1. An 18-Year-Old With Acute-on-Chronic Abdominal Pain
- Author
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D. Montgomery Bissell, Mark H. Corden, Frank Xu, Shiu-Yi Emily Chen, Jamie Frediani, Quin Y. Liu, and Kathleen Ostrom
- Subjects
Abdominal pain ,medicine.medical_specialty ,Adolescent ,Nausea ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Recurrent pancreatitis ,Recurrence ,Internal medicine ,Weight Loss ,Medicine ,Humans ,Cholecystectomy ,030212 general & internal medicine ,Paresthesia ,Past medical history ,Muscle Weakness ,business.industry ,Chronic pain ,medicine.disease ,Abdominal Pain ,Liver ,Pancreatitis ,Porphyria, Acute Intermittent ,Pediatrics, Perinatology and Child Health ,Acute Disease ,Vomiting ,Acute pancreatitis ,Hemin ,030211 gastroenterology & hepatology ,Female ,medicine.symptom ,Chronic Pain ,business ,Constipation - Abstract
An 18-year-old woman with a complex past medical history presented with 2 days of vomiting and lower abdominal pain. She had been admitted for the majority of the previous 5 months for recurrent pancreatitis and had undergone a cholecystectomy. Additional symptoms included nausea, anorexia, constipation, and a 40-lb weight loss over 4 months. She appeared uncomfortable, and an examination was remarkable for tachycardia, hypertension, and diffuse abdominal tenderness to light palpation. Her initial laboratory test results revealed mildly elevated liver enzymes (aspartate aminotransferase 68 U/L, alanine aminotransferase 80 U/L) and a normal lipase. She was admitted for pain control and nutritional support. Over the next few days, the lipase increased to 1707 U/L. Despite optimizing her management for acute pancreatitis, the patient’s symptoms persisted. Further history gathering and laboratory testing ultimately revealed her diagnosis. Our expert panel reviews her hospital course and elucidates the management of our eventual diagnosis.
- Published
- 2017