Biliary sludge and acute pancreatitis

Abstract

A 76-year-old nursing home resident was referred for evaluation of recurrent abdominal pain. He described it as a severe, dull ache in the central upper abdomen that lasted one to two hours at a time and did not radiate. He said that it was not associated with meals or alleviated by antacids and that nausea, vomiting, and fever were not involved. The patient had no history of similar pain. He had mild non-insulin-dependent diabetes mellitus, which was being treated with glyburide (5 mg daily). He had had a stroke four years ago, which left him with partial left-sided paralysis. On examination, he had no jaundice, pallor, or lymphadenopathy. He was not in pain, and the abdomen was not tender. Signs were normal, except for incomplete hemiparesis. His prostate was mildly enlarged. The stool was guaiac-negative. A complete blood count was normal, as were liver function tests and serum amylase and lipase values. Upper GI endoscopy showed mild reflux esophagitis but no other abnormalities. Abdominal ultrasonography showed a normal liver. The gallbladder, however, contained some low-amplitude echogenic material with no postacoustic shadowing. The material was mobile, gravitating to the most dependent part of the organ when the patient was turned. Intra- and extrahepatic ducts were normal, and the pancreas was unremarkable. Omeprazole was prescribed, 40 mg at bedtime, and the patient was returned to the nursing home.