Question

A 36 years old Caucasian obese female presents to the ER with a complaint of epigastric pain for the last 2 days. The pain radiates through to her back, is constant, sharp in nature, and reliever with sitting up. Associated symptoms include nausea and non-bloody emesis. Eating makes the pain worse and therefore she has not eaten for the last 24 hours. She is married with 2 children. She denies any alcohol or drug use. On assessment she is afebrile, HR is 100, RR 22, and BP is 110/70mmhg. She is restless from the pain, diaphoretic and has icteric sclera. Heart and lung assessment are unremarkable. The abdomen is soft with hypoactive bowel sounds and tender in the epigastric area and RUQ.
labs:
Sodium 140. potassium 3.0. Creatinine 1.0. BUN 20. WBC 12000, HCT 54. Hgb 18. Plt 200000. AST 70. ALT 75. Alkaline phosphatase 294. Total bilirubin 8.0. GGT 65. Lipase 1050.

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 diagnosis 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

Answer1. the clinical senerio is consistent with pancreatitis

Answer 2, Lipase 1050 is high , Alkaline phosphatase 249 high, bilirubin 8.0 high, GGT 65 high

Answer 3. Two major causes gallstones and  alcoholism.

Answer 4. Gallstones is the like etiology in this case.

Answer 5. pathophysiology of pancreatitis

• Ductal obstruction causes pancreatic inflammation leading to pancreatic autodigestion, persistent edema and possible pancreatic necrosis

A) Potassium level is abnormal due to dehydration , prolonged vomiting and calcium deposit in the pancreatic tissue

B) Abnormal GGT and alkaline phosphate indicate liver damange

c) Bilirubin elevates due to retain stone in the bile ducts or due to compression of the prancreatic edema in the bile duct. Lipase elevates due to inflammation of the pancreatic tissues. Inflammation of the pancreats causes extra released of lipase.

Answer 5.

• Psuedocyst
• pancreatic cancer
• kidney failure
• malnutrition
• breathing difficulty
• Diabetes