Pancreatitis

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 Learning Objectives
At the end, the students will be able to know
and describe the Pancreatitis and its
management.

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 Definition
• Pancreatitis is inflammation in the pancreas.
• 02 forms of pancreatitis.
1. Acute pancreatitis(AP) is a sudden inflammation that lasts
for a short time.
2. Usually goes away in a few days with treatment.
3. It may range from mild discomfort to a severe, life-
threatening illness like bleeding into the gland, serious
tissue damage, infection.
4. It is often caused by gallstones.

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 • 02 forms of pancreatitis.
1. Chronic pancreatitis(CP) is long-lasting inflammation of
the pancreas.
2. It most often happens after an episode of acute
pancreatitis.
3. Heavy alcohol drinking is big cause.
4. Other causes include cystic fibrosis, high levels of calcium
or fats in the blood and autoimmune conditions.

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 Symptoms
Acute Pancreatitis:
• Upper abdominal pain
• Abdominal pain that radiates
Chronic Pancreatitis:
to your back
• Upper abdominal pain
• Abdominal pain that feels
worse after eating • Losing weight without trying
• Fever • Oily, smelly stools (steatorrhea)
• Rapid pulse
• Nausea
• Vomiting
• Tenderness when touching
the abdomen 5
 Causes
• Pancreatitis occurs when digestive enzymes become activated while
still in the pancreas, irritating the cells of pancreas and causing
inflammation.

Other Conditions include:

•Alcoholism
•Gallstones
•Abdominal surgery/Injury to the abdomen
•Cigarette smoking
•Family history of pancreatitis
•Infection
•Pancreatic cancer
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 Complications

•Pseudocyst.
•Infection.
•Kidney failure.
•Breathing problems.
•Diabetes.
•Malnutrition. .
•Pancreatic cancer.
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 Diagnosis:
•Blood tests to look for elevated levels of pancreatic enzymes- Amylase
and Lipase

•Stool tests in chronic pancreatitis to measure levels of fat

•Glucose tolerance test to measure damage to the cells in the pancreas

that make insulin

•Ultrasound, CT scan, and MRI, look for gallstones and pancreas

inflammation, blockages in the pancreatic duct or bile duct, any other
abnormalities

•ERCP to look at the pancreatic and bile ducts using X-rays (standard for
diagnosing CP)
•Biopsy for malignancy 8
 Guidelines
• The American College of Gastroenterology (ACG)

• National Institute of Diabetes and Digestive and

Kidney Diseases (NIDDK)

• United European Gastroenterology guidelines

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  Acute Pancreatitis - Pharmacotherapy:
Goal of Treatment: Relieve pain and minimize complications.

1. Currently, no medications are used to treat acute pancreatitis

specifically.
2. Therapy is primarily supportive and involves:

 NPO to minimize exocrine stimulation of pancreas

 Intravenous (IV) fluid hydration
 Analgesics
 Antibiotics (in severe pancreatitis)
 Treatment of metabolic complications (eg, hyperglycemia and
hypocalcemia).
 Changes in diet ( low-fat meals that are high in nutrients)
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Pharmacotherapy on basis of Root Cause:
1. Removal of bile duct obstructions. A procedure called endoscopic
retrograde cholangiopancreatography (ERCP) uses a long tube with a
camera on the end to examine your pancreas and bile ducts. ERCP
can aid in diagnosing problems in the bile duct and pancreatic duct
and in making repairs.

2. Gallbladder surgery. If gallstones caused your pancreatitis, remove

gallbladder (cholecystectomy).

3. Pancreas surgery. Surgery may be necessary to drain fluid from your

pancreas or to remove diseased tissue.

4. Treatment for alcohol dependence. Drinking several drinks a day

over many years can cause pancreatitis. Recommended to avoid
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drinking.
Chronic Pancreatitis(CP)- Pharmacotherapy
No curative treatment for CP exists.

1. Pain management.
2. Changes in diet.
3. Treatment of Seatorrhea.

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•Pain Management.
• Pancreatic enzyme supplementation may be helpful in reducing
pain. Pancreatic stimulation and pain are caused by food. Cholecystokinin (CCK) is one of the
possible mediators of this response. When exogenous pancreatic enzymes are taken with a meal,
CCK-releasing factors are degraded and CCK release in response to a meal is reduced.

• Initial therapy consists of acetaminophen or NSAIDs. For severe,

refractory pain, narcotic analgesics often are required.

• Severe pain may be relieved with options such as endoscopic

ultrasound or surgery to block nerves that send pain signals from
the pancreas to the brain.

• Narcotic analgesics include: Acetaminophen with codeine,

hydrocodone/acetaminophen, Tramadol
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•Changes in Diet.

Ingesting smaller and more frequent meals, adding an H2-receptor

blocker or proton-pump inhibitor to decrease gastric acidity,
supplementation with medium-chain triglycerides, or limitation of fat
intake to 50-75 g/day.

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Treatment of Steatorrhea:

•Intravenous fluids (IV) to restore electrolytes and stop

dehydration

•Anti-diarrheal medications such as loperamide (Imodium) and

bismuth subsalicylate (Kaopectate, Pepto-Bismol)

•Pancreatic enzyme replacement therapy (PERT)

•Proton-pump inhibitors or PPIs

•MHC oils 15
Chronic Pancreatitis- Pharmacotherapy
Treatment of Steatorrhea:
• It is done through Pancreatic enzyme replacement therapy (PERT).

• All enzyme supplements contain Pancreatin – a mixture of pancreatic

enzymes: Lipase, Amylase And Protease.

• Dose: 50,000 to 75,000 units of lipase with a meal and 25,000 units with a
snack.

• Dosage form commonly come in 2 capsule sizes; 10,000 unit (mainly used in
children) and 25,000 unit capsules.

• Adults usually takes 2 or 4 of the 25,000 unit capsules per meal.

• Pancreatic enzyme preparations include Creon®, Nutrizym®, Pancrease® and

Pancrex®. 16
Other Treatment of CP:
Hormones can be used for the reduction of pancreatic
exocrine secretion:

Octreotide (somatostatin). Subcutaneous injection of

octreotide 3 times daily at 200mcg provided pain relief in
66% of patients.

Antidepressants, TCAs:
In addition to alleviating coexistent depression, tricyclic
antidepressants may improve pain and potentiate the
effects of opiates. Drug include: Amitriptyline
hydrochloride, Clomipramine 17
Thank you

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Reference:
• Dipirio ,2nd edition.Pg# 305-313

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