History
A 54-year-old lady presents with biliary pancreatitis complicated with respiratory failure requiring intensive care admission. She subsequently reports an increase in abdominal distension and persistent abdominal discomfort. She has no fever or jaundice. She is a non-drinker. She has a past history of hypertension. She is taking lisinopril and denies over-the-counter medications. She has been scheduled for a cholecystectomy.
•Temperature 37.5°C, pulse 72 bpm, BP 124/72mmHg, SaO2 98-100% on RA.
•Hydration satisfactory.
•Examination of the hands reveals no clubbing and normal-appearing palmar creases.
•Head and neck examination is unremarkable.
•Cardiovascular: HS dual, no murmur.
•Auscultation of her chest reveals right lower zone crepitation.
•Abdominal examination reveals a soft abdomen, with mild epigastric tenderness, no peritoneal signs, a vague epigastric mass and no detectable ascites.
•No signs of oedema.
Investigations
•CBC:
–WBC 8 x 109/L;
–haemoglobin 12.2g/dL;
–platelets 285 x 109/L.
•Total bilirubin 22μmol/L.
•ALP 32 IU/L.
•ALT 22 IU/L.
•Albumin 38g/L.
•Creatinine 80μmol/L.
•INR 1.1.
•Amylase normal.
What is your differential diagnosis specific to her situation?
Given her recent history of biliary pancreatitis, the following differential diagnoses should be considered:
•Pancreatic pseudocyst formation.
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