You are the triage nurse in the Emergency Department. Your patient, Mr. Sawyer,

Question

You are the triage nurse in the Emergency Department. Your patient, Mr. Sawyer, is a 48 year old man who presents with severe abdominal pain, poor appetite, and fatigue. He states the pain awakened him from sleep and he began vomiting. He denies any relief from the pain and he can’t get comfortable as the pain radiates to his back and right shoulder. He rates his current pain level as 10/10. He denies any previous medical or surgical history. He denies any tobacco or drug use. States he drinks “just a beer or two after work each day” though he reports to “more than usual” alcohol consumption this past weekend after attending a bachelor party. He lives with his wife and 2 children and works fulltime as a construction foreman. Initial vital signs: BP 160/94, resp 24, pulse 100, temp 99.6 orally, pulse ox 99%.

Amylase

418 U /L

Lipase

307 U/L

White Blood Cells

15.5 bc/L

Hemoglobin

13.8 g/dl

Hematocrit

39.2 %

Platelets

300 b/L

Now that you have reviewed Mr. Sawyer’s laboratory studies and were able to identify the likely cause of his abdominal pain discuss in detail the pathophysiology of his medical diagnosis. (You will need to utilize your patho text to appropriately answer this question, you may also utilize additional references, please cite all resources).

Amylase

418 U /L

Lipase

307 U/L

White Blood Cells

15.5 bc/L

Hemoglobin

13.8 g/dl

Hematocrit

39.2 %

Platelets

300 b/L

Explanation / Answer

As seen from the lab reports of increased WBC, Amylase and lipase and low hematocrit levels revealing that infection in pancreas i.e pancreatitis

Pathophysiology:

The likely cause of abdominal pain is due to acute pancreatitis, it is the predominant symptom patients may experience it radiate towards back and intensity is high for few days.

causative etiological factor- ------>reversible cell/ non reversible cell injury-----> if non reversible-----> necrosis and apoptosis------> initiation of abdominal pain or event----->Acinar cells gets injured----> impairment in zymogen granules to release proenzymes---->premature enzyme activation------->Auto digestion

In case of chronic pancreatitis, progresssive inflammation----->inflammation is irreversible and chronic---->fibrosis---->Calcification-------> impairment in pancreatic function

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