Question

Mr. ABC is a 42 y/o Hispanic male who presented for a complaint of epigastric abdominal pain x 2 days. The pain is constant and radiates to the back. He describes the pain as a contraction and cramp like in nature and it is worse with eating. Pain severity is 6. The pain is better with sitting medications at that time for diabetes, HTN, and high cholesterol. He has only taken one dose of the diabetes medication and that was the day he was given the medications by the doctor. He was seen by another clinic yesterday for the abdominal pain and they started him on Bactrim and omeprazole, which he took yesterday but has not taken today. He has not taken any other medication. He denies any previous history of thyroid disorders and ETOH use. Associated symptoms included nausea and vomiting.

Physical exam:

Vital: 98.4-88-16-144/87, O2 sat is 98% on room air.

Normocephalic

Alert & Orientedx3. Well developed.

Eyes: PERL. No nystagmus

Neck: Supple, no cervical lymphadenopathy

Cardiovascular: Normal rate and rhythm. No murmur, gallops. 2+/4+          

                            radial, brachial, dorsalis pedis pulses bilaterally.

Pulmonary: Regular and even. Lungs with clear.

Abdomen: Soft, diffuse tenderness, active bowel sounds. No peritoneal signs. Negative                   

                  Murphy’s sign.

Skin: Warm, dry and pale.

Right upper quadrant Sonogram: Negative for gallstones

Questions

1. The clinical scenario is most consistent with which diagnosis? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.

2. What data in the clinical scenario supports your diagnosis? Make sure to interpret the lab values you list below. You may simply list your answers below using a bullet point format. This does not have to be in a complete sentence. Interpret the labs that you list as part of your answer by indicating normal, high or low.

3. What risk factor(s) led to this person’s diagnosis? You may simply list your answer below using a bullet point This does not have to be in a complete sentence.

4. Describe the key pathophysiologic concepts of the diagnosis in question 1. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences.
   1. What are the two most common causes of the disorder identified in question 1.
   2. What is the most likely cause of this patient’s diagnosis?
   3. Describe the pathological process which explains why this person is experiencing pain?
   4. What does the lipase value indicate?
5. For what actual or potential complications related to the diagnosis in question 1 does he need to be monitored? You may simply list your answer(s) below using a bullet point format. This does not have to be in a complete sentence.

Lab	Result
Na+	135 mEq/L
K+	4.0 mEq/L
creatinine	0.57 mg/dL
BUN	8 mg/dL
Glucose	193 mg/dL
WBC	12,640
Hematocrit	41.9%
Hemoglobin	15.3 g/dL
MCV	81.7
Platelets	317,000
AST	25 IU/L
ALT	25 IU/L
Alkaline Phosphatase	89 IU/L
Total bilirubin	0.7 mg/dL
GGT	15 IU/L
Lipase	>600 IU/L
Cholesterol	374
Triglycerides	1444

Answer 1

1) The clinical scenario is most consistent with which diagnosis? You may simply list your answer below using a bullet point format. This does not have to be in a complete sentence.

• The clinical scenario is most consistent with Pancreatitis.
• The classical symptoms are epigastric abdominal pain which radiates to the back.
• The pain is described like cramp and contraction which gets worst during eating.
• Other symptoms are nausea and vomiting.

2) What data in the clinical scenario supports your diagnosis? Make sure to interpret the lab values you list below. You may simply list your answers below using a bullet point format. This does not have to be in a complete sentence. Interpret the labs that you list as part of your answer by indicating normal, high or low.

• In pancreatitis, the WBCs shows some type of infection as WBC count is elevated.
• The cholestrol and tryglicerides are elevated.
• Patient has >600 IU/L lipase levels

3) What risk factor(s) led to this person’s diagnosis? You may simply list your answer below using a bullet point This does not have to be in a complete sentence.

• The patient has Diabetes.
• He also has high levels of cholestrol and tryglicerides
• Patient has >600 IU/L lipase levels

4) Describe the key pathophysiologic concepts of the diagnosis in question 1. To answer this question completely, you must answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences.

1) What are the two most common causes of the disorder identified in question 1.

Answer - The causes are Abdominal surgery, Alcoholism, Certain medications, Cystic fibrosis, Gallstones, High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism), High triglyceride levels in the blood (hypertriglyceridemia), Infection, Injury to the abdomen, Obesity, Pancreatic cancer

2) What is the most likely cause of this patient’s diagnosis?

Answer - The WBCs shows some type of infection as WBC count is elevated.

The cholestrol and tryglicerides are elevated.

3) Describe the pathological process which explains why this person is experiencing pain?

Causative factors Pancreatic acinar cell damage Trypsin activated Kallikrein-kinin activation Chymotrypsin activation Elastase activation Phospholipase Az activation Lipase Edema, inflammation Edema, vascular damage Vascular damage, hemorrhage Coagulation necrosis Fat necrosis

4) What does the lipase value indicate?

A normal lipase level can range from 0-160 U/L. Patient has >600 IU/L which is elevated.

5) For what actual or potential complications related to the diagnosis in question 1 does he need to be monitored? You may simply list your answer(s) below using a bullet point format. This does not have to be in a complete sentence.

Patient needs to be monitored for Pseudocysts, Pancreatic necrosis and infection, Chronic pancreatitis and Acities