Ruth is a 49-year-old office worker who presents to the clinic with a chief complaint of abdominal pain x 2 days

Ruth is a 49-year-old office worker who presents to the clinic with a chief complaint of abdominal pain x 2 days. The pain has significantly increased over the past 6 hours and is now accompanied by nausea and vomiting. The pain is described as “sharp and boring” in mid epigastrum and radiates to the back. Ruth admits to a long history of alcohol use, and often drinks up to a fifth of vodka every day.

Physical Exam: 

Temp 102.2F, BP 90/60, respirations 22. Pulse Oximetry 92% on room air.

General: thin, pale white female in obvious pain and leaning forward. Moving around on exam table and unable to sit quietly.

CV-tachycardic. RRR without gallops, rubs, clicks or murmurs

Resp-decreased breath sounds in both bases with poor inspiratory effort

Abd- epigastric guarding with tenderness. No rebound tenderness. Negative Cullen’s and + Turner’s signs observed.  Hypoactive bowel sounds x 2 upper quadrants, and no bowel sounds heard in both lower quadrants.

The APRN makes a tentative diagnosis of acute pancreatitis based on history and physical exam and has the patient transferred to the ER where laboratory and radiographic exams reveal acute pancreatitis.

Question:

Explain how pancreatitis develops and the role alcohol played in this patient’s case.