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After completing this case study, the reader should be able to:
Identify subjective and objective findings consistent with chronic pancreatitis and acute exacerbations of chronic pancreatitis.
Evaluate patient-specific data and develop a problem list for patients with acute exacerbations of chronic pancreatitis.
Discuss therapeutic alternatives and outline a patient-specific plan for pain management during an acute exacerbation of chronic pancreatitis.
Recommend appropriate pancreatic enzyme replacement therapy for management of steatorrhea in a patient with chronic pancreatitis.
“I have had pain in my stomach for years, but now I just can’t take it anymore. It feels like a shot to the gut.”
Madeline Jane is a 35-year-old woman who presents to the ED complaining of pain in her abdomen and with radiation to her back. She also has noticed an increase in loose, foul-smelling stools and has observed a fatty content and consistency to her stool. Ms Jane has experienced pain in her abdomen for several years; she has also experienced chronic diarrhea with newly increased frequency in the last week. Concurrent with the pain are nausea and vomiting, which have also increased in intensity and frequency in the past week. Ms Jane presents to the ED today as she now has access to health insurance. She did not seek medical attention previously due to the financial implications of being uninsured.
There is no formal past medical history because the patient has not sought medical care since college due to being uninsured. Patient reports receiving the “usual” childhood vaccinations and medical care, but she has not seen a physician since college when she was dropped from her parent’s medical coverage. Ms Jane states that she has had pain in her stomach and diarrhea for years but just dealt with it. Within the past week she noticed an increase in pain, increase in frequency of diarrhea, and change in the consistency and fatty content of her stool.
Parents are alive and healthy. She is an only child. Patient does not drink alcohol, smoke cigarettes, or use illicit drugs per patient report. She is single and not sexually active. Ms Jane just started a new job as a medical claims processor at St. Anthony’s hospital; she has completed a college-level education.
Multivitamin one tablet by mouth daily, has been taking for several years
Acetaminophen 500 mg by mouth Q 6 H PRN for abdominal pain; frequent daily use
Loperamide two tablets initially, and then one tablet by mouth PRN diarrhea; she usually takes two to four tablets per day
No prescription medications...