Gallstone Pancreatitis

[southerndoc]

What's the highest lipase level you guys have ever seen?

Had a 35 year old woman, seen 4 days prior with biliary colic, referred to the surgery clinic the next morning. Well since her pain was better, she thought she wouldn't go. Comes in last night complaining of 5 hours of severe abdominal pain, nausea/vomiting (numerous times), etc. No fevers, no chills.

Her labs? Of course she now has a white count (16), bili, AST, ALT, and alk phos are through the roof, but the real kicker is her lipase...

28,000!

I've never seen a lipase that high before! Needless to say she wasn't managed on an outpatient basis this time.

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[roja]

Wow. That is really high. The hightest I have seen was in the 5000's.

Definately wasn't managed as an outpatient.

 

[spyderdoc]

Just a friendly reminder that although impressively high, we all (should) know (those d@mned Ranson's criteria) that amylase and lipase levels are not prognostic indicators of pancreatitis...

 

[DrQuinn]

Somethings that are impressively high are Southerndoc and Apollyon's post counts.

Q, DO

 

[southerndoc]

Somethings that are impressively high are Southerndoc and Apollyon's post counts.

Q, DO

Thanks for pointing that out Quinn.

Re: Ransons...

White count greater than 16: check
Glucose greater than 200: check
AST greater than 250: check
LDH greater than 350: check
age > 55: finally no check

4 points on the Ransons: 60-70% mortality

Ability to remember that in your head: good job

Knowing that your memory might be wrong and you screwed up the criteria: priceless

By the way, Ranson's has only been studied for alcoholic pancreatitis, not gallstone pancreatitis, right? (Maybe I'm wrong here.)

 

[southerndoc]

OK, my mortality stuff is off. Just looked it up. 4 points on the Ranson's equals 15-20% mortality. No mention of the relationship to gallstone pancreatitis though. Does anyone know if it relates?

Cheers!

 

[roja]

Meh, ranson's shmansons. Why ruin the fun of amazingly high lab values with something as boring as ransons?



And remember, its not the size of the lab value that matters. Its what you do with it.

 

[Apollyon]

Somethings that are impressively high are Southerndoc and Apollyon's post counts.

Q, DO

Huh? Wha? Hey! I wuz WORKIN' to-night! Peds ED, 12 y/o kid, stroked out 2 months ago, back with same s/s, pyloric stenosis in a 19 day old, fever, corneal abrasion (harmonica to the eye), testicular torsion that spontaneously detorsed, and Dermabond! (Oh, and the fine, fine, FINE surgery senior! Hell, yeah! She is "way cool!") (<-- believe it or don't - an attractive, normal, single, female surgery resident)

 

[LaCirujana]

(Oh, and the fine, fine, FINE surgery senior! Hell, yeah! She is "way cool!") (<-- believe it or don't - an attractive, normal, single, female surgery resident)

there are plenty of us, silly

 

[Apollyon]

there are plenty of us, silly

Well, I know you are, but you're hundreds of miles away!