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The pancreas is an important gland that is situated under the liver, close to the gallbladder, stomach, and bowel, which is responsible for releasing essential digestive enzymes and hormones.
A usual scenario for patients with pancreatitis is a complaint of pain originating from the left upper quadrant of the abdomen. However, not all complaints of left upper quadrant pain automatically equate to pancreatitis – other conditions can share some of the same symptoms.
Pancreas Anatomy
The tail of the pancreas lies anterior to the left kidney and close to the spleen. When analyzing what a patient might have, you have to ask a series of questions concerning the location of the pain. Therefore, OPQRST assessment must take place.
When assessing for pancreatitis, you have to consider a couple of things:
- The quality of pain
- What provoked the pain
- The onset of the pain
The Main Provoker of Pancreatitis
With pancreatitis, the main provoker would be food. Eating triggers the pancreas to shoot out specific enzymes that, instead of going into the duodenum, they explode within the pancreas. Such enzymes are protease, lipase, and amylase. Once these enzymes are activated inside the pancreas, they cause inflammation; thus, pancreatitis happens.
Signs and Symptoms of Pancreatitis
A patient who is suffering from pancreatitis would display the following signs and symptoms:
- Increased respiratory rate that is rapid and shallow due to the presence of pain.
- Increased heart rate, also because of the pain.
- Abdominal distension
- A tender left upper quadrant
- Decreased or absent bowel sounds caused by the activation of enzymes inside the pancreas instead of the small intestine, which leads to undigested and unabsorbed food.
- Diarrhea
Pancreatitis Labs
Health care providers who are providing care for patients with pancreatitis should be wary of the following laboratory results:
- Increased amylase (carbohydrate enzyme)
- Increased lipase (fat enzyme)
- Increased blood sugar due to the absence of insulin
- Grey Turner Sign (which is discoloration or bruising of the flank) and Cullen sign (periumbical bruising, both which are due to hemorrhage)
- Decreased albumin
- Hypocalcemia due to a liver issue
- Increased phosphorus or phosphate
- Hyperlipidemia
- Decreased coagulation factors
Pancreas Imaging
The following imaging tests are done to diagnose pancreatitis:
- X-ray – results will reveal an enlarged pancreas and liver.
- CAT scans or computerized tomography – a type of x-ray that enables a 360 image result.
- MRI or magnetic resonance imaging – to check for soft tissue injuries.
- Ultrasound – aside from evaluating the pancreas, an ultrasound will also check for gallbladder involvement.
Effective and reliable diagnosis depends on laboratory and imaging results. These tests rule out or confirm that the patient is experiencing pancreatitis.
Involvement of Other Organs
When dealing with pancreatitis, it is essential to consider the connection and proximity of the pancreas to its neighboring structures. The gallbladder, liver, and pancreas all work together. For example, if a stone, fluid, and blood obstruct the bile or hepatic duct will back up, causing inflammation.
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