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ication S is a 45-vear-old man who was admitted with com- nts of progressively severe, constant right upper quad- stabdominal pain, nausea, and vomiting for the past 24 He was at a party the previous weekend, where he med large quantities of alcohol at a family reunion, reports that he does not drink alcohol regularly. He a multivitamin daily and is not on any prescription In physical exam, he is noted to be in acute distress facial grimacing and clutching his abdomen. Vitals o reveal a temperature of 100.4°F (38°C); blood pres- f 102/58 mm Hg; pulse at 101 beats/min; and respi- sat 16/min. Laboratory data reveal a white blood count of 11,000 cells/mm’, hematocrit 45%, serum mine 1.4 mg/dL, total serum bilirubin 3.4 mg/dL, and serum amylase of 650 U/L. AST and ALT levels are both elevated. An abdominal ultrasound reveals a stone in the common bile duct. Treatment includes NPO status, place ment of a nasogastric tube (placed on low suction), initia- tion of IV fluids, and analgesics for pain control. J.S. is diagnosed with acute biliary pancreatitis and is scheduled for an endoscopic retrograde cholangiopancreatography (ERCP) procedure to remove the gallstone in his com- mon biliary duct. 1. What signs and symptoms are typical in AP, and what is the pathophysiologic mechanism? 2. What clinical and laboratory indices are used to assess prognosis in AP? 3. What is the treatment for AP?
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