Updated: 03/17/08 03:46 PM
HOME HEAL EDUCATE RESEARCH DIRECTORY OUTREACH


Authors: G. Leinbach, B.J. Reid, D.R. Saunders, and T.D. Nguyen
Download Chapter ♦ Download Lecture Slides & Notes

H. Case Histories

Case I

A 60-year old woman presents with vomiting and gnawing epigastric pain which has radiated to her back for 8 hours. She denies taking prescription medicines or abusing alcohol. Three years ago, she had an evaluation for fleeting episodes of right upper quadrant pain; an ultrasound of her right upper quadrant revealed gallstones, but she refused further investigation.

On examination, she is a healthy-appearing lady, but in obvious distress. She has tenderness to deep palpation in the epigastrium which appears to be disproportionately distended in relationship to the rest of her abdomen. Her radial pulse is 110 per minute, and her blood pressure is 90/60.

The initial laboratory evaluation includes hematocrit of 40 and serum amylase ten times normal.

  1. How would you explain the following phenomena if they occurred during an attack of acute pancreatitis?


    1. Fluid in the abdomen
    2. Radiation of pain to the back
    3. Jaundice
    4. Left pleural effusion
    5. Hypotension
    6. Hyperglycemia
    7. Hypocalcemia
    8. Respiratory distress
    9. A toxic course with fever developing over the next four days? Over the next 14 days?
    10. A dilated section of transverse colon seen on abdominal X-ray
    11. A dilated, fluid-filled stomach seen on abdominal X-ray
    12. Pancreatic enzymes in peripheral venous blood

  2. Based on your knowledge of pancreatic secretion, how would you propose to treat this patient?
Case II

Our patient is a 56-year old chronic alcoholic who has complained of bouts of severe epigastric pain over the past five years. Now he is complaining of losing weight although his appetite is reasonably good. His fasting blood sugar is twice normal, and his stools contain excessive amounts of triglyceride. What is your diagnosis and how would you support your hypothesis?

  1. How would you treat him?
Case III

This 67-year old man began to experience dull, epigastric pain which radiated to his mid-back three months ago. At first, lumbar arthritis was thought to be the cause, and the discomfort was lessened by taking an NSAID (ibuprofen). His appetite diminished, and one month ago, his friends thought that his eyes were yellow. The patient remarked that his stools were lighter in color and more bulky; his urine was darker.

  1. How would you proceed?
Practice Question

Based on your knowledge of pancreatic pathophysiology, explain why you would or would not use each of the following interventions as therapy in acute pancreatitis:

  1. intravenous infusion of secretin
  2. intravenous infusion of Ca2+
  3. intraduodenal infusion of trypsin
  4. intraduodenal infusion of amino acids and fatty acids



© Copyright University of Washington Division of Gastroenterology 1999-2008