ROSH Gastrointestinal Practice Exam

Which historical factor likely contributed to the diagnosis of a 55-year-old man with epigastric pain and elevated serum amylase?

1. Alcohol abuse

2. Chronic corticosteroid use

3. Hypertriglyceridemia

4. Obesity

The correct answer is: Alcohol abuse

Alcohol abuse is a significant historical factor that can contribute to the development of pancreatitis, which is often associated with symptoms such as epigastric pain and elevated serum amylase levels. In individuals with a history of chronic alcohol consumption, the pancreas can become inflamed, leading to acute or chronic pancreatitis. This inflammation causes damage to the pancreatic tissue and affects the secretion of digestive enzymes, resulting in elevated levels of serum amylase. Although chronic corticosteroid use and hypertriglyceridemia can also lead to elevated amylase levels or abdominal discomfort, they are not as directly linked to acute episodes of pancreatitis as alcohol abuse. Moreover, while obesity is a risk factor for several gastrointestinal conditions, it is less specifically associated with acute pancreatitis compared to the well-established link with alcohol consumption. Therefore, the historical factor most likely contributing to the clinical picture presented is alcohol abuse, as it directly correlates with the symptoms and lab findings observed in this patient.