B.K. is a 63-year-old woman who is admitted to the step-down unit from the emergency department (Ed)with nausea and vomiting (N/V) and epigastric and left upper quadrant (LUQ) abdominal pain that issevere, sharp, and boring and radiates through
to her mid back. The pain started 24 hours ago and awoke
her in the middle of the night. B.K. is a divorced, retired sales manager who smokes a half-pack of cigarettes daily. The Ed nurse reports that B.K. is anxious and demanding. B.K. denies using alcohol. Her vital
signs (Vs) are as follows: 100/70, 97, 30, 100.2° F (37.9° C) (tympanic), spo2 88% on room air and 92% on
2 L of oxygen by nasal cannula (NC). she is in normal sinus rhythm. she will be admitted to the hospitalist
service. she has no primary care provider (PCP) and has not seen a physician "in years."
The Ed nurse giving you the report states that the admitting diagnosis is acute pancreatitis of
unknown etiology. A computed tomography (CT) scan has been ordered, but unfortunately the CT scanner is down and will not be fixed until morning. However, an ultrasound of the abdomen was performed,
and "no cholelithiasis, gallbladder wall thickening, or choledocholithiasis was seen. The pancreas was not
well visualized due to overlying bowel gas." Admission labs have been drawn; a clean-catch urine specimen was sent to the lab, and the urine was dark in color.
What are the possible causes of pancreatitis?
The most common causes are biliary tract disease (obstructive process, such as a common bile
duct [CBD] stone) and excessive alcohol use. Other possible causes include external (blunt) trauma,
pancreatic obstruction, hyperlipidemia, hypercalcemia, and penetrating duodenal or gastric ulcers.
Certain drugs might cause pancreatitis if toxic levels are reached: opiates, sulfonamides, thiazides,
and steroids.
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