The client has been admitted with a diagnosis of acute pancreatitis. The nurse would assess this client for pain that is:
A. Severe and unrelenting, located in the epigastric area and radiating to the back.
B. Severe and unrelenting, located in the left lower quadrant and radiating to the groin.
C. Burning and aching, located in the epigastric area and radiating to the umbilicus.
D. Burning and aching, located in the left lower quadrant and radiating to the hip.
Correct Answer: A. Severe and unrelenting, located in the epigastric area and radiating to the back.
The pain associated with acute pancreatitis is often severe and unrelenting, is located in the epigastric region, and radiates to the back. Acute pancreatitis is common and is the leading cause of hospitalization amongst gastrointestinal disorders in the United States. The severity of the disease varies widely, from mild disease needing conservative treatment to severe and complicated disease with high morbidity and mortality.
Option B: The patient will commonly describe moderate to severe abdominal pain located in the epigastrium with nausea and anorexia. The nature of the pain can vary, often depending on whether the etiology is a biliary obstruction or a metabolic/toxicologic cause. Biliary etiology is more often described as a sharper pain, which radiates through to the back with more of acute onset.
Option C: Metabolic and toxicologic causes, such as alcohol, often have a more indolent onset with more dull and generalized pain. A thorough history regarding alcohol use and medications should be gathered, keeping in mind that over five years of heavy alcohol use is often needed to induce alcohol-related pancreatitis.
Option D: Family history should be reviewed, particularly when more common etiologies appear less likely, as there are rare genetically related cases of familial pancreatitis. A physical exam is often significant for elevated temperature, tachycardia, and in severe cases, hypotension. The abdominal exam will typically reveal epigastric tenderness with possible guarding and rigidity and decreased bowel sounds.
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