A 21 year old patient attended a pay the previous night and gives the following symptoms, pain in abdomen radiating to back, pulse 100/min, BP 100/76, Temp 39degC and vomiting before coming. Most probable diagnosis is
## **Core Concept**
The patient's symptoms suggest an acute abdominal condition with systemic involvement, indicated by abdominal pain radiating to the back, tachycardia (pulse 100/min), hypotension (BP 100/76), fever (Temp 39°C), and vomiting. These signs point towards a severe inflammatory or infectious process.
## **Why the Correct Answer is Right**
The correct answer, **D. Acute Pancreatitis**, is supported by the combination of severe abdominal pain radiating to the back, tachycardia, hypotension, fever, and vomiting. Acute pancreatitis often presents with these symptoms due to the inflammatory process of the pancreas. The pain radiating to the back is particularly suggestive of pancreatitis due to the retroperitoneal location of the pancreas and the irritation of nearby structures.
## **Why Each Wrong Option is Incorrect**
- **Option A:** While **A. Acute Appendicitis** can cause abdominal pain, fever, and vomiting, it typically presents with pain that initially localizes to the periumbilical area or epigastrium before moving to the right lower quadrant, which doesn't match the description given.
- **Option B:** **B. Intestinal Obstruction** can cause abdominal pain, vomiting, and tachycardia, but the pain is usually colicky and accompanied by abdominal distension, which is not mentioned.
- **Option C:** **C. Cholecystitis** typically presents with right upper quadrant pain, fever, and sometimes vomiting. While it can cause systemic symptoms, the pain pattern and radiation to the back are less typical.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that acute pancreatitis can be diagnosed using the **SIRS (Systemic Inflammatory Response Syndrome) criteria** and **Ranson's criteria** for severity assessment. Remember, pain radiating to the back is highly suggestive of pancreatitis.
## **Correct Answer:** D. Acute Pancreatitis