Vallarie Basa

HESI
July 22, 2016
Case #160
A. The Patient Medical History
The patient is a 38-year-old male who has abused alcohol his entire adult life. Preexisting medical conditions are not stated but risk factors of long-term alcohol abuse
include cardiovascular, liver and or pancreas disease. The patient is known to have had a
recent episode of binge drinking which is the consumption of an excessive amount of
alcohol in a short period of time. For men, the consumption of five or more drinks in
about two hours is considered binge drinking.
B. The Complaint
The patient experienced a gradual onset pain, which started to occur slowly, and is
becoming more noticeable. The gradual onset pain originated in hypochondriac region
(upper abdomen) that then radiates to his back. The pain persisted for several hours and
worsened each time he ate. Additionally, he complained about nausea; a feeling of
sickness which has lead him to experience repeated episodes of vomiting for the last
twenty-four hours.
C. The Objective Assessment
The patient appeared haggard with blood shut eyes and had a strong odor of alcohol. He
also suffered slurred speech a difficulty with word pronunciation and delayed response.
Indicating extensive pain, the patients arm is wrapped around the midsection of his
body. Patient also stated his alcohol abuse.
Physical exams are performed including palpation, gaseous distention and evaluation of
basic vitals including heart rate, blood pressure, oxygen saturation, breaths per minute
and temperature. Palpation is the application of fingers with light pressure on the surface
of the body to determine the consistence of organs beneath the skin. Gaseous distention
occurs when substances such as air or fluid accumulate in the abdomen causing an
outward expansion beyond the normal girth (shape of a normal organ).
Examinations reveals tenderness his upper hypochondriac region, a pseudo cyst which is
a circumscribed collection of fluid rich in pancreatic enzymes (natural chemicals that
help break down fat, proteins, and carbohydrates), blood, and necrotic tissue (dead
tissue), typically located in the mental bursa (lesser sac) of the abdomen. Vital signs are
also affected, with the heart rate increasing to 100-140 beats/min, a shallow and rapid
breathing pattern, and an interim high or low blood pressure with significant postural
hypotension (a form of low blood pressure in which a person's blood pressure falls when
suddenly standing up or stretching). Temperature may remain normal, but rise to 100 101 F, and sensation is diminished.

D. Analysis of Patient and Diagnostic Test

Health effects of long term abuse of alcohol result in many different chronic health
conditions. Mass intake of alcohol increases acid in the stomach, which in alcohol
abusers can lead to severe stomach pain or sores in the intestines.
Further clinical examinations of the gastrointestinal tract including a CBC, serum
chemistry panel, abdominal imaging scan. A CBC (complete blood count) is a blood test
used to evaluate the overall health of the patient and detects a wide range of disorders.
CBCs measures several components and features of the blood including leukocytes
(white blood cells: WBCs), erythrocytes (red blood cells: RBCs), platelets (thrombocytes:
a clotting factor in the blood) and hormones, which are regulatory substances.
Serum chemistry panels (SCP) are another form of evaluation for enzymes (natural
chemicals that help break down fat, proteins, and carbohydrates). This assessment is
performed on a blood sample drawn from the vein in the arm, processed and analyzed in
the laboratory. Certain component counts are compared to a normal range and
abnormalities are found when numbers excessively high. An enzyme called lipase is
responsible for the breakdown of fat and enzyme amylase breaks down starches like
carbohydrates. The two enzymes that become elevated in the serum in the first 24 to 72
hours of an acute attack are amylase and lipase. While amylase levels typically rise three
times greater than normal within the first two hours of symptom onset, the levels quickly
decrease in 36 hours. However, lipase levels increase within 4 to 8 hours of symptom
onset, peak around 24 hours, and remain elevated for at least 14 days. Levels of 10 to 140
units per liter (U/L), or 3 times the normal range indicates of an abnormality in one of the
main enzyme producing organ including the (stomach, small intestine and pancreas).
SCPs has the ability to analyze the status of several major body organs by comparing the
levels of certain enzyme production.
CBC and SCP resulted in numbers of islet cells, acinar cells and hormones is depleted.
Acinar cells cause inflammation and secretion of digestive enzymes into the small
intestine ducts (tubes) to support the digestion of bicarbonate, also known as a salt
containing element. Islet cells are cells that are dispersed throughout the pancreas,
playing a role of the endocrine gland, which releases two crucial hormones (insulin and
glucagon) that regulates blood sugar levels. Insulin helps store the sugar in your liver and
releases it when your blood sugar level is low or if you need more sugar, such as in
between meals or during physical activity. Glucagon functions similarly to insulin; it is
released when the body is not consuming enough sugar to sustain the normal amount of
sugar in the blood. Insulin and glucagon differ because two different cells secrete them.
Insulin is secreted by the beta cells of the pancreas and the alpha cells of the pancreas
secrete glucagon. When insulin is secreted, glucagon is inhibited to make sure the blood
sugar level is at equilibrium.
Ultrasound of the abdominal cavity is a two-dimensional imaging technique that utilizes
sound waves to study and treat hard to reach body areas. In scanning with ultrasound,
high-frequency sound waves are transmitted to the area of interest and the returning
echoes recorded. Ultrasound shows calcification, which is the accumulation of calcium

