Pancreatitis

Acute Pancreatitis

Function of the pancreas is to release proteolytic enzymes that assist in the breaking down food products so that nutrients can be absorbed.

Acute Pancreatitis Etiology and Pathophysiology

Pancreatic Ducts Pancreatic Ducts become become obstructedobstructed

Hypersecretion of the Hypersecretion of the exocrine exocrine enzymes of pancreasenzymes of pancreas

These enzymes enter the bile These enzymes enter the bile duct, where they are activated duct, where they are activated and with bile back up into the and with bile back up into the pancreatic duct pancreatic duct

Pancreatitis

Acute Pancreatitis Etiology and Pathophysiology

Trypsinogen- (a proteolytic enzyme) Normally released into the small

intestine, where it is activated to trypsin

In AP, activated to trypsin in the pancreas causing autodigestion of pancreas

Progression of Disease Autodigestion Acute Inflammation of Pancreas

Necrosis of Pancreas

Digestion of vascular walls Thrombus and Hemorrhage

Death

Precipitating Factors

Trauma Use of alcohol * Biliary tract disease Viral or Bacterial disease Cholelithiasis * Peptic Ulcer Disease

*most common causes

Acute Pancreatitis Clinical Manifestations Severe Abdominal painAbdominal pain is predominant symptom

Pain located in LUQ and mid-epigastrium Commonly radiates to the back Sudden onset Severe, deep, piercing, steady Aggravated by fatty meal or lying recumbent

position Not relieved by vomiting

Acute Pancreatitis Clinical Manifestations

Cyanosis, Dyspnea Bowel sounds decreased or absent Low-grade fever, Leukocytosis Hypotension, Tachycardia Jaundice Flushing Abnormal lung sounds - Crackles Discoloration of abdominal wall – Turner’s or Cullen’s

sign SIGNS OF SHOCK

Acute PancreatitisDiagnostic Studies

History and physical examination Laboratory tests

Serum amylase- hallmark test Serum lipase – also elevated Blood glucose Serum calcium Triglycerides

Acute PancreatitisDiagnostic Studies

Flat plate of abdomen Abdominal/endoscopic ultrasound Endoscopic retrograde

cholangiopancreatography (ERCP) Chest x-ray CT of pancreas Magnetic resonance

cholangiopancreatography (MRCP)

Acute Pancreatitis

Can be a medical emergency associated with a risk for life-

threatening complications

Acute Pancreatitis Complications

Two significant local complications Pseudocyst

Abscess

Acute PancreatitisComplications

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

Acute Pancreatitis Complications

Pancreatic abscess A large fluid-containing cavity within pancreas Results from extensive necrosis Upper abdominal pain Abdominal mass High fever Leukocytosis

Acute PancreatitisComplications

Main systemic complications are? PulmonaryPulmonary

CardiovascularCardiovascular

Electrolyte imbalance – HypocalcemiaElectrolyte imbalance – Hypocalcemia

Acute PancreatitisGoals of Care

Relief of pain

Prevention or alleviation of shock

Decrease respiratory failure

↓ of pancreatic secretions

Maintain Fluid/electrolyte balance

Treatment and Nursing Care 1. Pain management

IV morphine or Dilaudid

Antispasmodic agent Bentyl Pro-Banthine

Spasmolytics – Nitroglycerine

Positioning – sitting up and leaning forward

Why is it important to relieve pain?

Treatment

2. Prevention of Shock – hemodynamic stability

* Administer Blood, Plasma expanders, Albumin * LR solution

What is the cause of shock?

Treatment and Nursing Care

3. Suppress pancreatic enzymes * NPO * NG suction * Antacids, H2 receptor antagonists, antispasmotics

4. Decrease respiratory distress * Oxygen; check O2 saturation levels * Semi-fowlers position, knees flexed, position

changes * C, DB; incentive spirometer

5. Antibiotics

Treatment and Nursing Care 6. Correction of electrolyte imbalance/ hypocalcemia

7. Maintain Hydration / Nutrition

Treatment and Nursing Care

Surgical therapy – if related to gallstones ERCP Endoscopic sphincterotomy Laparoscopic cholecystectomy

Follow up care Dietary teaching

High-carbohydrate, low-fat diet Abstinence from alcohol,

Patient/family teaching * Signs of infection, high blood glucose, steatorrhea

Treatment - Home Care