnosis?
a) hepatitis
b) acute pancreatitis
c) cholecystitis
d) aaa
e) cirrhosis

Explanation:

• Alcoholism is a risk factor for acute pancreatitis.
• Colicky epigastric pain (often severe and may be relieved by leaning forward/fetal position) is a common symptom of acute pancreatitis.
• Fever can occur in acute pancreatitis (due to inflammation).
• Hepatitis typically presents with jaundice, fatigue, nausea more prominently (not the main symptoms here).
• Cholecystitis usually has right - upper quadrant pain (Murphy's sign), though can radiate, but alcoholism is not a major direct cause like in pancreatitis.
• AAA (abdominal aortic aneurysm) usually presents with a pulsatile abdominal mass (not described here) and pain that may be different in nature.
• Cirrhosis is a chronic condition with symptoms like ascites, jaundice, portal hypertension (not the acute presentation here).

Answer:

B. acute pancreatitis