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Acute pancreatitis due to gallstones — MCCQE Part 1 MCQ

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ModerateAbdominal PainAcute pancreatitis due to gallstonesMCCQE Part 1

A 47-year-old woman presents with severe epigastric pain radiating to the back after a fatty meal. She is nauseated, pulse is 104/min, and there is mild epigastric tenderness without peritonism. Lipase is 820 U/L and ALT is 165 U/L. What is the most likely diagnosis?

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Correct answer: D — Gallstone pancreatitis

Severe epigastric pain radiating to the back with lipase more than three times the upper reference limit indicates acute pancreatitis; the raised ALT suggests a biliary cause. Perforation would usually cause peritonism and free air, while mesenteric ischaemia causes pain out of proportion and vascular risk features. ECG should be considered in epigastric pain, but the enzyme pattern strongly supports pancreatitis.

Reference: Canadian Association of Gastroenterology pancreatitis guidance; MCC Objectives—Abdominal Pain