Epigastric pain, boring through to the back

A 46-year-old folds forward over the triage desk, vomiting, with pain drilling straight through him.

46-year-old manED, bay 6Fictitious educational patient

Gallstones on an ultrasound two years ago, never followed upNo alcohol for a decade

Day 0 · 13:20

Arrival

Six hours of constant epigastric pain radiating to the back, eased slightly by sitting forward, with repeated vomiting. He is sweaty and still. The lipase returns at four times the upper reference limit.

Vitals

HR108BP118/74RR20SpO296%T37.6

Results

Test	Day 0 · 13:40	Reference
LipLipase	260H	13–60 U/L
WBCWhite cell count	14.8H	4–11 ×10⁹/L
CRPC-reactive protein	38H	0–5 mg/L
CrCreatinine	118H	60–110 µmol/L
GluGlucose (random)	8.9H	4–7.8 mmol/L
CaCalcium (corrected)	2.31	2.12–2.62 mmol/L
ALTAlanine aminotransferase	148H	7–40 U/L
ALPAlkaline phosphatase	130H	40–120 U/L
BiliTotal bilirubin	34H	3–21 µmol/L

Classic pain plus a lipase over three times the limit. Does he need a CT today to make the diagnosis?

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