A chronic alcoholic patient came to emergency with severe pain in epigastrium and multiple episodes of vomiting. On examination, guarding was present in upper epigastrium. Chest X-ray was normal. What is the next best step?
Upper GI endoscopy
Serum lipase
Alcohol breath test
CECT
From the given case: ACUTE PANCREATITIS- Chronic Alcoholic- Severe pain in Epigastrium- Episodes of vomiting* Normal CXR- Perforation peritonitis is ruled out - no pneumoperitoneum Acute Pancreatitis: Etiology Clinical Presentation Gall stones Pain in Epigastrium- radiating to left back Alcoholism Ileus- Nausea & Vomiting Trauma to Abdomen Tachypnea Ampullary tumor Abdominal distention Drugs Guarding +nt Hyperparathyroidism Hypotension maybe +nt. Hypercalcemia Pancreatic divisum Viral infections Scorpion bite Malnutrition Idiopathic INVESTIGATIONS:Initial investigation:- Clinical findings- Amylase - Not specific- Lipase - Specific (preferred) Imaging: - CECT - IOC + Staging investigation.- Balthazar criteria- To be performed after 72 hours as pancreatic necrosis is evident 1st 24 hrs.- Upper GIE & Alcohol breath test - Not done as the patient is alcoholic- No history of upper GI bleeding