Acute pancreatitis

Intended learning outcomes.

By the end of case discussion students will be able to

1. Understand the exocrine and endocrine functions of the pancreas.

2. Demonstrate knowledge of the effect of malnutrition on physiological function

3. Demonstrate biochemical basis of Pancreatitis and its effects on physiological

functions.

4. Identify of the clinical laboratory investigation for diagnosis and monitoring of

acute pancreatitis

Scenario

John Smith, a 35-year-old British citizen, recently employed in petroleum company in

Damam, presents to the emergency department with severe abdominal pain that started
suddenly a few hours ago.

He describes the pain as a constant, sharp, and radiating to his back. He rates the pain as
9 out of 10 on the pain scale.

He feels nauseous and has been vomiting since the onset of pain. He denies any recent
trauma, but admits to occasional alcohol consumption.

Medical History

No significant medical history (diabetes or hypertension)

5 weeks ago, He describes episodes of a boring, dull pain, diffusely felt in both his upper
abdomen and back. The pain varies in severity, becoming worse shortly after eating a
fatty meal.
He noticed an increase in flatulence together with feces becomes bulky, greasy, a light
creamy color and excessively foul smelling, are difficult to flush away from toilet, leaving
an oily residue, he also find oily stain sometimes appears on his underwear

Lifestyle

Occasional alcohol consumption, non-smoker

Physical examination

He appears to be in distress and is guarding his abdomen. His abdomen is distended, with
tenderness and rebound tenderness on palpation. Bowel sounds are diminished.

Investigation

● ALT 36 (reference range: 5-40 U/L)

● ALP 96 (reference range: 35-104 U/L)
● Bilirubin 13 (reference range: <22 µmol/L)
● Hb 10.3 (11.5-16 g/dL)
● White blood cells 12.7 (4-11 x109/L)
● Platelets 190 (150-400 x109/L)
● ESR 90 (Reference range: <20mm/hr)
● Urea 2.7 (reference range: 2-6.5 µmol/L)
● Creatinine 90 (reference range: 55- 100 µmol/L)
● Sodium 140 (reference range: 134-145 µmol/L)
● Potassium 3.8 (reference range: 3.5-5.3 µmol/L)
● Serum Amylase 2000 U/L (reference range: 28-100 U/L)
● Serum Lipase 1650 U/L (reference range: 15-80 U/L)
Management plan

1. NPO (Nothing by mouth)

2. Intravenous fluid resuscitation
3. Pain management with intravenous analgesics (e.g., opioids)
4. Pancreatic enzyme supplements with antacids before and after the meal or
through a proton pump inhibitor Or enteric coated granule formulation of
pancreatin
5. Antiemetics
6. Antibiotics may be initiated if signs of infection are present.

Learning Agenda

● What is the function of pancreas?

➢ Exocrine
➢ Endocrine
● What is the role of pancreas in lipid digestion?
● What is the role of pancreas in protein digestion?
● What is the biochemical basis of acute pancreatitis?
● What are the risk factors of acute pancreatitis?
● What is the role of alcohol consumption in the pathogenesis of acute
pancreatitis?
● What is the explanation for weight loss?
● What is the explanation for tiredness and weakness?

● What could be the cause of muscle wasting?

● What could account for the changes to his stools and excessive flatus?

● What could cause faces to be ‘oily/greasy’?

● How is dietary fat normally digested and absorbed?

● What are the implications of improper fat digestion and absorption on the
absorption of any micronutrients?
● What are the diagnostic markers of acute pancreatitis?

● What is your interpretation of the investigation report?

● What is the justification of the management plan?

● What is the expected prognosis?

● What is the follow up plan?