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LEARNING OBJECTIVES

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

  • Determine the subjective and objective information (include medical history, signs, symptoms, and laboratory values) commonly associated with acute pancreatitis.

  • Evaluate precipitating factors associated with acute pancreatitis.

  • Describe the potential etiologies and systemic complications associated with acute pancreatitis.

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

  • Develop therapeutic goals and a therapeutic plan with appropriate monitoring parameters to assist the healthcare team in realizing desired therapeutic outcomes in a patient with acute pancreatitis.

PATIENT PRESENTATION

Chief Complaint

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

HPI

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.

PMH

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

FH

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 a “statin.” One sister, also with “cholesterol issues,” taking an unknown medication. The sister also has a remote history of pancreatitis.

SH

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. He now drinks only on weekends for a total of about six beers; he reports sharing a couple of pitchers with two friends last night with dinner. Drinks at least two cups of coffee each morning.

Meds

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” (day 10 of 10)

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

All

Amoxicillin/clavulanate makes his stomach upset

ROS

The patient states that he has been feeling well until last night. His back soreness from unloading pallets of heavy sod 1 week ago has resolved with occasional ibuprofen use. He just finished a course of antibiotics this morning ...

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