PANCREATITIS
ACC, RNSG 1247
Acute Pancreatitis
Definition
An acute inflammatory process of the
pancreas
Degree of inflammation varies from ___
edema to ______ necrosis
Most common in middle-age
African American rate three times
higher than for whites
Acute Pancreatitis:
Risk Factors
Primary risk factors are
________ ____ ______ (women)
Gallbladder disease
_____________ (men)
* May stimulate production of digestive
enzymes
Pancreatitis from gallstones
(AP) Acute Pancreatitis:
Pathophysiology
Trypsinogen
Normally released into the small
intestine, where it is activated to trypsin
In AP, activated trypsin is present or
released in pancreas thus auto
digestion of pancreas
What happens in autodigestion?
Acute Pancreatitis: pathophysiologic
results of autodigestion
Fig. 44-14
Acute Pancreatitis:
“Degree of involvement”
Edematous pancreatitis
Mild and self-limiting
Necrotizing pancreatitis
Degree of necrosis correlates with
severity of manifestations
Acute Pancreatitis
Clinical Manifestations
Abdominal pain is predominant
symptom
Pain located in LUQ
Pain may be in the midepigastrium
Commonly radiates to the back
Sudden onset
Severe, deep, piercing, steady
Aggravated by eating
Not relieved by vomiting
Acute Pancreatitis
Clinical Manifestations
Cyanosis, Dyspnea
Edema
N/V, Bowel sounds decreased or absent
Low-grade fever, Leukocytosis
Hypotension, Tachycardia
Jaundice
Flushing
Abdominal tenderness, distention
Abnormal lung sounds - Crackles
Grey Turner’s or Cullen’s sign
Acute Pancreatitis
Complications
Two significant local complications
Pseudocyst
Abscess
Acute Pancreatitis
Complications (local)
Pseudocyst
Cavity surrounding outside of pancreas
filled with necrotic products and liquid
secretions
Abdominal pain
Palpable epigastric mass
Nausea, vomiting, and anorexia
Elevated serum amylase
Pancreatic pseudocysts
Acute Pancreatitis
Complications (local)
Pancreatic abscess
A large fluid-containing cavity within
pancreas
Results from extensive necrosis in the
pancreas
Upper abdominal pain
Abdominal mass
High fever
Leukocytosis
Acute Pancreatitis
Complications : Systemic
Main systemic complications
Pulmonary
Pleural effusion
Atelectasis
Pneumonia
Cardiovascular
Hypotension
Tetany (caused by hypocalcemia)
Acute Pancreatitis
Diagnostic Studies
History and physical examination
Laboratory tests
Serum amylase
Serum lipase
2-hour urinary amylase and renal amylase
clearance
Blood glucose
Serum calcium
Triglycerides
Acute Pancreatitis
Diagnostic Studies
Flat plate of abdomen
Abdominal/endoscopic ultrasound
Endoscopic retrograde
cholangiopancreatography (ERCP)
Chest x-ray
CECT of pancreas
Magnetic resonance
cholangiopancreatography (MRCP)
Acute Pancreatitis: Goals of
Treatment and Nursing Care
1. Manage _____
– IV morphine, Hydromorphone
– Combined with antispasmodic agent
2. Prevent or alleviate _____
- Plasma or volume expanders
• - LR solution
3. Suppress __________ _______
- NPO, NG suction, antacids, H2 receptor
antagonist
4. Prevent ________
Acute Pancreatitis
Treatment and Nursing Care
Surgical therapy – if related to
gallstones
ERCP
Endoscopic sphincterotomy
Stent placement
Laparoscopic cholecystectomy
Endoscopic Sphincterotomy
Acute Pancreatitis
Treatment and Nursing Care
Nutritional therapy
NPO status initially
IV lipids - monitor triglycerides
Enteral or parenteral feeding
Small, frequent feedings if allowed
High-carbohydrate, low-fat, high-protein
Acute Pancreatitis
Nursing Diagnoses
Acute pain
Deficient fluid volume
Imbalanced nutrition: Less than body
requirements
Ineffective therapeutic regimen
management
Acute Pancreatitis:
Home Care
Pain control/prevention
Dietary teaching
High-carbohydrate, low-fat diet
Abstinence from alcohol, also caffeine,
smoking
Patient/family teaching
* Signs of infection, high blood glucose,
steatorrhea
Chronic Pancreatitis: Definition
Continuous, prolonged inflammatory,
and fibrosing process of the pancreas
Pancreas becomes destroyed as it is
replaced by fibrotic tissue
Strictures and calcifications can also
occur
Chronic Pancreatitis
Etiology and Pathophysiology
May follow acute pancreatitis
May occur in absence of any history
of acute condition
Two major types
Chronic obstructive pancreatitis
Chronic calcifying pancreatitis
Chronic Pancreatitis:
Types and risk factors
Chronic obstructive Chronic calcifying
pancreatitis pancreatitis
Associated with – AKA alcohol induced
biliary disease; – Inflammation and sclerosis
commonly associated in the head of the pancreas
with cholelithiasis and around the pancreatic duct
Other causes
include: *** Ducts are obstructed with
protein precipitates blocking
Cancer of ampulla of the pancreatic duct causing it to
Vater, duodenum, or calcify then fibrosed and
pancreas atrophied.
Chronic Pancreatitis
Clinical Manifestations
Abdominal pain
Located in the same areas as in AP
Heavy, gnawing feeling; burning and
cramp-like
Malabsorption with weight loss
Constipation
Mild jaundice with dark urine
Steatorrhea
Frothy urine/stool
Diabetes mellitus
Chronic Pancreatitis
Clinical Manifestations
Complications include
Pseudocyst formation
Bile duct or duodenal obstruction
Pancreatic ascites
Pleural effusion
Splenic vein thrombosis
Pseudoaneurysms
Pancreatic cancer
Chronic Pancreatitis
Diagnostic Studies
Laboratory tests
Serum amylase/lipase
May be ↑ slightly or not at all
↑ Serum bilirubin
↑ Alkaline phosphatase
Mild leukocytosis
Elevated sedimentation rate
Chronic Pancreatitis
Diagnostic Studies
CT
MRI
MRCP
Transabdominal ultrasound
Endoscopic ultrasound
Secretin stimulation test
ERCP
Chronic Pancreatitis: Goals of
Treatment and Nursing Care
Prevention of attacks
* Follow acute therapy during acute attack
Relief of pain
Control of pancreatic exocrine and
endocrine insufficiency
* Pancreatic enzyme replacement; bile salts
* Acid-neutralizing and acid-inhibiting drugs
Bland, low-fat, high-carbohydrate diet
Chronic Pancreatitis
Treatment and Nursing Care
Surgery
Indicated when biliary disease is present
or if obstruction or pseudocyst develops
Divert bile flow ( Ex:
choledochojejunostmy)
Or relieve ductal obstruction ( Ex:
sphincterectomy)
Chronic Pancreatitis
Home/Ambulatory Care
Focus is on chronic care and health
promotion
Dietary control
No alcohol
Control of diabetes
Taking pancreatic enzymes
Patient and family teaching
Pancreatic Cancer
Highest mortality rate
Other risk factors: smoking, DM,
family history
Cause of high mortality: hard to detect
when surgical removal is still possible
Signs/Symptoms: weight loss,
nausea, changes in stool , diabetes
TX: surgery, chemotherapy
The End