Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Pancreatitis (Inflammation of the Pancreas)

Evaluate breaches in the standard of care to evaluate a Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Pancreatitis (Inflammation of the Pancreas)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Moderate to severe unrelenting mid-epigastric pain / radiating to the back
    Anorexia
    Nausea / vomiting
    Dyspnea
    Fever
    Confusion / restlessness
    Not elicited
    Answer unknown
    Why is this important?
    Patients with acute pancreatitis present with upper abdominal pain usually in the mid epigastric region radiating to the back of a rapid onset, associated with nausea, vomiting, fever, restlessness. The pain is ameliorated by bending forward and is aggravated by lying flat on the back or after eating.
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  • Which of the following risk factors did the patient possess? (Choose all that apply) Why is this important?
    Answer this question
    A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.
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  • Was a medical history obtained? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's examination, enables the clinician to make educated evaluations, and be better equipped to advise the patient.
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  • Were the patient’s vital signs recorded? Why is this important?
    Answer this question
    Systemic signs can include fever, tachycardia, tachypnea, and, in severe cases, hypotension.
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  • Was a physical examination performed? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.
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  • Was the patient discharged and later diagnosed with pancreatitis? Why is this important?
    Answer this question
    The symptoms of acute pancreatitis may be diffuse, non-specific, and can mimic other less serious syndromes.
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  • Which of the following diagnostic laboratory investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    Routine laboratory studies can provide important clues to diagnosis
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  • Which of the following diagnostic imaging studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    An MRI provides unsurpassed soft tissue contrast and multiplanar capability with spatial resolution.
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  • To which of the following specialist was the patient referred? (Choose all that apply) Why is this important?
    Answer this question
    Once priorities and goals have been agreed on, referral to the appropriate professionals should be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines should be utilized to enable all patients to achieve their maximum potential.
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  • Was the patient diagnosed with acute pancreatitis? Why is this important?
    Answer this question
    A careful review of the patient's history and appropriate laboratory studies can help the physician identify the etiology of the condition and can guide management.
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  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise.
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  • Which of the following criteria was used to assess the severity and prognosis? Why is this important?
    Answer this question
    There are several different scoring systems used to assess the severity of pancreatitis, including Ranson, Glasgow, APACHE II, and APACHE III. Patients who present with more than three Ranson criteria are considered to have severe acute pancreatitis. Patients with three or four Ranson criteria have a predicted mortality of 15 percent; those with seven or eight criteria have a predicted mortality of 100 percent.
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  • With what grade of pancreatitis was the patient diagnosed? Why is this important?
    Answer this question
    The severity of pancreatitis (mild, moderate or severe) is diagnosed by the presence of the defined criteria given in each scoring systems (Ranson / Glasgow / APACHE II / APACHE III.
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  • Did the clinician recommend hospitalization? Why is this important?
    Answer this question
    Patients with severe acute pancreatitis should be monitored in an intensive care unit. Severe pancreatitis necessitates hospitalization with aggressive fluid resuscitation in an intensive care unit.
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  • Was the patient maintained on “nil per oral (nothing by mouth)” status? Why is this important?
    Answer this question
    The patient should have nothing by mouth until nausea and vomiting cease, bowel sounds return, and abdominal pain has subsided.
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  • Which of the following conservative treatment options were recommended? (Choose all that apply) Why is this important?
    Answer this question
    Early intravenous fluid resuscitation is associated with reduced morbidity and mortality. Treatment of pain and/or sphincter spasm is achieved with the use of analgesics. Infection can develop in necrotizing pancreatitis, and the use of antibiotic treatment should be considered in patients with significant pancreatic necrosis and biliary pancreatitis with cholangitis. Enteral or parenteral nutrition may be required for those patients who cannot tolerate oral feeding for a prolonged period of time (more than 4 days).
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  • Did the patient improve with medical management? Why is this important?
    Answer this question
    Surgical consult should be obtained if necrosis or abscess is identified, in biliary pancreatitis, in hemorrhagic pancreatitis, or if Ranson score continues to worsen despite careful medical management.
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  • Which of the following lifestyle modifications were recommended? (Choose all that apply) Why is this important?
    Answer this question
    Alcohol abstinence is mandatory in individuals who engage in heavy alcohol use (more than 100 g/day), as this population has high rates of alcohol-related pancreatitis. Smoking cessation if relevant may be needed.
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  • From which of the following complications did the patient suffer? (Choose all that apply) Why is this important?
    Answer this question
    Pseudoaneurysm formation may lead to bleeding into a pseudocyst cavity or ductal system. Some of the clinical complications associated with pancreatitis include sterile/infected pancreatic necrosis, hemorrhagic pancreatitis, pancreatic abscess or pseudocyst, intestinal/common bile duct obstruction.
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