Gastrointestinal Pathology - Case 2 - Part 1
   

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A 62 year old man with a history of tobacco abuse and end stage lung disease received a single lung transplant 2 years previous to this admission. In December, he was treated for acute pancreatitis by endoscopic retrograde cholangiopancreatography (ERCP) removal of a 6 mm common bile duct stone.

AMYLASE, SERUM - U/L Trend

Date

Result/Unit

H/L

Ref Interval

12/09/02 04:00 AM 

35 U/L 

 

30-110  

12/03/02 12:42 AM 

2560 U/L 

H

30-110  

He returned on February 2nd with abdominal pain. The following labs were obtained on admission:

Name

Result/Unit

 

Ref Interval

LIPASE, SERUM or PLASMA

192 U/L

H

30-190

Name

Result/Unit

 

Ref Interval

ALKALINE PHOSPHATASE

129 U/L

H

38-126

POTASSIUM

4.9 mmol/L

 

3.3-5.0

SODIUM

139 mmol/L

 

136-144

GLUCOSE

102 mg/dL

 

64-128

BILIRUBIN, TOTAL

0.6 mg/dL

 

0.2-1.3

CALCIUM, SERUM OR PLASMA

8.2 mg/dL

L

8.4-10.2

ALBUMIN

2.5 g/dL

L

3.5-4.6

TOTAL PROTEIN

5.7 g/dL

L

6.3-8.2

CREATININE, SERUM - mg/dL

2.2 mg/dL

H

0.8-1.5

CHLORIDE

102 mmol/L

 

98-107

ASPARTATE AMINOTRANSFERASE

16 U/L

 

15-59

UREA NITROGEN

49 mg/dL

H

9-22

CARBON DIOXIDE

29 mmol/L

 

22-29

ANION GAP

8 mmol/L

 

8-14

ALANINE AMINOTRANSFERASE

29 U/L

 

13-72

Name

Result/Unit

 

Ref Interval

AMYLASE, SERUM - U/L

278 U/L

H

30-110

02/02/03

MANUAL DIFFERENTIAL

Name

Result/Unit

 

Ref Interval

POLYMORPHONUCLEAR

35 %

L

44-76

BAND

48 %

H

0-5

02/02/03

CBC with PLT COUNT/AUTO DIFF

Name

Result/Unit

 

Ref Interval

WHITE BLOOD CELL COUNT

11.17 K/uL

H

3.20-10.60

RED BLOOD CELL COUNT

3.18 M/uL

L

4.69-6.07

HEMOGLOBIN

9.7 g/dL

L

14.6-17.8

HEMATOCRIT

29.1 %

L

40.8-51.9

PLATELETS

316 K/uL

 

177-406

1. What is your differential diagnosis?