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Acute pancreatitis presents with severe epigastric pain radiating to the back, nausea, vomiting, and elevated amylase and lipase. Alcohol and gallstones are the most common causes. PUD causes burning epigastric pain relieved by food. Gastritis causes dyspepsia. Cholecystitis causes RUQ pain and Murphy’s sign. PANCE requires recognition of pancreatitis triad (pain + enzyme elevation + imaging if needed).

Von Willebrand disease is the most common inherited bleeding disorder. It causes mucocutaneous bleeding, prolonged bleeding time, and prolonged aPTT due to factor VIII involvement. Hemophilia A/B cause deep bleeding (hemarthroses). ITP causes low platelets but normal PT/aPTT. PANCE hematology emphasizes lab patterns in bleeding disorders.

Bulimia nervosa involves recurrent binge eating followed by compensatory behaviors (vomiting, laxatives, exercise) with normal or slightly high BMI. Binge eating disorder lacks purging. Anorexia nervosa requires low BMI. Depression may include appetite changes but not binge-purge cycles. PANCE psychiatry focuses on distinguishing eating disorders.

Myasthenia gravis is associated with thymoma. Therefore, CT chest is recommended to evaluate the thymus. MRI/CT brain does not detect thymoma. EEG is for seizures. PANCE neurology integrates systemic associations with neuromuscular diseases.

Appendicitis classically presents with periumbilical pain migrating to RLQ, fever, and leukocytosis. Diverticulitis typically affects LLQ in older patients. Crohn’s causes chronic RLQ pain with diarrhea/weight loss. Mesenteric ischemia presents with severe pain out of proportion to exam. Appendicitis recognition is high yield for PANCE GI emergencies.