Exemplar 4.4: Pancreatitis

There are 2 types of pancreatitis: Acute and chronic (what a shocker). Below are descriptions of the 2 types. Drag and drop the correct answer. Acute pancreatitis is an inflammatory disorder that involves self-destruction of the pancreas by its own enzymes through [blank_start]autodigesion[blank_end]. The milder form is called [blank_start]interstitial edematous pancreatitis[blank_end]; it leads to inflammation and edema of the pancreatic tissue, and it is often self limiting. The more severe form is called [blank_start]necrotizing pancreatitis[blank_end]; it is characterized by inflammation, hemorrhage, and ultimately death of pancreatic tissue. Although the exact cause of acute pancreatitis is unknown, the following factors may lead to activation of the pancreatic enzymes and cause the symptoms of acute pancreatitis: -[blank_start]Gallstones[blank_end] may obstruct the pancreatic duct or cause bile reflux, activating pancreatic enzymes in the duct system. -[blank_start]Alcohol[blank_end] causes duodenal edema, and may increase pressure and spasm in the sphincter of Oddi, causing pancreatic outflow. Regardless of what caused it, the process begins with the release of activated pancreatic enzymes into pancreatic tissue. [blank_start]Trypsin[blank_end] in particular will digest pancreatic tissue and activate other enzymes, such as [blank_start]phospholipase A[blank_end] (responsible for digesting cell membrane phospholipids) and [blank_start]elastase[blank_end] (responsible for digesting elastic tissue of blood vessel walls). All of this will lead to proteolysis, edema, vascular damage and hemorrhage, and necrosis of parenchymal cells. Chronic pancreatitis, on the other hand, is characterized by chronic inflammation, fibrosis, and gradual destruction of functional pancreatitis tissue. [blank_start]Alcoholism[blank_end] is the primary risk factor, but about 10-20% of cases are idiopathic. A genetic mutation associated with [blank_start]cystic fibrosis[blank_end] may play a role in the idiopathic cases. In chronic cases related to alcoholism, pancreatic secretions have an increased concentration of [blank_start]insoluble proteins[blank_end]. These proteins calcify and block the [blank_start]pancreatic ducts[blank_end] and flow of pancreatic juices. In other cases, a stricture or stone may block the outflow, causing [blank_start]chronic obstructive pancreatitis[blank_end]. Recurrent episodes of inflammation eventually lead to [blank_start]fibrotic[blank_end] changes in the perenchyma, with loss of exocrine function. This leads to malabsorption from pancreatic insufficiency. It can also cause a loss of endocrine function.

Alcoholism is a risk factor in both acute and chronic pancreatitis.

Destruction from chronic pancreatitis is reversible. Destruction from acute pancreatitis, on the other hand, is not.

Which of the following is NOT a factor associated with acute pancreatitis?

Select the individuals that display a risk factor for developing chronic pancreatitis.

You have a male patient come after passing out at home. His wife reports that he's been nauseated and hasn't been able to keep anything down for the past 24 hours. She also reports that he's been complaining of pain right above his belly button. Upon physical assessment, you find that his abdomen is distended and rigid. His heart rate is at 110 bpm, his BP is at 90/60, his respirations are at 25 per minute, and his temperature is at 102.5 degrees Fahrenheit. When you were taking his pulse, his hands were cold and clammy. Which type of pancreatitis do you think this patient has, based off his symptoms?

Select the options that are NOT a complication of untreated acute pancreatitis.

You have a patient in your office complaining about recurrent episodes of pain in her left upper abdomen. She hasn't been able to eat, and whenever the pain comes back she feels nauseated. She said that she's dropped about 10 pounds from being unable to eat. She also notes that she's been taking laxatives a lot more often because she's having a hard time defecating. When she does defecate, she notes that her fecal matter is frothy and smells absolutely horrible. Which kind of pancreatitis does this individual have?

Select all of the potential complications of chronic pancreatitis.

Which of the following is NOT an appropriate intervention for treating acute pancreatitis?

Which of the following is NOT a medication given for chronic pancreatitis?

You are assessing a patient that you believe has pancreatitis. Select everything that would be in your assessment.

You are implementing care for a patient with pancreatitis. He will need an endoscopic transduodenal sphincterotomy. He is NPO, both in preparation for his surgery and to promote rest of his pancreas. You believe him to be at risk of electrolyte imbalances. due to presence of abdominal distension. Select the appropriate interventions