The serum amylase returns as 1155 U/L (normal: 40-140U/L).
Ah, you realise! This is a classic picture of acute pancreatitis – she has vomited and is describing severe, sudden-onset epigastric pain radiating around to the back which is relieved by sitting forwards.
The causes of acute pancreatitis can be learnt using the mnemonic: I GET SMASHED
I: idiopathic
G: gallstones (40%)
E: ethanol (40%)
T: trauma
S: steroid use
M: mumps and malignancy
A: autoimmune
S: scorpion venom
H: hyperparathyroidism, hypercalcaemia, hyperlipidaemia, hypothermia
E: ERCP, emboli
D: drugs
The most sensitive and specific study for pancreatitis is a CT abdomen, which may show enlargement of the pancreas with irregular contours, necrosis, pseudocysts and peri-pancreatic fat obliteration.
Which of these prognostic criteria scores could you now apply to Sally’s case?