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Questions:
1.Read the scenario below and identify the likely acute digestive system disorder the patient is experiencing.
2.Explain the underlying pathophysiology (aka. cellular/tissue changes) and relate it to abnormal examination and diagnostic findings.
3. Explain additional diagnostic testing, medical treatment, and nursing care to treat the patient and/or prevent future complications.
Scenario:
Trudi Cleaver is a 54-year old female in the emergency department for increasing abdominal pain over the past 12 hours. The pain started after consuming a lot of fatty foods and alcohol during a friend’s birthday party. She also reports nausea and vomiting. Vomitus had no evidence of bleeding. She reports dyspnea, weakness, lightheadedness, diaphoresis, and a “racing” heart.
Past medical & family history
She has never smoked and consumes alcohol only for special occasions. She was incidentally diagnosed cholelithiasis 4 years ago after having an abdominal scan following a minor motor vehicle collision, but was asymptomatic and did not require treatment. She has a history of vitiligo and moderate hearing loss in her right ear following multiple childhood ear infections.
Both parents are living. Her father is aged 77 years old and has a history of hypertension, stable angina, and early chronic obstructive pulmonary disease. Her mother is aged 75 years and has a history of diverticulitis, cataracts, and iron-deficiency anemia. Her brother died at age 34 while serving in the military during the Afghanistan War.
Vital signs
Heart rate = 132 beats/min, regular
Respirations = 28 breaths/min, slightly labored
Oxygen saturation = 89% on 2L of oxygen via nasal canula
Temperature = 102.2° Fahrenheit (oral)
Blood pressure = 90/52 mmHg
Pain = 9/10, midabdominal and radiating to the back
Physical examination
Neurologic – lethargic, easily aroused, oriented, cooperative, grimacing and guarding abdomen
Skin – cool, diaphoretic, pale, intact, color appropriate for ethnicity with vitiligo noted on arms and knees
Abdomen – Bowel sounds hypoactive. Abdomen firm, distended, tender, and tense. Abdomen extremely tender especially in upper quadrants. Small amount of dark, yellow, cloudy urine.
Cardiovascular – heart rate rapid and regular, S1, S2, peripheral pulses thready and 1+, pedal edema 1+, and bilateral jugular venous distention
Pulmonary – lung sounds clear in apices, but bases diminished with crackles; short of breath with exertion
Musculoskeletal – full range of motion, strength 3/5 in extremities
Diagnostic test results
Chest x-ray – lungs with small bilateral pleural effusions and atelectasis
12-lead electrocardiogram (ECG) – sinus tachycardia, no acute ischemic changes
Computerized tomography (CT) scan of abdomen – Acute pancreatic inflammation with surrounding fluid collection, cholelithiasis, and thickened bile ducts walls. No free air or other abnormalities.
Fecal and gastric samples – no occult blood detected
Serum results – abnormal results and normal ranges below, all other results within their normal range
Result Normal
Blood urea nitrogen = 41………………………(6-20 mg/dL)
Creatinine = 3.1…………………………………….(0.9-1.3 mg/dL)
Glucose = 191……………………………………….(90-110 mg/dL
Amylase = 432………………………………………(40-140 U/L)
Lipase = 540………………………………………….(10-140 U/L)
White blood cells (WBC) = 19,000……….(4,500-11,000 cells/μL)
Neutrophils = 72%………………………………..(56-62%)
Platelets (PLT) = 112.4………………………….(150-400 1000 cells/μL)

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