31st July 2023

An 84-year-old woman presents with severe central abdominal pain. She has a background of paroxysmal atrial fibrillation

An 84-year-old woman presents with severe central abdominal pain. She has a background of paroxysmal atrial fibrillation and is found to have an irregularly irregular pulse today. On examination, her abdomen is soft but tender throughout. The rest of the examination is normal.

Bloods show the following:

Amylase 600 u/L (70 – 300)
pH 7.32 (7.35 – 7.45)
pCO2 4.2 kPa (4.5 – 6.0)
Bicarbonate 12 mmol/L (22 – 26)
Lactate 3.2 mmol/L (0.6 – 2.0)

What is the most likely cause of the raised amylase?

Select the SINGLE most appropriate option from the list below. Select ONE option only.