Pancreatitis: Clinical

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Pancreatitis: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 53-year-old-man comes to the office for follow-up after being hospitalized for his first episode of acute alcohol-induced pancreatitis last month. He feels well and denies any abdominal pain, nausea, anorexia, or diarrhea. His medical history is significant for heavy chronic alcohol use, and he does not take any medications. His immediate family members are all healthy. He smokes one pack of cigarettes per day. His vitals are within normal limits. Laboratory results show serum electrolytes, cholesterol and triglyceride levels are within normal limits. In addition to limiting alcohol intake, which of the following is most likely to reduce this patient’s risk of developing chronic pancreatitis?  


Pancreatitis is inflammation of the pancreas.

In acute pancreatitis, the pancreas’ own digestive enzymes get suddenly get activated within the pancreas and cause autodigestion which results in inflammation and hemorrhaging.

In chronic pancreatitis, there are indolent causes of inflammation that damage the pancreas, leading to impairment of both endocrine and exocrine functions of the pancreas.

Now, first thing’s first. Acute pancreatitis is usually caused by gallstones and ethanol abuse, but there are other causes as well, and the full list can be remembered using the mnemonic “I GET SMASHED”: where ‘I’ refers to unknown, or Idiopathic, causes; ‘G’ is obstruction by Gallstones, ‘E’ is Ethanol abuse; ‘T’ is a pancreatic Trauma, which is more likely if the trauma is the result of a puncture injury, like a knife wound rather than a punch; ‘S’ is the use of Steroids; ‘M’ is infection with Mumps virus, ‘A’ is the result of Autoimmune diseases; the second ‘S’ is the result of a Scorpion sting—which is probably the most exciting item on this list and one of the more rare causes - so check your shoes!; ‘H’ is a cheat and stands for both Hypertriglyceridemia and for Hypercalcemia; ‘E’ is trauma from an Endoscopic retrograde cholangiopancreatography or ERCP which is a technique used to diagnose and treat various biliary and pancreatic diseases; and finally ‘D’ stands for Drugs, like sulfa drugs, reverse-transcriptase inhibitors, and protease inhibitors.

Individuals with acute pancreatitis usually have severe epigastric abdominal pain that radiates to the back, along with nausea and vomiting over several hours.

In mild cases, there may be tenderness in the epigastrium, and in severe cases, there might be hypovolemic shock which can cause tachypnea, hypoxemia, and hypotension or systemic inflammatory response syndrome or SIRS, which can cause those same symptoms as well as fever.


Pancreatitis refers to the inflammation of the pancreas, an organ located in the abdomen that produces hormones responsible for glycemia control, and enzymes that help digest food. Pancreatitis can be acute, or chronic.

Acute pancreatitis can be caused by gallstones, alcohol consumption, pancreatic trauma, and infections such as with mumps virus. It is characterized by epigastric abdominal pain, nausea, and vomiting.

Chronic pancreatitis is a long-term condition that can cause progressive and permanent damage to the pancreas. Causes of chronic pancreatitis include long-term alcohol abuse, genetic mutations, pancreatic duct obstruction due to tumors, and autoimmune conditions, like systemic lupus erythematosus. Treatment typically involves hospitalization, pain management, and addressing the underlying cause of pancreatitis. In severe cases, surgery may be necessary.


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