Question

A 50-year-old man, who is a chronic alcoholic, presents to the emergency room with a sudden onset of abdominal pain that radiates to the back. A blood test reveals elevated serum pancreatic lipase levels and a CT abdomen suggests inflamed pancreas. Both of these findings together confirm the diagnosis of acute pancreatitis. The patient was admitted and appropriately managed. The pain reduces over the next two days. On day 3, the patient reports worsening of pain, nausea, and vomiting. An emergency CT abdomen was ordered, and the images reveal a pseudocyst around the pancreas. A pancreatic pseudocyst is a cavity surrounding the pancreatic head filled with pancreatic enzymes and is a common complication following acute pancreatitis. In a few hours following the diagnosis, the patient’s symptoms worsen, develops a fever, hematemesis (blood vomiting), cold and clammy skin, multi-organ failure, and dies. As a physician, you think that the patient developed these complications and died because the pancreatic pseudocyst ruptured. Based on the knowledge learned in this course, provide an explanation as to why this rupture led to complications and death of the patient.

Clue: Think about what the functions of pancreatic enzymes are, and why these enzymes are secreted first in an inactive form and not directly in an active form.

Answer 1

Pancrease is a retroperitoneal gland which secrete pancreatic juice which contains pancreatic enzymes to the duodenum through pancreatic duct. The pancreatic juice contains water, some salt, sodium bicarbonate, and digestive enzymes, The digestive enzymes are mainly starch digesting enzyme called amylase, proteolytic enzymes such as trypsin, Chymotrypsin, carboxypeptidase, and elastase. The triglyceride digesting enzyme is pancreatic lipase and the nucleic acid digesting enzymes are ribonuclease and deoxyribonuclease.

The proteolytic enzymes are produced in the pancrease in an inactive form to prevent the digestion of the pancreatic cells by the enzymes. The trypsin is produced in the form of Trypsinogen, and converted to the active form in the lumen of small intestine to produce Chymotrypsin, carboxypeptidase and elastase by the activating enzyme called Brush border enzyme enterokinase.

pancreatic pseudocyst contain large amount of Proteolytic pancreatic enzymes in active forms. the rupture cause digestion of protein in the adjacent organs which leads to hemorrhage, organ dysfunction, ascitics and peritonitis, septicemia and leads to death.