Snapshot A 15-year-old boy with severe nodulocystic acne presents to the emergency room for sudden onset epigastric pain radiating to the back, as well as nausea and vomiting. An abdominal computed tomography shows findings concerning for pancreatitis. On further chart review, the physician discovers that he has been taking isotretinoin, and the dermatologist had been monitoring his triglycerides as they were mildly elevated at the last clinical visit. However, the patient reports that he had not only doubled his dose in the last week in an attempt to speed up the process but also had been eating burgers and fries for every meal. Laboratory results show significantly elevated levels of triglycerides in the blood. Introduction Clinical definition login to view 1 more bullet Epidemiology login to view 17 more bullets Pathogenesis login to view 2 more bullets Prognosis login to view 1 more bullet Ranson Criteria / Clinical Signs On Admission Within 48 hours Glucose > 200 mg/dL Age > 55 years LDH > 350 IU/L WBC > 16,000/mL AST > 250 IU/dL Calcium < 8.0 mg/dL Hematocrit ↓ by >10% PaO2 < 60 mmHg Base deficit > 4 mEq/L BUN ↑ by 5 mg/dL Sequestered fluid > 6 L Ranson Criteria / Mortality 3-4 signs 20% mortality 5-6 signs 40% mortality 7+ signs 100% mortality Presentation Symptoms login to view 5 more bullets Physical exam login to view 9 more bullets Imaging Abdominal radiograph login to view 3 more bullets Abdominal ultrasound login to view 7 more bullets Computed tomography (CT) of abdomen and pelvis with contrast login to view 10 more bullets CT-guided fine needle aspiration login to view 3 more bullets Studies Serum labs login to view 3 more bullets Diagnostic criteria login to view 4 more bullets Differential Peptic ulcer disease login to view 2 more bullets Treatment Management approach login to view 2 more bullets Conservative login to view 6 more bullets Medical login to view 1 more bullet Surgery login to view 6 more bullets Complications Pancreatic pseudocyst Fistula formation Pancreatic abscess Hemorrhagic pancreatitis Pleural effusions (often on the left) Chronic pancreatitis