Question

A patient has pain in the epigastrium that radiates to the back. The serum amylase is normal, and USG of the abdomen reveals a gall stone and a bulky pancreas. A CT scan was done, which clinched the diagnosis. The scenario is suggestive of which of the following?

• A. Acute pancreatitis
• B. Acute cholecystitis
• C. Duodenal ulcer
• D. Acute appendicitis

Hint:

Gallstone plus bulky pancreas equals pancreatitis, even when amylase is normal.

Answer 1

The Correct Option is A

Approach this by combining the pain character with the imaging findings. Pain centred in the epigastrium that pierces straight through to the back is the hallmark location of pancreatic inflammation, and the ultrasound adds two decisive pieces of information: a gallstone, which is the leading cause of acute pancreatitis, and a bulky, swollen pancreas, which reflects parenchymal edema. The normal serum amylase might seem to argue against the diagnosis, but amylase frequently returns to normal in delayed presentations and in certain etiologies, so it cannot rule out pancreatitis, and that is precisely why a contrast CT was used to confirm the inflamed gland and clinch the answer. Eliminating the alternatives sharpens the conclusion: acute cholecystitis localises to the right upper quadrant with a tender, often palpable gallbladder rather than a bulky pancreas; a duodenal ulcer gives food-relieved epigastric pain without pancreatic enlargement; and appendicitis produces right iliac fossa pain entirely unrelated to this imaging. The convergence of back-radiating epigastric pain, gallstones and a bulky pancreas on CT makes the diagnosis acute pancreatitis.\[\boxed{\text{Acute pancreatitis}}\]