Case Study 5 Pancreatic Function

Case Study 5: (28-1) Part 1
A 38-year-old man entered the emergency department with the complaint of severe, mid-abdominal pain of 6 hours duration. A friend, who had driven him to the hospital, stated that the patient fainted three times as he was being helped into the automobile. The patient had a 15 year history of alcoholism and drank 1 to 2 pints of whiskey per day. He has been hospitalized for acute alcoholism 3 months ago, at which time he had minor abnormalities of liver function. On this admission, his blood pressure was 80/40 mm Hg; pulse 110 /min and thread. Respirations: 24/min and shallow.
Lab results:
Amylase- serum    640 units (3.5-260 units)
Sodium- serum     133 mmol/L ( 135-145 mmol/L)
Potassium- serum     3.4 mmol/L (3.8-5.5 mmol/L)
Calcium- serum    4.0 mmol/L ( 4.5-5.5 mmol/L)
BUN- serum    32 mg/ dL ( 8-25 mg/dL)
WBC     16, 500/ uL
HGB    12 g/dL

Questions: Answer in complete sentences and defend your answers.

1.    What is the probable disease?
2.    What is the cause for the low serum calcium?
3.    What is the cause for the increased blood urea nitrogen?

Case Study 5: 28-2 part (2)

A 56-year-old man is an alcoholic presents with a 2 week history of mid-abdominal pain. He also describes clay colored stools, mild icterus, nausea, vomiting, and a 10 lb. weight loss.

Lab results
Bilirubin     4.2 mg/dL ( 0.3-1.0 mg/dL)
LDH     625 IU/L (0-200 IU/L)
ALT    76 IU/L ( 0-46 IU/L)
ALKP     462 IU/L ( 0-80 IU/L)
Amylase    80 IU/L  (0-85 IU/L)
Urine bilirubin    3+ (negative)

Questions: Answer in complete sentences and defend your answers.
1.    What organ system is primarily involved?
2.    What are the major diagnostic considerations?
3.    What do the laboratory results mean? What additional laboratory tests would be useful in establishing a diagnosis?
4.    What other studies or procedures might be required?