INTRODUCTION: Liraglutide is a GLP -1 agonist, a class of type two diabetes mellitus injectable treatments, which has shown benefits of controlling blood glucose levels with a minimal risk of hypoglycemia. Liraglutide delays the movement of food from the stomach into the small intestine which causes early satiety and a decrease in appetite. CASE DESCRIPTION/METHODS: A 40-year-old female presented to the emergency department with a two-day history of acute onset of sharp epigastric pain radiating to the back associated with nausea. The lipase level was elevated at 1,595 U/L and triglycerides were normal. Upon further evaluation, right upper quadrant ultrasound revealed cholelithiasis. CT abdomen and pelvis revealed cholelithiasis without evidence of cholecystitis. Magnetic Resonance Cholangiopancreatography (MRCP) showed gallstones and mild gallbladder wall thickening. There were no signs of pancreatic ductal dilatation or mass lesions. The patient's medical history was significant for obesity, hypertension and asthma. Liraglutide injections were started four weeks prior to her presentation for weight loss. She denied any history of pancreatic disease, alcohol use, tobacco use or herbal supplementations. The patient medications were significant for lisinopril and pantoprazole. DISCUSSION: In 2014 liiraglutide has been approved by the Food and Drug Administration (FDA) for weight loss at a higher dose. In the phase III trials Liraglutide Effect and Action in Diabetes (LEAD), liraglutide was shown to have a substantial decrease not only in hemoglobin A1C over a placebo, but in weight reduction as well. Since its use for weight loss, there have been concerns for acute pancreatitis. Acute pancreatitis is an inflammatory disease of the pancreas. Etiologies most commonly include gallstones or alcohol use. In cases where there is no history of alcohol use or obstructive gallstone disease it is imperative to search for alternative causes. In the case we presented, the patient underwent MRCP which did not reveal signs of pancreatic ductal obstructions. A careful review of her medical history and medications did not provide any risk factors for developing pancreatitis except for liraglutide injections for weight loss. The possibility of autoimmune or viral acute pancreatitis was ruled out. Liraglutide has been reported to cause acute pancreatitis. It has been suggested that it is more common to develop acute pancreatitis while on liraglutide in patients who have a history of pancreatitis or gall bladder disease.

IntroductionNeuroblastoma is the commonest extracranial solid tumour in children and accounts for 15% of all paediatric deaths due to malignancies 1,2 . It commonly presents as abdominal pain and abdominal mass. It may present with obstructive jaundice due to bile duct obstruction [3][4][5][6] . We report a case of neuroblastoma with acute pancreatitis. Case reportAn eight year old boy was admitted with a history of abdominal pain for 3 months and abdominal distension for 1 month. The abdominal pain was dull, severe, agonizing, mostly confined to the epigastric region, radiating to the back, aggravated after taking food, relieved by leaning forward and associated with anorexia and diarrhoea. Abdominal distension was gradually worsening (Figure 1). There was no history of taking any drugs such as azathioprine, 6-mercaptopurine, methyldopa or thiazide diuretics and no history of abdominal trauma or previous viral illness. There was, no family history of pancreatitis and no contact history of tuberculosis.Two days after admission, he developed continuous fever (highest temperature 104 0 F) and non-bilious vomiting. On examination on day 3 of admission, he was fretful, febrile, had mild pallor, a pulse rate of 84/min, blood pressure of 110/70 mm Hg, a respiratory rate of 34/min and oxygen saturation (SPO2) of 97% in room air. Anthropometrically _________________________________________