Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
====
"I hear and I forget. I see and I remember. I do and I understand." - Confucius
====
"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
====
" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
====
"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
====
"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
====
"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
====
"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
====
"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
====
"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
====
"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
====
"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
====
"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
====
"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
====
"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
====
"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
====
"There are no facts, only interpretations." - Nietzsche
====
"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
====
"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 8
Mar -
In which I reveal what caused the pancreatitis
18 Aug2009
MRCP suggested cholecystitis. We consulted surgery – laporoscopic cholectystectomy the next day with confirmation of cholecystitis.
The big clue is the ALT > 150. While not highly sensitive, this is highly specific for gallstone pancreatitis. My 3rd year student found the reference to that clue. I had always thought that the alk phos was the most useful test in this situation – so I learned something.
Even without that clue, the symptoms made us highly suspicious of gallstone pancreatitis. This is the most common cause in the US. I believed his no alcohol history, and found no clues on labs that he was not telling the truth.
h/t to David whose first post he spot on.
Related posts:
- What caused the pancreatitis?
- Arguing for marijuana legalization
- What I said about pain control
- 17 days at the VA – Day 10
- False positives – from 6 years ago
Related posts brought to you by Yet Another Related Posts Plugin.
2 Responses to In which I reveal what caused the pancreatitis
david
August 18th, 2009 at 9:37 pm
DB,
Thanks. I agree with you. There is no requirement for cholecystitis in diagnosing gallstone pancreatitis. The gallbladder itself could have been pristine. It is the gallbladder bile, the source of the microlithiasis, that is the culprit.
If you think about it, the finding of cholecystitis on MRCP did nothing to increase the odds that the gallbladder was the source of the pancreatitis.
Michael Kirsch, M.D.
August 19th, 2009 at 5:38 am
I could have used your astute student this yr. Saw pt with recurrent pancreatits. Cause remained a mystery to me. Ultimately, disovered she was an alcoholic. She had denied any abuse and held a responsible job. Was it my fault that I missed it? Could be. She fooled me and I’ll be more suspicious next time.