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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Evaluate precipitating factors associated with acute pancreatitis.

  • Determine signs, symptoms, and laboratory abnormalities commonly associated with acute pancreatitis.

  • Describe potential systemic complications associated with acute pancreatitis.

  • Recommend appropriate pharmacologic and nonpharmacologic therapies for patients with acute pancreatitis.

  • Develop monitoring parameters to assist in realizing desired therapeutic outcomes.

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PATIENT PRESENTATION

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Chief Complaint

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“I’ve got a really bad pain in my stomach.”

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HPI

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Bill Jones is a 42-year-old man who presents to the ED shortly after midnight on a Friday night because of intense midepigastric pain radiating to his back. He states that the pain started shortly after dinner the night before but has progressively worsened. The pain is unrelated to physical activity, and he began vomiting around midnight tonight.

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PMH

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Alcohol withdrawal seizures 5 months ago, which have not recurred. Hypertension, which is medically controlled.

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FH

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Father died at age of 56 from an MVA; mother is 72 years old and has type 2 DM and “cholesterol issues,” for which she is taking an unknown medication. One sister, also with “cholesterol issues,” taking an unknown medication. The sister has a remote history of pancreatitis as well.

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SH

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Divorced with three children. Employed as a groundskeeper at a golf course. Quit smoking 2 weeks ago, admits to a 40 pack-year history of smoking. He states that he used to consume 6–10 beers per day until 5 months ago when he had a withdrawal seizure but now drinks only on weekends a total of about 6 beers; he reports sharing a couple of pitchers with two friends last night with dinner. Drinks at least two cups of coffee each morning.

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Meds

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  • Phenytoin 200 mg twice daily since his seizure

  • Hydrochlorothiazide 25 mg once daily for blood pressure

  • Doxycycline 100 mg twice daily for 10 days for “cellulitis” (now cleared as today is day 10)

  • Ibuprofen 200 mg OTC several doses per day PRN sore back muscles

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All

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Amoxicillin/clavulanate makes his stomach upset

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ROS

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He states that he has been feeling well until last night. His back soreness from unloading pallets of heavy sod a week ago has resolved with occasional ibuprofen use. He just finished a course of antibiotics this morning for mild cellulitis that was limited to a 1 × 2-in area of the left lower tibia. He has vomited approximately six times since midnight. No complaints of diarrhea or blood in the stool or vomitus. No knowledge of any prior history of uncontrolled blood sugars or cholesterol.

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Physical Examination

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Gen
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