Acute Pancreatitis 2

Question

Vignette: A 25-year-old male presents to the emergency department with a one-day history of severe nausea, vomiting, and generalized weakness. He also complains of an intense, constant abdominal pain that started suddenly. His medical history is significant for cystic fibrosis. His blood pressure is 105/65 mmHg, heart rate is 110/min, respiratory rate is 20/min, and temperature is 37.5°C (99.5°F). Physical examination reveals diffuse abdominal tenderness but no rebound or guarding. The rest of the examination is unremarkable. Lab results show a serum sodium of 130 mEq/L, potassium of 3.0 mEq/L, chloride of 95 mEq/L, and bicarbonate of 28 mEq/L. Which of the following best explains the likely cause of this patient's presentation?

Choices

A) Addison’s disease

B) Cushing's syndrome

C) Pancreatic insufficiency

D) Chronic kidney disease

E) Diabetes mellitus

Answer

C) Pancreatic insufficiency

Explanation

This patient's history of cystic fibrosis, along with his presenting symptoms and lab results suggesting hypotonic dehydration (hyponatremia, hypokalemia), suggest pancreatic insufficiency. Cystic fibrosis is a genetic disorder that leads to the production of thick, sticky mucus that can damage many of the body's organs, including the pancreas. The mucus can block the ducts in the pancreas, preventing digestive enzymes from reaching the intestines to help break down and absorb food. This leads to malabsorption of nutrients and subsequent electrolyte imbalances, as seen in this patient. Pancreatic insufficiency can also lead to abdominal pain and malnutrition, which can cause weakness and fatigue.