Pancreatitis with no CBD dilitation
52 y/o M with HCV presents with RUQ & epigastric abdominal pain with associated nausea, vomitting and inability to tolerate PO. No EtOH use. Exam significant for volume depletion, icterus and RUQ tendermess/epigastric tenderness with negative Murphy’s sign & no shifting dullnes. Labs reveal hypochloremia, volume contraction, Transaminitis in 20o0s. TBilil 111, DBili 9, AlkP 200 and Lipase of 550. TG, Ca normal. US & MRCP revealed cholilithiasis with stones in gall bladder but no obstruction or anatomic malformation.
Pt treated like a pancreatitis patient with IV fluids, pain control & NPO status. Further imaging or prophylactic antibiotics not needed due to low severity of disease per scoring criteria. (Ranson’s & APACHE II).
Further work-up significant for negative ANA, anti-smooth, IgG4, HIV & EBV. However, Hep C + and CMV IgM & IgG positive.
ALT in diagnosis of Gallstone Pancreatitis “may not apply when you have significantly elevated transaminitis”