Case history
Case history #1
A 53-year-old man presents to the emergency room complaining of severe mid-epigastric abdominal pain that radiates to the back. The pain evolved over 1 hour. He also complains of nausea, vomiting, and anorexia, and gives a history of heavy alcohol intake over many years, including this past week. He is tachycardic, tachypneic, and febrile with hypotension. He is slightly agitated and confused. He is diaphoretic and tender in the epigastric region with guarding and rebound tenderness.
Case history #2
A 47-year-old overweight woman is admitted with generalized abdominal pain. She has been unable to eat or drink due to nausea and vomiting. She states the pain started in the right upper quadrant suddenly 6 hours ago, but is now in the epigastric region. An ultrasound obtained on her last visit to the emergency room revealed gallstones with no inflammation of the gallbladder, and she was told that she should see a surgeon. She looks jaundiced and in distress. She has point tenderness under her ribs on the right, which is worsened with deep palpation. No mass is palpable.
Other presentations
Pancreatitis can mimic an acute surgical abdomen with rigid abdomen and peritoneal signs. It may also be uncovered in critically ill patients as a cause of acute respiratory distress, hypotension, and fever.[6]
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