Acute Pancreatitis

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Acute Pancreatitis Elisabeth A. Fandrich Montana Tech, Nursing Department NURS 1566 Core Concepts of Adult Nursing Noel Mathis RN, BSN, MSN April 28, 2008

Acute Pancreatitis

Acute Pancreatitis The pancreas is the only gland in the body which is both exocrine and endocrine. It plays a 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 the duodenum to break down proteins and fats and to neutralize hydrochloric acid. Its endocrine functions are the production of the hormones insulin and glucagon which regulates how the body utilizes glucose.

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Acute pancreatitis is the new or short-term inflammation of the pancreas. Although it can occur 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 in 3502,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 is located 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 and lethargy, headache, confusion and irritability in addition to the more common symptoms described above. Acute pancreatitis can lead to hypovolemic shock, so precautions should be taken to

Acute Pancreatitis prevent this (isotonic IV fluid replacement). 3502,D,J presented to the emergency department complaining 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 symptoms through a complete assessment including history and physical. Laboratory testing of blood and urine samples are needed to confirm a diagnosis of pancreatitis. Diagnostic imaging studies (CT scan, X-ray, Ultrasound and ERCP) are also used for diagnostic purposes. Lab tests that are

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commonly 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 are inconclusive, or complications of pancreatitis need to be identified (gallstones), then diagnostic imaging studies are indicated. Along with a complete assessment of 3502,D,J, lab results and a CT scan confirmed the diagnosis of acute pancreatitis. Pertinent lab values for this patient were as follows: 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: 27-76 mg/dL) 10, triglyceride (normal: 35-160 mg/dL) 6,239, LDL (normal:<130 mg/dL) unable to calculate because of high triglyceride level, serum glucose (normal: 65-100 mg/dL) 274, creactive 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 the gastrointestinal mucosa, oxygen supplementation for patients having respiratory difficulty, IV fluid replacement (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

Acute Pancreatitis NPO for several days), and insulin. For long term management, lifestyle changes are indicated. Cessation of alcohol consumption and a high carbohydrate, low fat diet consumed in smaller, more frequent meals will help prevent subsequent occurrences of pancreatitis. If the pancreas is unable to produce adequate insulin, diabetes management will be necessary. In cases of pancreatitis involving gallstones, surgery (cholecystectomy) may be needed. 3502D,J’s treatment included the use of antiemetic, analgesics, NPO status, nasogastric suction, total parenteral nutrition, IV fluid replacement, antibiotics, insulin administration, antihypertensives, and the insertion of a central line to facilitate administration of these medications (most of which are IV).

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Most patients who have had acute pancreatitis are able to fully recover. 5-10% of patients will have chronic conditions as a result of the pancreatitis such as kidney failure, brain damage, diabetes mellitus and dypsnea. Upon discharge patients need to be educated about the importance of abstaining from alcohol, as this is the only way to reduce the chances of reoccurring episodes. 3502,D,J and his family received patient teaching regarding medication regime and diabetes management. In his case, at the time of discharge, his blood glucose levels were still very high, indicating that insulin production was impaired. Areas addressed were blood glucose monitoring, determination of insulin dosage, insulin administration, diet and exercise. Prognosis for this patient is good, even though he suffered a severe case of acute pancreatitis that required him to be hospitalized for 10 days. Some of the things that assist in improving his prognosis are overall good physical condition, no tobacco use, infrequent alcohol use (before his illness), openness to suggestions about lifestyle modification, strong support network, financial capability to procure diabetic medications and supplies, and verbalization of intent to manage his condition and prevent any recurrent episodes of pancreatitis.

Acute Pancreatitis

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References Balentine D.O, FACP, J. (2007). Pancreatitis. Retrieved April 21, 2008, from eMedicineHealth Web site: http://www.emedicinehealth.com/pancreatitis/article_em.htm Munoz MD, A (2000, July, 1). Diagnosis and management of acute pancreatitis. American Family Physician, Retrieved March 21, 2008, from http://www.aafp.org/afp/20000701/164.html

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