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Pancreatitis: Pathology review
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While in the Emergency Department, two individuals came in with severe epigastric pain. Michael who is 45, complains of pain that radiates to his back, vomiting, and nausea.
All of these symptoms appeared after he came home from partying at the bar a few hours ago.
On the clinical examination, there’s epigastric tenderness without guarding or rebound, decreased bowel sounds, and purple discoloration around the periumbilical region. He also tends to bend over to relieve the pain.
Anna, who is 29 years old, on the other hand, says the pain started abruptly and that it doesn’t radiate anywhere. She also noticed it gets worse after her meals. On examination, she presents with epigastric pain, scleral icterus, and fever.
Both were admitted and started on IV fluids.
Blood tests were ordered, which revealed lipase and amylase levels that were 3 times more than normal.
Ok, so from what we can gather, both people have acute pancreatitis.
The exocrine pancreas releases digestive enzymes through smaller ducts which drain in the main pancreatic duct.
Acute pancreatitis occurs when there is a sudden and severe inflammation, which usually resolves within a few days with proper treatment. It is commonly caused by gallstones and alcohol, and typically presents with epigastric pain that radiates to the back, nausea, vomiting, and decreased bowel sounds.
Chronic pancreatitis occurs when there is a long-term inflammation that can cause permanent damage to the pancreas and lead to serious complications. It is usually due to long-term alcohol use, genetic diseases like SPINK1 mutations and cystic fibrosis, pancreatic duct obstruction due to tumors, and autoimmune conditions.
People with chronic pancreatitis may be initially asymptomatic for a long time, but they might develop epigastric pain that radiates to the back, steatorrhea, fat-soluble vitamin deficiency like vitamin A, D, or E; diabetes, and unintentional weight loss.
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