salts in body tissue resulting it to harden. Computed Tomography scan (CT scan) with
contrast which is an
agent medical contrast medium used to improve the visibility of internal bodily
structures. Calcified areas and fluid collection like a pseudo cyst have illuminated on the
pancreas, indicating an abnormality.
E. Diagnosis
With the basis symptoms of severe abdominal pain, vomiting, nausea, low and high
levels indicating pancreatic enzymes and illuminated imaging scans the patient is
diagnosed with acute pancreatitis. Acute pancreatitis is a condition that occurs in males
age forty or above who has had long term alcohol abuse.
The combination of alcohol abuse and low levels of indicated hormones, enzymes and
visual calcification of the pancreas results in a diagnosis of acute pancreatitis. The
diagnosis of the patient may have some uncertainties because the patient can have a
potential condition from medical and family history such as hereditary pancreatitis.
Previous medical issues or procedures can be an added factor for the patient's discomfort.
F. Treatment
The very first treatment care for acute pancreatitis is hydration. During an episode of
acute pancreatitis a patient can easily become dehydrated. Therefore, fluids are provided
through intravenous (IV) lines, which is a tube that is connected through a vein. Patient
may be fasting for a couple days to give the pancreas time to heal and recover. The
patient may receive nutritional support including education on what types of food is
compounded with enzymes that are easier to break down. Meals planning with smaller
portions and more frequent meals to gradually introduces and initiate the normal function
of the pancreas.
Painkillers such as an acetaminophen, ibuprofen and morphine may be administered to
help relieve pain though they have a tendency to make patients feel drowsy. Morphine is
an opium medicine also known as a narcotic. It is a short-acting formulation as needed to
relieve moderate to severe pain.
G. Prognosis and Treatment Plan
The patient must restrain from indulging in addictive substances (alcohol) is strictly
advised in order to prevent chronic (long term) pancreatitis. This disease can cause
disability or even death. The physician can assist their patient by providing their patient
with a great support system. As well as a counselor or therapist.
Should the patients condition worsen, a procedure called endoscopic retrograde
cholangiopancreatography (ERCP) may occur. This procedure consists of the removal of
the gallstones, which is one of the causes for pancreatitis; some cases may even result in
the gallbladder (small sac-shaped organ beneath the liver, in which bile is stored after
secretion by the liver and before release into the intestine) to be removed. An ERCP is
performed primarily to correct a problem in the bile ducts and pancreas. This means the
test enables specific treatment. If a gallstone is found during the exam, it can often be

removed, eliminating the need for major surgery. If a blockage in the bile duct causes
yellow jaundice or pain, it can be relieved by sphincterotomy or stent placement.

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