ROSH Gastrointestinal Practice Exam

What is the most likely diagnosis for a 42-year-old woman with epigastric pain, nausea, and a history of alcohol use?

1. Cholecystitis

2. Duodenal ulcer

3. Pancreatitis

4. Renal colic

The correct answer is: Pancreatitis

In this scenario, the symptoms and patient history point towards pancreatitis as the most likely diagnosis. The presentation of epigastric pain and nausea is commonly associated with pancreatic inflammation. Additionally, a significant history of alcohol use is a critical risk factor for the development of acute pancreatitis, as excessive alcohol consumption can lead to the activation of pancreatic enzymes within the pancreas, causing inflammation and pain. The location of the pain—epigastric—also aligns well with pancreatitis. This condition often presents with severe, steady pain that can be radiating and is typically exacerbated after eating, especially if the meal is rich in fats or alcohol. The other potential diagnoses do not fit as closely with the combination of symptoms and risk factors. For example, while cholecystitis can also cause epigastric pain and nausea, it often has additional symptoms such as fever or the presence of gallstones, and is more common in individuals with gallbladder disease rather than a direct correlation with alcohol use. Duodenal ulcers typically present with pain that improves with eating, and renal colic is associated with flank pain due to kidney stones. Given the patient's history and symptomatology, pancreatitis most accurately captures the overarching clinical picture.