Rosh Emergency Medicine Practice Test

Which is the most common cause of acute pancreatitis in a patient presenting with upper abdominal pain, nausea, and elevated lipase?

1. Cholelithiasis

2. Chronic alcohol use

3. Endoscopic retrograde cholangiopancreatography

4. Hypertriglyceridemia

The correct answer is: Cholelithiasis

The most common cause of acute pancreatitis, particularly in clinical practice, is cholelithiasis, or gallstones. This condition occurs when gallstones block the cystic or common bile duct, leading to an inflammatory response in the pancreas. The presence of upper abdominal pain, nausea, and elevated lipase levels in a patient suggests pancreatic inflammation, commonly resulting from these obstructive processes. Cholelithiasis is more prevalent in the general population compared to the other causes listed. For instance, while chronic alcohol use is indeed a significant risk factor for developing pancreatitis, it is less frequently the primary cause compared to gallstones, especially in patients who do not have a substantial history of alcohol consumption. Similarly, endoscopic retrograde cholangiopancreatography (ERCP) can trigger pancreatitis as a complication, but it is not a common presenting cause. Hypertriglyceridemia can lead to acute pancreatitis as well, though it tends to be less common and is often seen in specific patient populations with pre-existing lipid metabolism issues. Understanding the epidemiology and pathophysiology behind these causes is crucial for accurately diagnosing and managing acute pancreatitis in clinical settings.