A 50-year-old man, who is a chronic alcoholic, presents to theemergency room with a sudden onset of abdominal pain that radiatesto the back. A blood test reveals elevated serum pancreatic lipaselevels and a CT abdomen suggests inflamed pancreas. Both of thesefindings together confirm the diagnosis of acute pancreatitis. Thepatient was admitted and appropriately managed. The pain reducesover the next two days. On day 3, the patient reports worsening ofpain, nausea, and vomiting. An emergency CT abdomen was ordered,and the images reveal a pseudocyst around the pancreas. Apancreatic pseudocyst is a cavity surrounding the pancreatic headfilled with pancreatic enzymes and is a common complicationfollowing acute pancreatitis. In a few hours following thediagnosis, the patient’s symptoms worsen, develops a fever,hematemesis (blood vomiting), cold and clammy skin, multi-organfailure, and dies. As a physician, you think that the patientdeveloped these complications and died because the pancreaticpseudocyst ruptured. Based on the knowledge learned in this course,provide an explanation as to why this rupture led to complicationsand death of the patient.

Clue: Think about what the functions of pancreaticenzymes are, and why these enzymes are secreted first in aninactive form and not directly in an active form.