Card 7 / 30: A 65 year old man comes to the emergency room with the acute onset of peri-umbilical abdominal pain, nausea, and vomiting. He drinks alcohol regularly. He takes no medications. On exam, he has a low grade temperature but other vital signs are stable. He has tenderness in the mid-abdomen without rebound or guarding. His lab tests are: ALT 58 U/l AST 95 U/l Total bilirubin 1.1 mg/dl Alkaline phosphatase 89 U/l Amylase 1105 U/l Lipase 1404 U/l Which of the following is the most likely pathophysiologic mechanism to explain the condition which is causing this patients pain?
A) Prolonged hypotension causing ischemia
B) Cytotoxic damage to peri-portal hepatocytes
C) Reduced stimulation of intracellular calcium signaling pathways
D) Inappropriate activation of pancreatic enzymes
E) Reduced pancreatic enzyme synthesis and secretion

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