Ans. C) Acute Pancreatitis

Acute pancreatitis is an inflammation of the pancreas that manifests with severe upper abdominal pain that radiates to the back. The pain is often described as being relieved by sitting or bending forward. One of the radiological signs associated with acute pancreatitis seen on abdominal X-ray is the "colon cut off sign." This sign indicates a gas-filled segment of the colon at the splenic flexure, which abruptly ends due to spasm or inflammation caused by the nearby inflamed pancreas.

Common Causes:

Gallstones
Alcohol consumption

Symptoms:

Severe epigastric pain radiating to the back
Nausea and vomiting
Elevated serum amylase and lipase levels

Radiological Signs on X-ray:

Sentinel loop sign: Dilated loop of small bowel near the inflamed pancreas.
Renal halo sign: A fat-attenuation line seen in the perirenal space.
Gasless abdomen: Lack of gas in the intestine due to ileus.
Ground glass appearance: Due to edema and inflammation.
Colon cut off sign: Gas-filled segment of the colon at the splenic flexure abruptly ending.

Other Options:

Option A. Acute Cholecystitis:
- Acute cholecystitis is inflammation of the gallbladder, typically presenting with right upper quadrant pain, fever, and positive Murphy's sign. Radiological findings might show gallstones and thickening of the gallbladder wall but not the colon cut off sign.
Option B. Acute Appendicitis:
- Acute appendicitis typically presents with right lower quadrant pain, fever, and tenderness at McBurney's point. Imaging might show an enlarged appendix or localized fluid collection but not the colon cut off sign.
Option D. Chronic Pancreatitis:
- Chronic pancreatitis involves persistent inflammation of the pancreas, leading to fibrosis. Symptoms include chronic abdominal pain, malabsorption, and diabetes mellitus. Imaging might show calcifications in the pancreas and ductal changes, but the colon cut off sign is not typically associated with chronic pancreatitis.

Educational Objective:

The "colon cut off sign" on X-ray is indicative of acute pancreatitis, characterized by severe epigastric pain radiating to the back.

Fmge Dec 2021

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