A 65 year old man comes to the emergency room with the acute onset of peri-umbilical abdominalpain, 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?
