123.The answer is e.(Tintinalli, pp 573-575.)Abdominal pain that radi-
ates to the back and is associated with nausea, vomiting, epigastric tender-
ness, and an elevated lipase in a patient with a history of ethanol abuse all
point to a diagnosis of alcoholic pancreatitis.Although patients with mild
pancreatitis, no evidence of systemic complications, and a low likelihood of
biliary tract disease may be managed as outpatients, this patient requires
admission for the potentially rapid progression of symptoms, severity of
pain, and possible unreliability of the patient. The initial treatment for acute
pancreatitis is supportive: bowel rest, fluid resuscitation, and analgesia.
Ninety percent of patients recover without complications. Surgery is reserved
for complications of alcoholic pancreatitis, such as pseudocysts, phlegmons,
and abscesses.
(a, b, and d)As discussed above, this patient with pancreatitis requires
admission to the hospital for medical management. An exploratory laparo-
tomy is not indicated. (c)Endoscopy is used for patients with ulcerative
disease. ERCP is also used in patients in whom the etiology of pancreatitis
remains unclear after initial assessment.
128 Emergency Medicine