Digestive Case Study 6:

 

A 13-year-old boy is referred with recurrent pancreatitis. He has experienced numerous bouts of abdominal pain since age 3 each associated with rises in amylase and lipase. He now has almost daily abdominal pain . He has recently developed pale stools and weight loss of 4kg. There are no symptoms of jaundice, fevers, or pulmonary disease. There is a family history of chronic pancreatitis. His father and grandfather both have chronic abdominal pain and a diagnosis of chronic pancreatitis.

Abdominal Ultrasound has shown a dilated pancreatic duct.

A sweat test is negative. Serum lipids and calcium are normal.

 

ERCP is performed to confirm the diagnosis and to assess if endoscopic intervention is possible.

 

Pancreatography confirms Chronic Pancreatitis. There is a markedly dilated main pancreatic duct, and dilated side branches. There appears to be a number of intraductal filling defects in the head of the gland consistent with stones. (Cambridge IV) There are no dominant strictures, or pseudocysts. A grading scale for the severity of changes seen at pancreatography, using the Cambridge criteria (5), assists in classifying patients for different medical, endoscopic, radiologic and surgical therapy.

 

Diagnosis: The strong family, negative metabolic tests and ERCP findings make Heriditary Pancreatitis the most likely diagnosis. 

 

The diagnosis has traditionally been based on the findings of pancreatitis, usually starting in childhood, in two or more family members, in the absence of known precipitating factors.  Symptoms usually commence within the first two decades of life; 80% having their first attack of pancreatits by age 20.

 

Questions:

 

1.) Describe the mechanical and biochemical processes of digestion.  Indicate where each takes place.

 

2.) What role does the pancreas play in digestion and blood sugar maintenance?  Discuss in terms of both enzyme and hormone action.

 

3.) How might the diagnosis of pancreatitis affect the digestive processes?

 

4.) What is the cause of abdominal pain?

 

5.) What is a sweat test?  Why was it performed on the patient?

 

6.) Using the Cambridge criteria, how would you rank this patient?

 

7.) Discuss treatment options and long term prognosis.