Question:
A patient has pain in the epigastrium that radiates to the back. The serum amylase is normal, and USG of the abdomen reveals a gall stone and a bulky pancreas. A CT scan was done, which clinched the diagnosis. The scenario is suggestive of which of the following?
A patient has pain in the epigastrium that radiates to the back. The serum amylase is normal, and USG of the abdomen reveals a gall stone and a bulky pancreas. A CT scan was done, which clinched the diagnosis. The scenario is suggestive of which of the following?
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Gallstone plus bulky pancreas equals pancreatitis, even when amylase is normal.
Updated On: Jun 24, 2026
- Acute pancreatitis
- Acute cholecystitis
- Duodenal ulcer
- Acute appendicitis
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The Correct Option is A
Solution and Explanation
Step 1: Read the clinical pattern. Epigastric pain radiating to the back, together with gallstones on ultrasound, strongly suggests gallstone-induced acute pancreatitis.
Step 2: Reconcile the normal amylase. Serum amylase can be normal in acute pancreatitis, especially when the patient presents late or in hyperlipidemic/alcoholic settings, so a normal value does not exclude the diagnosis.
Step 3: Use imaging. Ultrasound shows the precipitating gallstone and a bulky (edematous) pancreas, and contrast-enhanced CT confirms pancreatic inflammation and severity, which is why the CT clinched the diagnosis.
Step 4: Eliminate the other options. Acute cholecystitis causes right upper quadrant pain with a tender gallbladder, not back-radiating epigastric pain with a bulky pancreas. Duodenal ulcer pain is relieved by food and does not give a bulky pancreas. Acute appendicitis presents with right iliac fossa pain.
Step 5: Conclusion. The picture is of acute (gallstone) pancreatitis.
Step 2: Reconcile the normal amylase. Serum amylase can be normal in acute pancreatitis, especially when the patient presents late or in hyperlipidemic/alcoholic settings, so a normal value does not exclude the diagnosis.
Step 3: Use imaging. Ultrasound shows the precipitating gallstone and a bulky (edematous) pancreas, and contrast-enhanced CT confirms pancreatic inflammation and severity, which is why the CT clinched the diagnosis.
Step 4: Eliminate the other options. Acute cholecystitis causes right upper quadrant pain with a tender gallbladder, not back-radiating epigastric pain with a bulky pancreas. Duodenal ulcer pain is relieved by food and does not give a bulky pancreas. Acute appendicitis presents with right iliac fossa pain.
Step 5: Conclusion. The picture is of acute (gallstone) pancreatitis.
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