ADULT

Pancreat
itis
Katelyn Esposito, BSN, RN
NURS 7047
October 12th, 2022
Pathophysiology:
Acute pancreatitis is an inflammatory condition of the pancreas characterized by
abdominal pain and elevated levels of pancreatic enzymes in the blood. Acute
pancreatitis is a leading gastrointestinal cause of hospitalization in the United States
(Vege, 2022)

• Pancreatitis occurs when pancreatic enzyme secretions build up and begin to digest the organ
itself. It can occur as acute painful attacks lasting a matter of days, or it may be a chronic
condition that progresses over a period of years (Vege, 2022)

• Several conditions are associated with acute pancreatitis. Of these, gallstones and chronic
alcohol use disorder account for approximately two-thirds of cases. 
The Pancreas:
• The pancreas is located behind the
stomach in the upper left abdomen.
• It is surrounded by other organs
including the small intestine, liver,
and spleen.
• Several major blood vessels
surround the pancreas, the superior
mesenteric artery, the superior
mesenteric vein, the portal vein and
the celiac axis, supplying blood to
Pancreatitis:
more about the
Causes
Pancreatitis:
common
Symptoms
CASE STUDY
INTRODUCTIO
N

Bret, a 58-year-old man

presents with a sudden onset
of severe epigastric pain
radiating to his back and
shoulder. The patient also
complains of nausea with
vomiting.
OLDCARTS
• ONSET: x3 days (Mild), suddenly Acute
• LOCATION: Mid-upper abdominal pain, radiating to back and shoulder
• DUARTION: Began as mild (3 days), progressed and is now severe x6
hours, constant
• CHARACTERISTICS: Stabbing pain
• AGGRIVATING FACTORS: Sitting upright, Palpation
• RELIEVING FACTORS: None
• TREATMENTS (AND RESPONSES): None
• SEVERITY: 10/10
History of present
illness
• B.L is a 58-year-old male who presents today with
severe epigastric pain that radiates to his back
and shoulder. The patient also reports nausea and
vomiting.
• He reports diffuse abdominal pain over the past 3
days but states the the pain is now ”unbearable”.
• He also reports the nausea began this morning, and
he states he has thrown up 6 times since midnight .
Past medical history
PAST MEDICAL HISTORY: Hypertension –
Hyperlipidemia - Chronic Back Pain
PAST SURGICAL HISTORY: Appendectomy (as a
child, 1972)
FAMILY HISTORY: Father, deceased at 49 years old-
MI, alcoholic, Mother, unknown, Brother, alive and well.
No known family history of gastrointestinal
diseases/cancer.
SOCIAL HISTORY: Divorced, 2 children. Works mostly
remote, Insurance sales. Reports 6-10 beers/day x 15 (or
more) years. Current smoker, 25 pack years. Denies
elicit drug use.
ALLERGIES: PCN (rash)
Past medical history –
continued
HOME MEDICATIONS:
• Lisinopril 40mg PO BID
• Simvastatin 40mg PO DAILY
• Norco 5/325mg q8h PRN Moderate-Severe back
pain (Follows with pain mgmt.)
-VITAL SIGNS-
BP: 188/91, Temp: 99.5, Resp: 26/minute, HR:
106bpm, SpO2: 97% Room Air
Height: 6’1’’ Weight: 95.2kg (210lbs)
Review of systems
General: Denies weight changes, fatigue, chills, night sweats
HEENT: Denies vision changes, headaches, hearing changes, difficulty swallowing and nasal
congestion
Cardiac: +HTN, denies CP, denies palpitations, denies SOB, denies arrythmias and murmurs.
Pulm: Denies COVID-19 known exposure, denies SOB, denies cough, denies URI symptoms
GI: +Abdominal pain 10/10. +Nausea/vomiting. Began 3 days ago, mild. Reports sudden onset on
stabbing pain that radiates to the shoulder.
GU: Denies hematuria, frequency or urgency. Denies flank pain. Reports slight decrease in urine
volume.
Musculoskeletal: +Chronic back pain, denies recent injury or trauma.
Neuro: Slight tremor notes to bilateral hands when extended. Patients last drink 8 hours prior to
arrival.
Physical Exam
General: Well nourished, restless and agitated, diaphoretic. Wrapping arms around the
abdomen, forward leaning.
Neurological: A&Ox3, no focal deficits noted. Speech clear. Strength equal and strong upper
and lowers, bilaterally. Slight tremor notes to bilateral hands when extended. Patients last
drink 8 hours prior to arrival. Gait normal
Skin: Dry, No lesions, no Grey Turner or Cullen sign.
HEENT: Scalera white, no lymphadenopathy, oral mucosa dry, no carotid bruit, no JVD.
Cardiovascular: S1S2,, Tachycardic and regular, no rubs/murmurs or gallops. No edema.
Normal pulses
Lungs: All lung fields clear. Slight tachypnea. No stridor, no wheeze.
Gastrointestinal: Hypoactive BSx4 quads, +guarding, pain with light palpation. Moderate
distention. No hernia
Diagnostic test & lab results- pertinent
RESULTS

