Step I Acute pancreatitis

[arda]

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The patient clearly has pancreatitis but it actually asks etiology of it.Since alp is increased i thought patient has bile stone causing acute pancreatitis.Thus i choose leucocytosis.

What are your thoughts ?

 

[J ROD]

what is the correct answer?

 

[arda]

B

 

[J ROD]

Ok, notice how AST > ALT which indicates alcohol induced pancreatitis. Alcohol can cause erythrocyte problems leading to the increase in MCV.

 

[J ROD]

From what I know it can also cause a decrease in calcium.

Why I was unsure of B or C. I do not find this question all that great.

 

[Laplace]

From what I know it can also cause a decrease in calcium.

Why I was unsure of B or C. I do not find this question all that great.

Typical convoluted Uworld question. It's asking what else happens with the underlying etiology (alcohol in this case). Alcohol causes megaloblastic anemia via B12/folate deficiency. While hypocalcemia occurs during fat necrosis associated with pancreatitis, it has nothing to do with alcohol as far as I know.

 

[J ROD]

I would also assume the drop in calcium to be more associated with chronic if they were looking for that.

 

[acciddropping]

He has an acute pancreatitis and you see hypocalcemia in chronic pancreatitis.

 

[J ROD]

He has an acute pancreatitis and you see hypocalcemia in chronic pancreatitis.

it can also be seen in acute. But in step 1 world, I would agree.

 

[Psai]

First aid also says that you can see hypocalcemia in acute

 

[arda]

you can see hypocalcemia in acute pancreatitis,actually it is included in ranson criterias which determines the severity of acute pancreatitis.

At admission:

1. Age in years > 55 years
2. White blood cell count > 16000 cells/mm3
3. Blood glucose > 10 mmol/L (> 200 mg/dL)
4. Serum AST > 250 IU/L
5. Serum LDH > 350 IU/L

Within 48 hours:

1. Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
2. Hematocrit fall > 10%
3. Oxygen (hypoxemia PaO2 < 60 mmHg)
4. BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
5. Base deficit (negative base excess) > 4 mEq/L
6. Sequestration of fluids > 6 L

 

[notbobtrustme]

hypocalcemia doesn't cause pancreatitis though. it's a byproduct of what's going on with pancreatitis.

 

[teotuf]

hypocalcemia doesn't cause pancreatitis though. it's a byproduct of what's going on with pancreatitis.

Neither does increased MCV or B9/B12 deficiency.

This is just a badly worded question and let's just leave it at that.

 

[Arg10Messi]

Typical convoluted Uworld question. It's asking what else happens with the underlying etiology (alcohol in this case). Alcohol causes megaloblastic anemia via B12/folate deficiency. While hypocalcemia occurs during fat necrosis associated with pancreatitis, it has nothing to do with alcohol as far as I know.

Took the words right outta my mouth.

 

[Instatewaiter]

This isn't a badly worded questions.

B is right b/c it is from alcoholism which they are trying to tell you is the etiology of this patient's pancreatitis. Alcoholsim in and of itself will cause a macrocytosis even WITHOUT B12/folate deficiency.

A, C, D, and E are all wrong because they are common, secondary findings from pancreatitis.
while leukocytosis is associated with pancreatitis, it does not point to a specific etiology of pancreatitis. '
Low Ca is from soap formation, secondary to pancreatitis, not the cause.
High glucose- I thing they are getting at secondary diabetes here. Not sure.
High sodium is from dehydration- an assocaition but not a causation of pancreatitis