Pancreatic Pablo — Acute Pancreatitis
Boring epigastric pain to the back, lipase ↑, Ca²⁺ ↓ — NPO and rest the gland
Pablo doubles over after a heavy meal and a night of drinking. The pain bores through to his back, he cannot lie flat, and he is drenched in sweat.
Pablo's pancreas is digesting itself. Severe epigastric pain radiating straight through to the back, worse lying flat and better leaning forward. Lipase is the most specific lab. Calcium falls as fat necrosis binds it, and Cullen's or Turner's sign means bleeding.
Read Pancreatic Pablo's full story →The story arc
The setup
Years of alcohol use and a history of gallstones — the two leading causes sitting in one patient.
The turn
Sudden severe epigastric pain radiating to the back, nausea, vomiting that brings no relief, and he curls forward in the bed.
The crisis
Lipase five times normal, calcium 7.4, glucose 210, and a bluish discoloration around his umbilicus.
The save
NPO with IV fluids to rest the pancreas, opioid analgesia, antiemetics, electrolyte replacement, and no alcohol ever again with a low-fat diet on reintroduction.
NCLEX study section — Acute Pancreatitis
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Gastrointestinal & Renal
Take this chapter into practice questions on the same topic.