{"id":4476,"date":"2012-02-24T16:02:32","date_gmt":"2012-02-24T21:02:32","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/im-residency\/?p=4476"},"modified":"2012-02-24T16:02:32","modified_gmt":"2012-02-24T21:02:32","slug":"pancreatitis-with-no-cbd-dilitation","status":"publish","type":"post","link":"https:\/\/www.bumc.bu.edu\/im-residency\/2012\/02\/24\/pancreatitis-with-no-cbd-dilitation\/","title":{"rendered":"Pancreatitis with no CBD dilitation"},"content":{"rendered":"<p>52 y\/o M with HCV presents with RUQ &amp; epigastric abdominal pain with associated nausea, vomitting and inability to tolerate PO. \u00a0No EtOH use. Exam significant for volume depletion, icterus and RUQ tendermess\/epigastric tenderness with negative Murphy&#8217;s sign &amp; 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 &amp; MRCP revealed cholilithiasis with stones in gall bladder but no obstruction or anatomic malformation.<\/p>\n<p>Pt treated like a pancreatitis patient with IV fluids, pain control &amp; NPO status. Further imaging or prophylactic antibiotics not needed due to low severity of\u00a0disease\u00a0per scoring criteria. (Ranson&#8217;s &amp; APACHE II).<\/p>\n<p>Further work-up significant for negative ANA, anti-smooth, IgG4, HIV &amp; EBV. However, Hep C + and CMV IgM &amp; IgG positive.<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMcp054958\">Pancreatitis Review &#8211; NEJM<\/a><\/p>\n<p><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7942684\">ALT in diagnosis of Gallstone Pancreatitis<\/a> &#8220;may not apply when you have significantly elevated transaminitis&#8221;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>52 y\/o M with HCV presents with RUQ &amp; epigastric abdominal pain with associated nausea, vomitting and inability to tolerate PO. \u00a0No EtOH use. Exam significant for volume depletion, icterus and RUQ tendermess\/epigastric tenderness with negative Murphy&#8217;s sign &amp; no shifting dullnes. Labs reveal hypochloremia, volume contraction, Transaminitis in 20o0s. TBilil 111, DBili 9, AlkP [&hellip;]<\/p>\n","protected":false},"author":5942,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[4854],"tags":[17621,4866],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/posts\/4476"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/users\/5942"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/comments?post=4476"}],"version-history":[{"count":0,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/posts\/4476\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/media?parent=4476"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/categories?post=4476"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/im-residency\/wp-json\/wp\/v2\/tags?post=4476"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}