Which of the following is a clinical manifestation of decompensated cirrhosis? (select all that apply)

Rationale:
A. Lactulose is usually administered orally to soften stools, not as a short-retention enema.
B. A Fleet enema is a hypertonic solution that draws fluid into the colon, is retained briefly, and promotes rapid evacuation of stool to relieve constipation.
C. Tap water enemas are hypotonic and typically require immediate expulsion, not short retention.
D. Mineral oil enemas are retention enemas, meant to soften stool over a longer period, not for rapid evacuation.

Rationale:
A. Serum calcium levels are often decreased in acute pancreatitis due to fat saponification, not increased.

B. Serum lipase is typically elevated, not decreased, in acute pancreatitis, and is often more specific than amylase for pancreatic injury.

C. WBC count usually increases due to inflammation and possible infection; a decreased WBC is not expected.

D. Increased serum amylase is a hallmark laboratory finding in acute pancreatitis. Amylase is released from damaged pancreatic cells into the bloodstream. Levels typically rise within 6–12 hours of onset of symptoms and remain elevated for 3–5 days. Monitoring amylase, along with lipase (which remains elevated longer), helps confirm the diagnosis and assess the severity of pancreatic inflammation. Elevated amylase, in the context of abdominal pain radiating to the back, nausea, and vomiting, supports the provider’s suspicion of acute pancreatitis.