CT Impression: Acute pancreatitis associated

with thickened stomach wall.
EKG: Sinus Tachycardia
Na= 134 WBC=17,000 LDH= 411
K= 3.5 Hgb= 18 Alk Phos= 256
Cl= 99 Hct= 53 Amylase= 1874
HCO3= 25 Lipase= 2116
BUN= 34 AST= 291
Cr= 1.5 ALT= 276 Troponin: 0.421
Mg= 1.7 Total CK: 98
Differential
diagnosis
ACUTE ALCOHOLIC
PANCREATITIS
PEPTIC ULCER DISEASE
CHOLESYSTITIS
INTESTINAL
OBSTRUCTION
CORONARY
SYNDROME/MI
Problem list
Imaging LABS:
CT Abdomen: Indicative of pancreatitis Hyperlipidemia Mild dehydration
Mild hypokalemia
Symptoms; subjective & objective
Mild AKI
Abdominal Pain
Elevated Liver Enzymes
Nausea/Vomiting
Nausea/Vomiting Mild Hypo
Tachycardia magnesium
HTN
+ETOH Abuse
Assessment (primary diagnosis)

Acute pancreatitis
Based on the patient’s presenting symptoms,
risk factors, history significant for excessive
alcohol abuse, laboratory findings &
imaging.
The most likely diagnosis is Acute
Pancreatitis.
Recommendations/treatment plan/
follow up
• Admit to Inpatient
• Hydrate: 0.45% NS + 20meq
KCL/L @ 150cc/Hr.
• NPO Status
• Pain Control: Morphine Sulfate
4mg IV q4-6h PRN severe pain
• Inspirex q1hr while awake
• Accurate I&O
• Consult social services, +ETOH
abuse
• CIWA Assessment q shift
• Lorazepam 1mg iv prn, PER
CIWA PROTOCOL
• Stool for occult blood X3
• CYCLE CARDIAC ENZYMES
x2
• Magnesium sulfate 2mg iv X 1
Community resources
& support groups
Online Support:
https://jointempest.com
Personalized Support:
https://www.smartrecovery.org
CELLULAR APP SUPPORT:
https://hellosundaymorning.org/daybreak/
12-STEP PROGRAM:
https://www.aa.org

CRISIS TEXT LINE: TEXT HOME TO 741741

 Citations & references
Buttaro, T. M., Polgar-Bailey, P., Sanberg-Cook, J., & Trybulski, J. (2021).
Primary care interpersonal collaborative practice (6th ed.). Elsevier.

Cash, J. C., Glass, C. A., & Mullen, J. (2021). Family practice guidelines (5th
ed.). Springer.

Gapp, J., & Chandra, S. (2022, June 21). Acute Pancreatitis. National Library of
Medicine. https://www.ncbi.nlm.nih.gov/books/NBK482468/

Vege, S. (2022, April 27). Clinical manifestations and diagnosis of acute

pancreatitis. Up to Date.
https://www-uptodate-com/contents/clinical-manifestations-and-diagnosis-of-ac
ute-pancreatitis
THE END