Case 12.E—Acute Pancreatitis
A forty-nine-year-old stockbroker lost his job after being caught shaving funds from his client’s accounts.
He was admitted to the emergency department by a couple of his buddies, who reported that he had
been having a drinking session that had gone on for days. His friend had called to check on him and
found him collapsed in the kitchen, hunched over a chair with severe abdominal pain. On examination,
he was in shock and had severe abdominal tenderness.
1. What is pancreatitis? What is the distinction between acute and chronic pancreatitis? What
about mild or severe acute pancreatitis? What are the major causes of acute or chronic
pancreatitis? What is the likely cause of acute pancreatitis in our patient? Explain how alcohol
can cause pancreatitis? Explain how gallstones cause pancreatitis?
a. Inflammation and scarring in the pancreas
b. Acute pancreatitis
i. Reversible inflammatory condition- swelling and sometimes destruction of
pancreatic tissue (UTD,2021)
ii. Active form of pancreatitis (UTD,2021)
iii. Symptoms are sudden, patient often recovers in a few days (Norris,2020)
iv. Most common causes are gallstones an excessive ETOH consumption
v. In our patient drinking is the most likely cause(UTD,2021)
1. Mild-Not associated with complications or organ dysfunction and
recovery is uneventful (NHS, 2021).
2. Severe- severe pancreatic dysfunction, local and systemic complications
and complicated recovery (NHS, 2021).
c. Chronic pancreatitis
i. Symptoms may never fully subside (UTD,2021)
ii. Irreversible scar that forms from ongoing inflammation.
iii. Can lead to DM and impaired food digestion(UTD,2021)
iv. Most common causes excessive ETOH, smoking and recurrent acute
infections(UTD,2021)
d. Gallstones- biliary tract obstruction-pancreatic duct obstruction- activates the enzymes
of the pancreatic duct system (Norris, 2020).
e. Alcohol- oxidative and nonoxidative metabolism of ethanol by the pancreas and harmful
byproducts (Norris,2020)
i. Relatively unknown exact cause
2. What is the pathogenesis underlying acute pancreatitis? How does this underlying
pathophysiology relate to main signs and symptoms associated with acute pancreatitis?
i. “Involves the auto digestion of pancreatic tissue by inappropriately activated
pancreatic enzymes (Norris, 2020)”
ii. Begins with activation of trypsin- that activates pancreatic digestive enzymes-
cause pancreatic injury, with intense inflammatory response(Norris, 2020)
iii. Symptoms relate to inflammation, growth/rupture of pseudocysts.
1. Pancreatitis duct obstructions= pseudocysts (Norris,202).
iv. S/s
1. **Abdominal pain** epigastric or periumbilical and may radiate (Norris,
2020)
2. Fever, tachycardia, hypotension, abdominal tenderness, respiratory
distress, and abdominal distension (Norris, 2020).
A forty-nine-year-old stockbroker lost his job after being caught shaving funds from his client’s accounts.
He was admitted to the emergency department by a couple of his buddies, who reported that he had
been having a drinking session that had gone on for days. His friend had called to check on him and
found him collapsed in the kitchen, hunched over a chair with severe abdominal pain. On examination,
he was in shock and had severe abdominal tenderness.
1. What is pancreatitis? What is the distinction between acute and chronic pancreatitis? What
about mild or severe acute pancreatitis? What are the major causes of acute or chronic
pancreatitis? What is the likely cause of acute pancreatitis in our patient? Explain how alcohol
can cause pancreatitis? Explain how gallstones cause pancreatitis?
a. Inflammation and scarring in the pancreas
b. Acute pancreatitis
i. Reversible inflammatory condition- swelling and sometimes destruction of
pancreatic tissue (UTD,2021)
ii. Active form of pancreatitis (UTD,2021)
iii. Symptoms are sudden, patient often recovers in a few days (Norris,2020)
iv. Most common causes are gallstones an excessive ETOH consumption
v. In our patient drinking is the most likely cause(UTD,2021)
1. Mild-Not associated with complications or organ dysfunction and
recovery is uneventful (NHS, 2021).
2. Severe- severe pancreatic dysfunction, local and systemic complications
and complicated recovery (NHS, 2021).
c. Chronic pancreatitis
i. Symptoms may never fully subside (UTD,2021)
ii. Irreversible scar that forms from ongoing inflammation.
iii. Can lead to DM and impaired food digestion(UTD,2021)
iv. Most common causes excessive ETOH, smoking and recurrent acute
infections(UTD,2021)
d. Gallstones- biliary tract obstruction-pancreatic duct obstruction- activates the enzymes
of the pancreatic duct system (Norris, 2020).
e. Alcohol- oxidative and nonoxidative metabolism of ethanol by the pancreas and harmful
byproducts (Norris,2020)
i. Relatively unknown exact cause
2. What is the pathogenesis underlying acute pancreatitis? How does this underlying
pathophysiology relate to main signs and symptoms associated with acute pancreatitis?
i. “Involves the auto digestion of pancreatic tissue by inappropriately activated
pancreatic enzymes (Norris, 2020)”
ii. Begins with activation of trypsin- that activates pancreatic digestive enzymes-
cause pancreatic injury, with intense inflammatory response(Norris, 2020)
iii. Symptoms relate to inflammation, growth/rupture of pseudocysts.
1. Pancreatitis duct obstructions= pseudocysts (Norris,202).
iv. S/s
1. **Abdominal pain** epigastric or periumbilical and may radiate (Norris,
2020)
2. Fever, tachycardia, hypotension, abdominal tenderness, respiratory
distress, and abdominal distension (Norris, 2020).
