Week 10

         The chosen diagnosis for this discussion is acute pancreatitis. Acute pancreatitis represents one of the most common cause of hospitalizations related to gastrointestinal disturbance in the U.s, and its incidence is on the increase in the US and throughout the globe. The illness's severity ranges from mild disease that requires conservative therapy to severe and complex disease with a high rate of morbidity and death. This exercise examines the diagnosis and treatment of acute pancreatitis, emphasizing the importance of the interprofessional team in the treatment of this illness. Pancreatitis pathogenesis includes both localized pancreatic damage and a systemic inflammatory manifestation. The inappropriate activation of conversion of trypsinogen to trypsin inside the acinar cell rather than in the duct lumen is the initiating event. This is thought to be caused by difficulties with both ph and also calcium homeostasis, as well as high ductal pressures frequently due to duct blockage). , Many toxins that cause pancreatitis (including alcohol) are thought to cause ATP depletion, leading to elevated intra-acinar concentrations of calcium which stimulates the conversion previously mentioned. . When these zymogens are activated early, they cause tissue damage and the production of Damage Associated Molecular Patterns (acronym of DAMPs). At the end, the inflammatory cascade is activated, leading to the specific signs and symptoms (Chatila et al.,2019).

Soap Note:

         Subjective – Chief complaints include discomfort at the right upper flan and mid-back pain, which incapacitates the patient. Frequently the pain tends to irradiate in a specific linear manner at the level of the upper abdomen.

         Objective – Usually, the patient remains both oriented and alerted and has a regular heart rate and rhythm. At the level of the lungs, there are no signs of rhonchi, wheezes, or rales. The abdomen can be distended, but the bowel sounds remain present. During laboratory tests, the amylase levels can increase very fast in the first 6 hours and peak at around 24 hours. It tends to remain at an elevated level for approximately 8 to 14 days. Due to the fact that the pancreas is passing through a stage of inflammation, the values of lipase will also be elevated (Gapp,Chandra,2021).

          Assessment – The differential diagnosis includes the following: peptic ulcer disease (which also tends to present as pain at the level of the upper abdominal level), myocardial infarction (especially inferior MI, which tends to be irradiated at the same level), diabetic ketoacidosis ( usually the patient is known of suffering from diabetes and tends to have uncontrolled levels of blood glucose), acute hepatitis ( due to the organ being located close to the pancreas, sometimes it can mimic acute pancreatitis; even so, it frequently presents with specific liver laboratory tests which are modified and also jaundice). For patients with this diagnosis, it is vital to provide an assessment of the severity, which will indicate the prognostic. Multiple clinical types of indexes were provided, the most frequent ones being CTSI and BISAP (MohyudMorissey,2021).

         Plan - Early vigorous fluid resuscitation remains the cornerstone of acute pancreatitis treatment. If no additional contraindications exist, lactated Ringer's solution is the suggested fluid, starting with a bolus of approximately 20 mL/kg and subsequent rates of 3 mL/kg per hour (typically 350 to 500 mL per hour). The fluid resuscitation is monitored using a combination of hematocrit, blood urea nitrogen, and urine output. The fluid rate is adjusted every 6 hours in the beginning. Continued non-response suggests a significant risk of MODS and warrants an increase in the amount of treatment. The etiology of pancreatitis determines the next steps in treatment. Early cholecystectomy is particularly indicated in gallstone pancreatitis. In situations with concomitant cholangitis and apparent biliary blockage, an early ERCP (in the first 24 hours) is beneficial (Chatila et al.,2019)

References

Chatila, A. T., Bilal, M., & Guturu, P. (2019). Evaluation and management of acute pancreatitis. World journal of clinical cases, 7(9), 1006–1020. https://doi.org/10.12998/wjcc.v7.i9.1006

Gapp J, Chandra S. (2021) Acute Pancreatitis. . In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482468/

Mohy-ud-din N, Morrissey S. (2021) ,Pancreatitis. . In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538337/