Exemplar - Pancreatitis

Basic Patho: acute or chronic inflammation of the pancreas. Inflamed cells leak digestive enzymes  further
damage to the pancreas. What are the concepts besides glucose regulation? Infection, Tissue Integrity,
Perfusion. Pancreatic enzymes may enter the bloodstream  injury to surrounding organs. Which organs?
Stomach, liver spleen, gallbladder, and lungs.

Acute pancreatitis: occurs suddenly, pts very sick and lasts for a short period of time then resolves.

Chronic pancreatitis: does not resolve, slow and chronic destruction of the pancreas.

Causes: excessive alcohol consumption, acute and chronic cholelithiasis: gallstones obstructing the common
bile duct, elevated triglycerides: levels above 1,000 mg/dL occlude the capillaries in the pancreas.

Manifestations
Labs/Diagnostics
Acute Pancreatitis
What could be happening if the Hgb/Hct drop
 Sudden onset of epigastric pain that is
to 11.4 and 35.2?
felt in the LUQ or mid-abdomen and
can radiate to the back or shoulder  Hemorrhaging (there will be blue
blades. This pain is usually deep and discoloration in the abdomen).
sharp and can become more intense
by eating foods high in fat content.
 This pain can last for several days and
some pts complain of severe pain
when lying flat or bending forward.
 N/V
 Anorexia
 Pts w/ alcohol pancreatitis may not
have pain s/s until several hours or
days after binge drinking.
 General clinical presentation of pts w/
acute pancreatitis includes ab fullness
from gas, hiccups, ingestion, fever,
tachycardia, and hypotension.

Chronic pancreatitis

 Similar to chronic differing in clay-

colored stools and weight loss
(pancreas no longer secreting
pancreatic enzymes).
 Treatments/Interventions Teaching
Acute pancreatitis  Avoid alcohol, caffeine, fatty and
spicy foods.
 IV meds/for pain (NS), PPIs/H2
 Bland, low fat (decreased lipase
blockers for increased acid
production), high protein foods (more
production
tissue damage).
 NPO
 High carbs, unless glucose problems
 Feeding the pt by TPN (bypasses the
GI tract and puts nutrients directly
into the bloodstream).
 Positioning for comfort
 Blood glucose monitoring w/ sliding
scale protocol.
 NG tube connected to low suction
(when excessively vomiting, can
cause metabolic alkalosis- due to
removal of stomach acid, K+ and Na+
can be lost from vomiting (watch for
hypokalemia and hyponatremia).

Chronic pancreatitis

 Pain management
 IV fluid replacement
 Electrolyte management
 Nutritional support
 Insulin therapy to treat glucose levels
 Pancreatic enzyme replacement
therapy (PERT), which is used to
treat malabsorption and provides
lipase, amylase, and protease.
 H2 blockers and PPIs are prescribed
for increased gastric acid.