Pancreatitis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍upper abdominal pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Radiation ‍none to ‍back

Rated at ‍012345678910 / 10 ‍

Described as ‍crampingburning

Pattern ‍persistentintermittent

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍noneeating

Alleviating factors: ‍nonefasting, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍dizziness

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍jaundice

‍back pain



Contributing factors:

‍alcohol abuse

‍smoking

no history of: ‍prior pancreatitis, ‍gallstones, ‍alcoholism, ‍hypertriglyceridemia, ‍hypercalcemia

no use of: ‍GLP-1 inhibitors (semaglutide, liraglutide, exenatide, dulaglutide, albiglutide), ‍DPP-4 inhibitors





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Pancreatitis ‍likelysuspectedpossible

DDx: acute pancreatitis, chronic pancreatitis, alcoholic pancreatitis, gallstone pancreatitis, drug-induced pancreatitis, hypertriglyceridemia-induced pancreatitis, autoimmune pancreatitis, biliary colic, cholecystitis, peptic ulcer disease, gastritis, gastroenteritis, intestinal obstruction, ischemic bowel disease, perforated viscus, intra-abdominal abscess, renal colic, kidney stones, diabetic ketoacidosis, mesenteric ischemia, abdominal aortic aneurysm, inferior myocardial infarction





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍LFTs, ‍lipase, ‍amylase, ‍lipid profile, ‍triglycerides, ‍calcium, ‍glucose, ‍CRP, ‍troponin, ‍ß-hCG

- Abdominal ultrasound

- CT scan of abdomen

- Chest X-ray

- MRCP

- ERCP

Treatments:

- NPO

- IV fluids

- ‍Analgesics

- ‍Opioids

- ‍Anti-emetics

- ‍PPIs

- Reassess medications that may have caused pancreatitis (GLP-1, DPP-4)

- Light diet for the next days

Further care:

- Referral to gastroenterologist

- Follow-up in ‍ ‍daysweeks

- Return if pain worsens, fever develops, jaundice appears, or if new symptoms develop such as vomiting or changes in stool color

- Referral to ER if severe abdominal pain, severe vomiting, or fever occurs