In which condition would you expect epigastric pain that radiates to the back, especially in a patient with a history of gallstones?

• A. Acute cholangitis
• B. Acute pancreatitis
• C. Ruptured abdominal aortic aneurysm
• D. Ruptured ectopic pregnancy

Answer: (B)

The presentation of epigastric pain that radiates to the back, particularly in a patient with a history of gallstones, is most consistent with acute pancreatitis. This condition often arises due to the impact of gallstones, which can block the pancreatic duct and lead to inflammation of the pancreas. The pain is typically described as severe and may be accompanied by other symptoms such as nausea, vomiting, and potentially fever.

In acute pancreatitis, the pain is usually located in the upper abdomen but can radiate to the back due to inflammation and irritation of surrounding tissues and structures. The positioning of the pain can be uncomfortable; patients often find relief by sitting forward, which differs from other abdominal conditions.

This established connection between gallstones and acute pancreatitis, along with the characteristic nature of the pain, supports the idea that this is the correct answer. Understanding the underlying pathophysiology—whereby blocking the pancreatic duct leads to local pancreatic damage and associated symptoms—reinforces how gallstones can trigger this condition effectively.