Acute pancreatitis is a common and potentially fatal condition, with several well-known causes including gallstones, excessive alcohol consumption and specific medications. We report a case of an 89-year-old man presenting with acute pancreatitis, which we believe to be secondary to a diaphragmatic herniation of the pancreas. This extremely rare anatomical abnormality can be found incidentally in the asymptomatic patient or may present with a variety of acute symptoms. However, there have been only isolated reports of these cases presenting as acute pancreatitis. While the majority of acute pancreatitis cases can be explained by common causes, it is important that clinicians be aware of and should consider investigating for other more unusual possibilities, such as pancreatic herniation, before labelling an episode as ‘idiopathic’.
Background In Milton Keynes half of people die in hospital. It is not known how many patients and their families have the opportunity to discuss end-of-life care in hospital. Methods Review of the electronic medical records of all those that died in Milton Keynes Hospital during November 2012. Findings Of the 67 records analysed cancer, chronic obstructive pulmonary disease or left ventricular failure was the primary or secondary cause of death in 62% (n=42). 31% of patients (n=21) were seen by the palliative care team. Patients seen by palliative care were significantly more likely to have a signed Do Not Attempt Resuscitation form (95%; n=20 vs 78%; n=36; p=0.004), a discussion about end-of-life treatment (n=4; 19% vs. n=2; 4%; p=0.003), and more likely to state their preferred place of death (n=7; 33% vs. n=2; 4%; p=0.001). End-of-life issues were often discussed with the family rather than the patient themselves. End-of-life was discussed with the families of patients seen by palliative care in 90% of cases (n=19) compared to 54% (n= 25) of those not seen by palliative care. Conclusions The end-of-life wishes were not discussed in all patients.All aspects of end of life care were significantly more likely to be discussed with patients or families who had been
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