NURS 6501: MIDTERM EXAM: Please contact Assignment Samurai for help with NURS 6501: Midterm Exam or any other assignment. Email: assignmentsamurai@gmail.com   An adult patient with a history of multiple episodes of acute pancreatitis and alcohol use disorder presents with recent recurrent episodes of abdominal pain, new-onset diabetes, and steatorrhea. Which pathological process occurring in the pancreas is most likely causing these manifestations? Group of answer choices

• Hereditary pancreatic enzyme deficiency leading to a loss of exocrine function
• Chronic pancreatic ductal obstruction leading to a loss of endocrine and exocrine function
• Targeted autoimmune destruction of islet cells leading to a loss of endocrine function
• Progressive pancreatic inflammation and fibrosis leading to loss of exocrine and endocrine function

  The correct answer is: Progressive pancreatic inflammation and fibrosis leading to loss of exocrine and endocrine function. Explanation: The patient presents with symptoms suggestive of chronic pancreatitis, which is a progressive inflammatory disorder of the pancreas. Chronic pancreatitis is often associated with long-term alcohol use and can lead to both exocrine and endocrine dysfunction:

1. Exocrine dysfunction: The pancreas loses its ability to secrete digestive enzymes, leading to steatorrhea (fatty stools), a hallmark of malabsorption.
2. Endocrine dysfunction: The pancreas also loses its ability to produce insulin, leading to new-onset diabetes.

The progression of the disease leads to pancreatic fibrosis (scarring), which further impairs both the endocrine and exocrine functions of the pancreas. Other options:

• Hereditary pancreatic enzyme deficiency: This would be a rare cause of pancreatic dysfunction and typically would not present with the characteristic symptoms of chronic pancreatitis (recurrent abdominal pain, diabetes, and steatorrhea).
• Chronic pancreatic ductal obstruction: While ductal obstruction can contribute to pancreatitis, it is typically the inflammation and fibrosis caused by repeated episodes of pancreatitis that lead to the loss of both exocrine and endocrine functions. The description suggests a more widespread involvement, which aligns with chronic pancreatitis.
• Targeted autoimmune destruction of islet cells: This is characteristic of type 1 diabetes or autoimmune pancreatitis, but not typically seen in the context of alcohol use disorder or recurrent acute pancreatitis. In autoimmune pancreatitis, the inflammation would be more localized and would not explain the steatorrhea or the chronic episodes of pancreatitis.

Thus, progressive pancreatic inflammation and fibrosis are the most likely causes of this patient's symptoms.