Harvard University Patient Pancreatitis and Biliary Colic Questions QUESTION 1 A 50-year-old man, who is a chronic alcoholic, presents to the emergency roo

Harvard University Patient Pancreatitis and Biliary Colic Questions QUESTION 1
A 50-year-old man, who is a chronic alcoholic, presents to the emergency room with a sudden onset of abdominal pain that radiates to the back. A blood test reveals elevated serum pancreatic lipase levels and a CT abdomen suggests inflamed pancreas. Both of these findings together confirm the diagnosis of acute pancreatitis. The patient was admitted and appropriately managed. The pain reduces over the next two days. On day 3, the patient reports worsening of pain, nausea, and vomiting. An emergency CT abdomen was ordered, and the images reveal a pseudocyst around the pancreas. A pancreatic pseudocyst is a cavity surrounding the pancreatic head filled with pancreatic enzymes and is a common complication following acute pancreatitis. In a few hours following the diagnosis, the patient’s symptoms worsen, develops a fever, hematemesis (blood vomiting), cold and clammy skin, multi-organ failure, and dies. As a physician, you think that the patient developed these complications and died because the pancreatic pseudocyst ruptured. Based on the knowledge learned in this course, provide an explanation as to why this rupture led to complications and death of the patient.
Clue: Think about what the functions of pancreatic enzymes are, and why these enzymes are secreted first in an inactive form and not directly in an active form. QUESTION 2
A 40-year-old-woman, who leads a sedentary lifestyle with a BMI of 38.6, comes to the emergency room with the sudden onset of abdominal pain. The pain developed immediately following her dinner. The patient reports that she earned a promotion at her job that day in the morning and she decided to “treat” herself with a modestly lavish dinner. She had a 14-inch local specialty superior-cheese pizza that features a premium 3-inch topping of multiple cheese varieties. The patient also reports that she has had similar symptoms in the past and recalls an episode several months ago when she attended the Texas State Fair. In the State Fair, she enjoyed all the fried food, especially the fried ice-cream and fried Oreos. As a physician, you think the patient developed this pain because of gall bladder contractions (i.e., gall bladder colic). Based on the knowledge learned in this course, provide a detailed explanation listing the steps that occurred following the patient’s dinner to the development of gall bladder colic.
A 16-year-old high school student comes to your office for an obesity evaluation. She has a BMI of 32.3. She cries to you saying, “I don’t want to go to school anymore. I constantly get bullied and teased for being fat. I am scared to tell my parents.” She has been exercising vigorously almost every day for the past 4 years and has been limiting her calorie intake. She says “I am really frustrated of trying to lose weight. I am ready to give up. I am worthless.” As a physician, you reassure her and explain to her that excessive calorie intake and lack of exercise are not the only reasons for obesity, and it could also be due to other hormonal imbalances. The patient now feels better and says, “Really! This is interesting, doctor. That means this is not my fault and it could be potentially treated. I am really glad that I came to visit you. Doctor, on a side note, I am also interested in pursuing medicine and planning to enroll as a pre-med in college. I am curious as to what hormonal imbalances could cause obesity and how?”. What would be your reply?

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