Acute Pancreatitis Case Study

HISTORY OF PRESENT ILLNESS: This 46-year old gentleman with past medical history significant only for degenerative disease of the bilateral hips, secondary to arthritis presents to the emergency room after having had 3 days of abdominal pain. It initially started 3 days ago and was a generalized vague abdominal complaint. Earlier this morning the pain localized and radiated to the right lower quadrant. He had some nausea without emesis. He was able to tolerate p.o earlier around 6am, but he now

My patient is a 64-year-old that came in for upper abdominal pain. She felt her pain was worse when she lied down flat, so she had been trying to sit up and lean forward for most of the day. As the day went on her pain got worse, so she came into Emergency Department for further evaluation. She did not have any nausea or emesis and no change in her bowel habits. No fevers or chills. No trauma to the abdomen. In the hospital, she is diagnosed with acute pancreatitis.

T.B. is a 65-year-old retiree who is admitted to your unit from the emergency department (ED). On arrival you note that he is trembling and nearly doubled over with severe abdominal pain. T.B. indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid-back as a deep, sharp boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. T.B. experienced an acute onset of pain after eating fish and chips

In August, 2015, Joel first sought medical care for what he believed was indigestion. Unfortunately, his pain did not subside with treatment and actually became worse. The abdominal pain was so bad, Joel could barely sit or stand. Thinking he had pancreatitis or

“Each year, acute pancreatitis sends more than 200,000 Americans to the hospital. Many of those who suffer from pancreatic problems are also heavy drinkers” (“Beyond Hangovers: Understanding Alcohol's Impact Your Health” 15). The pancreas is an important organ which aids in digestions and energy conversion. The pancreas directs enzymes to the small intestine to digest nutrients and it also secretes insulin and glucagon. The body’s main source of energy is glucose and insulin allows additional glucose to be stored away in the body properly. Too much alcohol damages cells in the pancreas, causing complications with insulin, leaving the organ open to inflammation. Alcohol causes the pancreas to discharge the enzymes intended for the small intestine back into the pancreas which can lead to inflammation and the swelling of tissues and blood vessels. Pancreatitis is the inflammation which causes the organ to malfunction and if one continues to drink, it can magnify into chronic pancreatitis when the inflammation is constant (“Beyond Hangovers: Understanding Alcohol's Impact Your Health” 15-16). Pancreatitis causing severe abdominal pain, persistent diarrhea, and is not curable. Sixty-percent of circumstances result from alcohol; although, some have been linked to gallstones (Freeman).

Incretin based drugs have proven to be effective glucose-lowering agents (Butler et al, 2013). But there have been concerns with respect to the long-term consequences of using such therapies. The issues raised were regarding their causal relationship with acute pancreatitis (AP). There are clearly conflicting evidence that have been presented in preclinical studies and in epidemiologic studies which suggest an association which may or may not be a causal relationship between these drugs and AP. (Butler et al, 2013)

The normally thin secretions thicken as a result of the illness and cause blockages in tubes and passageways in the pancreas and lungs. The illness requires daily maintenance, but improvements are being made to increase the quality of life for patients. In the past those who suffered with the illness didn’t live long, however advances in treatments and early detection allow people to live a normal life, well into their 50s.

Thus allowing me to form a differential diagnosis and rule out certain causes, such as; constipation, and indigestion. Subsequently, the physical examination enabled me to confirm a diagnosis of acute abdomen. As the patient was not experiencing any worrying (red flag) symptoms associated with abdominal emergencies, such as; appendicitis or pancreatitis. However, I did forget certain aspects of the physical examination and had to be prompted by the MO. Although with more practice such incidence would be reduced.

It is always challenging to accurately diagnose abdominal pain in the primary care settings. An extensive knowledge of the anatomy and physiology could help narrow down possible causes of abdominal pain.

mucus can block the ducts of the pancreas, and that prevents the enzymes from reaching the

In light of question number three A-B, Cystic fibrosis causes variations from the norm in almost all exocrine and numerous endocrine organs. This disturbance of organs extremely thwarts the elements of the Pancreas during absorption bringing about “…an abnormal mucous secretion that causes obstruction of single mucin-producing cells. The pancreas secretes less enzyme (ex: trypsin, lipase and amylase), so malabsorption ensues with its attendant deficiency disorders” (Walsh et al.)

Client J.D. is a 45 year old white male who presents to the emergency department with a chief complaint of severe epigastric and LUQ pain that radiates to his back and shoulder. He has been nauseated and has vomited several times. Client J.D. has been previously healthy. The pain awoke the client from sleep about 24 hours ago and it has become progressively worse since then. His vital signs: 90/50-150-32-100.5-96% on RA. The client also has elevated serum amylase and lipase levels. The client has abdominal tenderness, muscular guarding, and his bowel sounds are diminished. Lung auscultation revealed crackles in the base of the left lung. He rates his pain 8/10. The client describes the pain as constant and sharp and it becomes worse when he is lying on his back. The client is currently NPO and is on the stretcher in the fetal position in an attempt to gain some relieve from the discomfort. The client may be experiencing an episode of acute pancreatitis. It is recommended that this client be seen immediately. IV fluids of LR should be started along with an abdominal CT scan, pain medication, an anti-emetic for the nausea and vomiting and the client should be admitted for observation.

They can be single or multiple, and are sometimes multi-loculated. The main differences between ANCs and APFCs are that ANCs contain necrotic materials, and also develop from necrotizing pancreatitis (Fig 28), sometimes associated with pancreatic ducts disruption, and occasionally they can get infected. Because of CT’s low contrast resolution, MRI may be indicated in the early course of the disease to differentiate ANCs from APFCs. With time, parenchymal necrosis becomes more obvious, which aids in the distinction of ANCs from APFCs. MRI is more sensitive in depicting solid tissue within ANCs (Manikkavasakar et al, 2014).

An American study published in 1999 states that 25% of AP in children is of unknown etiology, and 13% to 33% of the cases are attributed to blunt trauma making it to be the most common cause of pancreatitis in both adult and pediatrics (5). However, more recent study claims that pediatric AP due to trauma is less common than previously believed, and a more broad list of causes is seen, including biliary tract disease, systemic diseases, autoimmune disorders, anatomical anomalies, drugs, and genetic and hereditary diseases (6). Racial and geographical variations are recognizable in the course and etiology of pediatric AP(7). A study conducted in Japan and published in 1994 states that congenital dilatation of the common bile duct is more common in Japanese and Chinese children, wheres trauma is more common among Western children(PDF 8). Another retrospective chart review study conducted in the United States collected data between 1998 and 2008 states that 17% of African-American children were admitted to a pediatric intensive care unit, while only 7% of white children were admitted. The same study found that boys and malnourished children have longer stay than girls, obese and children of healthy weight

Acute pancreatitis is a rapid inflammatory process when the tissue of pancreas “digests” itself due to enzymatic activity. The main reason for that is alcohol abuse and gallstones (Pfrimmer, 2008). Upon physical assessment of this patient, my findings were severe