Question

A 36 year old caucasian, obese, female presents to the ED with a complaint of epigastric pain for the last 2 days. THe pain radiates through to her back, is consistant, sharp in nature and relieved with sitting up. Associated symptoms includes nausea and non-bloody emesis. Eating make the pain worse and therefore she has not eaten for the last 24 hrs. He is married and has two children. She denies any alcohol and drug use. One assessment she is afebrile, heart rate 100, respirations 22, and BP 110/70mmhg. SHe is restless from the pain, diaphorietic and has a icteric sclera. Heart and lung assessment are unremarkable. abdomen is soft with hypoactive bowel sound and tender in the epigastric area and RUQ.

LAB;

Sodium- 140

Potassium- 3.0

Creatnine- 1.0

BUN- 20

WBC 12000

Hct- 54%

Hgb-18

platetes 200,000

AST- 70

ALT 75

Alkaline phosphatase 294

Total bilirubin- 8.0

GGT- 65

Lipase- 1050

2020 Summer

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M9 Case Study

Submit Assignment

• Due Saturday by 11:59pm
• Points 100
• Submitting a text entry box or a file upload
• Available until Jul 18 at 11:59pm

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 that you list. 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 are the two most common causes of the diagnoses in question 1? Which etiology is most likely causing the diagnosis in question 1? You may simply list your answer below using a bullet point format. 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.

a. Why is the potassium value abnormal?

b. What do the abnormal GGT and Alkaline Phosphate indicate?

c. Why are the lipase and bilirubin elevated?

5. For what actual or potential complications related to the diagnosis in question 1 does she 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.

Answer 1

1. Diagnosis: Pancreatitis

2. Lab findings

· Bilirubin increased

· Potassium decreased

· GGT level increased

· Alkaline phosphatase increased

· Lipase level increased

3. Causes are:

· Hypercalcemia, gallstones and hypertriglyceridemia.

· Increased bilirubin and hypokalemia are the etiological signs for the patient.

4. Pathophysiologic changes

a. Normal potassium level are 3.6-5.2 mm/L but the patient have a low potassium level of 3 mm/L. This is lower because of nausea and vomiting.

b. The patient have alkaline phosphatase concentration of 294 but the normal patient have a concentration of 20-140 IU/L. Normal GGT level are 9-48 units but the patient have an abnormal level of 65. Abnormal GGT level indicate liver dysfunction and greater alkaline phosphatase indicate presence of gallstones or blockage in bile ducts which can lead to pancreatitis.

c. Total bilirubin in the patient is 8 however the normal range lies within the range of 0.1-1.2 mg/dl. Total lipase concentration in patient is 1050 U/L. however, the normal range is 0-160 U/L. 10 time greater lipase level in the blood is because of acute pancreatitis. Increased bilirubin indicate blockage in bilirubin clearance and liver dysfunction. Liver dysfunction can lead to acute pancreatitis.

5. Complications

· Acute complications: malnutrition, pancreatic cancer, infection and kidney failure

· Potential complications: breathing problems, digestion issues.