Patient Pancreatitis and Biliary Colic

QUESTION 1

A 50-year-old man, who is a chronic alcoholic, presents to the emergency room with a sudden onset of abdominal pain that radiates to the back. A blood test reveals elevated serum pancreatic lipase levels and a CT abdomen suggests inflamed pancreas. Both of these findings together confirm the diagnosis of acute pancreatitis. The patient was admitted and appropriately managed. The pain reduces over the next two days. On day 3, the patient reports worsening of pain, nausea, and vomiting. An emergency CT abdomen was ordered, and the images reveal a pseudocyst around the pancreas. A pancreatic pseudocyst is a cavity surrounding the pancreatic head filled with pancreatic enzymes and is a common complication following acute pancreatitis. In a few hours following the diagnosis, the patient’s symptoms worsen, develops a fever, hematemesis (blood vomiting), cold and clammy skin, multi-organ failure, and dies. As a physician, you think that the patient developed these complications and died because the pancreatic pseudocyst ruptured. Based on the knowledge learned in this course, provide an explanation as to why this rupture led to complications and death of the patient.
Clue: Think about what the functions of pancreatic enzymes are, and why these enzymes are secreted first in an inactive form and not directly in an active form.