Acute Pancreatitis Patho

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Acute Pancreatitis 1 Acute PancreatitisElisabeth A. FandrichMontana Tech, Nursing Department NURS 1566 Core Concepts of Adult Nursing Noel Mathis RN, BSN, MSNApril 28, 2008Acute Pancreatitis

Acute Pancreatitis 2The pancreas is the only gland in the body which is both exocrine and endocrine. It playsa very important role in the digestive process. Its exocrine functions are the production of pancreatic enzymes and bicarbonate which are transported through the pancreatic duct to theduodenum to break down proteins and fats and to neutralize hydrochloric acid. Its endocrinefunctions are the production of the hormones insulin and glucagon which regulates how the bodyutilizes glucose.Acute pancreatitis is the new or short-term inflammation of the pancreas. Although it canoccur in anyone, it is rare in children, and more common in men than in women. The majority of cases are the result of alcohol abuse and gallstones. Other causes include hyperlipidemia,genetics, traumatic injury, certain medications and chemicals, surgery, infections such as mumps,and abnormalities of the pancreas or intestine. In approximately 15% of the cases of acute pancreatitis, the cause is unknown. The causative factors that most likely induced pancreatitis in350

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,D,J were excessive alcohol ingestion a few days prior to the attack, uncontrolled(undiagnosed) hyperlipidemia and uncontrolled (undiagnosed) diabetes mellitus.The most distinct symptom that is experienced by patients with pancreatitis is pain. The pain can develop very suddenly, or come on gradually. It is usually very intense pain that islocated in the medial portion of the upper quadrants or in the upper left quadrant of the abdomen.It may intensify after meals or when lying supine. The pain typically lasts several days. Other symptoms that patients with pancreatitis experience are fever, chills, nausea and vomiting,swelling and tenderness of the abdomen and tachycardia. In very severe cases of pancreatitis, patients may have symptoms of dehydration, hypotension, orthostatic hypotension, fatigue andlethargy, headache, confusion and irritability in addition to the more common symptoms describedabove. Acute pancreatitis can lead to hypovolemic shock, so precautions should be taken to

Acute Pancreatitis 3 prevent this (isotonic IV fluid replacement). 350

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,D,J presented to the emergency departmentcomplaining of severe abdominal pain. He reported that he had been vomiting earlier in the day.Diagnosis of pancreatitis is made by ruling out other potential causes of these symptomsthrough a complete assessment including history and physical. Laboratory testing of blood andurine samples are needed to confirm a diagnosis of pancreatitis. Diagnostic imaging studies (CTscan, X-ray, Ultrasound and ERCP) are also used for diagnostic purposes. Lab tests that arecommonly ordered are amylase, lipase, routine hematology, routine chemistry, lipid panel, arterial blood gases, glucose, serum HCG (pregnancy test), INR/PT and urinalysis. If the lab tests areinconclusive, or complications of pancreatitis need to be identified (gallstones), then diagnosticimaging studies are indicated. Along with a complete assessment of 350

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,D,J, lab results and a CTscan confirmed the diagnosis of acute pancreatitis. Pertinent lab values for this patient were asfollows: amylase (normal: 25-115 u/L) 474, lipase (normal: 8-75 u/L) 804, hemoglobin A1c(normal: 4.2-6.5%) 8.4, total cholesterol (normal: <200 mg/dL) 888, HDL (normal: 27-76mg/dL) 10, triglyceride (normal: 35-160 mg/dL) 6,239, LDL (normal:<130 mg/dL) unable tocalculate because of high triglyceride level, serum glucose (normal: 65-100 mg/dL) 274, c-reactive protein (normal: 0-1.0) 6.5, and WBC (normal: 3.5-10 K/uL) 12.11. A chest x-ray,ultrasound and serial CT scans were performed and re-confirmed the diagnosis of severe acute pancreatitis, but did not identify the presence of gallstones.Treatment of acute pancreatitis primarily focuses on alleviation of symptoms and prevention of further pancreatic damage. Hospitalization is usually required. The patient will be placed on NPO status, nasogastric suction may be utilized to prevent ulcerative damage of thegastrointestinal mucosa, oxygen supplementation for patients having respiratory difficulty, IV fluidreplacement (an isotonic solution will be used), analgesics (Demerol is the drug of choice),antiemetics, antibiotics (if infection is suspected), total parenteral nutrition (if the patient will be

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