A 28-year-old woman complains of girdle pain in her epigastric and left subcostal areas with irradiation to the back, nausea, and vomiting without relief. On examination a surgeon observes stomach distension and meteorism. There are positive Mondor's, Mayo-Robson's, and Cullen's symptoms. What is the most likely diagnosis?

Answer options

1. Splenic infarction
2. Aortic dissecting aneurysm
3. Acute intestinal obstruction
4. Acute pancreatitis
5. Acute cholecystitis

Explanation

Acute pancreatitis clinical presentation pain is the cardinal symptom. It characteristically develops quickly, reaching maximum intensity within minutes rather than hours, and persists for hours or even days. The pain is frequently severe, constant, and refractory to the usual doses of analgesics. Pain is usually experienced first in the epigastrium but may be localized to either the upper quadrant or felt diffusely throughout the abdomen. There is radiation to the back in about 50 % of patients, and some patients may gain relief by sitting or leaning forwards. Nausea, repeated vomiting, and retching are usually marked accompaniments. On examination, the appearance may be that of a patient who is well or, at the other extreme, one who is gravely ill with profound shock, toxicity, and confusion. Bleeding into the fascial planes can produce bluish discoloration of the flanks (Grey Turner’s sign) or umbilicus (Cullen’s sign). Abdominal examination may reveal distension due to ileus or, more rarely, ascites with shifting dullness. A mass can develop in the epigastrium due to inflammation. There is usually muscle guarding in the upper abdomen, although marked rigidity is unusual. Bailey & Love’s short practice of surgery. – 27th edition. – P. 1222.