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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.


Chief Complaint

“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 38-year-old woman who presents to the ED complaining of pain in her abdomen with radiation to her back. She also has noticed an increase in loose, foul-smelling stools with an oil-like consistency. Ms Jane has experienced intermittent pain in her abdomen for several years; she has also experienced chronic diarrhea with increased frequency in the last week. Concurrent with the pain are nausea and vomiting, which have increased in intensity and frequency in the past week. She states that she has a chronically dry mouth leading to difficulty swallowing, but with the increased nausea and vomiting, she has had decreased oral intake. 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 in over 10 years.


Parents are alive and healthy. She is an only child.


Occasional alcohol use (less than one glass of wine per week).

(+) tobacco use (12 pack years; currently 0.5 pack/day).

Denies any illicit drugs.

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 500–1000 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 ...

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