Question

2. Joe Harrison, a 62-year-old bank executive, presents to the emergency room with severe abdominal pain. He describes the pain as excruciating, and indicates it is located in the mid epigastrium with radiation into his back. The patient states he has not eaten anything in the past 24 hours, but 2 days ago attended a wedding dinner and consumed a large meal and about 4 to 5 alcoholic beverages. Mr. Harrison admits to being a "social drinker," ingesting 2 to 3 alcoholic beverages several days a week. Based on his clinical presentation and history, Mr. Harrison is admitted with a diagnosis of rule-out pancreatitis. (Learning Objectives 4 and 5) Blood and urine samples are sent to the lab, and the results indicate that the serum amylase and lipase are markedly elevated. How do these findings correlate to the diagnosis of acute pancreatitis? a. The nurse notes that Mr. Harrison's stool is pale and bulky, while his urine is a dark tea color. Correlate these findings to the pathophysiology of acute pancreatitis b. Mr. Harrison's WBC is 18,500, and his serum glucose is 325. His LDH is 300 IU/L and the AST is 120 U/mL. Based on the Criteria for Predicting the Severity of Pancreatitis, what is Mr. Harrison's mortality risk? c.

Answer 1

(a) Pancreatitis is a medical condition wherein the pancreas of the patient is inflammed.This results in rupture of the gland and its cells. Pancreas is responsible for producing 2 digestive enzymes - lipase and amylase. Hence, during inflammation, it is very likely that the ruptured pancreas shall cause leakage of these as a result of which their serum and urine levels shall be evelated.

(b) one of the causes of pancreatitis could be obstruction in the gall bladder, say due to gall stones. As bile salts give the normal colour to the stool. Abnormality in the levels of bile salts in the it can alter its colour.

(c) Mortality risk for a person sufferring from pancreatitis is calculated using Ranson's criterion. Hence for Mrs. Harrison it is 15%.

Criterion is as follows

Age> 55yrs

glucose>220mg/dL

WBC >18000/ml

AST >250U/L

LDH>400U/L