Question

B.A. is an obese male, age 60, who presents at the emergency department with bruising around the umbilical area and along his flanks. He states he did not injure himself, so he is not sure why the bruises appeared. B.A. reports that he “does not feel well at all.” He complains of pain in the abdominal area that radiates to his back. B.A. rates the pain as an 8 out of 10. B.A.’s abdomen is swollen, and he reports feeling nauseated. B.A. has not kept himself in optimal health. In addition to struggling with his weight, B.A. has had his gallbladder removed due to gallstones. He suffers from alcoholism. Blood laboratory values reveal elevated white blood cell count, elevated serum amylase, elevated serum lipase, and elevated blood glucose.

What are some of B.A.’s risk factors for acute pancreatitis?

Why are the Cullen and Grey Turner signs important?

Why are serum amylase and lipase elevated?

Answer 1

Risk factors for acute pancreatitis	Client picture (risk factors)
Most common cause is Gall bladder disease, in particular gall stones Second most common cause is chronic alcohol intake Smoking is an independent risk factor	B.A's gallbladder was removed due to gall stones B.A is alcoholic

2.Intravascular damge from circulating trypsin may cause areas of cyanosis or greenish to yellow brown discoloration of the abdominal wall. Other areas for ecchymosis include the Flanks, Grey Turner's spots or sign, a bluish flank discoloration and the periumbilical area , Cullen's sign- a bluish periumbilical discoloration. These result from seepage of blood stained exudate from the pancreas and may occur in severe cases. Shock may occur because of hemorrhage into the pancreas, toxemia from activated pancreatic enzymes or hypovolemia as a result of fluid shift into the retroperitoneal space(massive fluid shift)

3.The most common pathogenic mechanism is the autodigestion of the pancreas. The etiologic factors injure the pancreas and activate the pancreatic enzymes (serum amylase and lipase) in the pancreas rather than in the intestine. This may be due to reflux of bile acids into the pancreatic ducts through an open or distended sphincter of Oddi. This reflux may be caused by blockage created by gallstones. Obstruction of pancreatic ducts results in pancreatic ischemia

The primary diagnostic tests for acute pancreatitis is serum amylase and lipase. The serum amylase level is usually elevated early and remains elevated for 24-72 hrs. Serum Lipase , which is aso elevated in acute pancreatitis, is an important test because other disorders(mumps, cerebral trauma, renal transplantation) may increase serum amylase level