DISORDERS OF PANCREAS

Aqsa Khalid
Nursing Instructor
AAIN,GDEC,LHR
ANATOMY OF PANCREAS
 PANCREATITIS
• Inflammation of the pancreas
• serious disorder
• acute and chronic forms
• medical emergency associated with a high risk
of life-threatening complications
Acute Pancreatitis
 Acute Pancreatitis
• mild, self-limited disorder to a severe, rapidly fatal
disease
Mild acute pancreatitis
• characterized by edema and inflammation confined to
the pancreas
• Minimal organ dysfunction
• return to normal function usually within 6 months
Severe acute pancreatitis
• widespread and complete enzymatic digestion of the
gland
• Enzymes damage the local blood vessels, and bleeding
and thrombosis can occur
 ETIOLOGICAL FACTORS
• Biliary tract disease
• History of long-term alcohol abuse
• Bacterial or viral infection
• Complication of mumps virus
• Spasm and edema of the ampulla
• Blunt abdominal trauma
• Peptic ulcer disease
• Ischemic vascular disease
• Hyperlipidemia
• Hypercalcemia
• Use of corticosteroids, thiazide diuretics, oral contraceptives
• Post surgery
• Instrumentation of the pancreatic duct
• Acute idiopathic (up to 10% of the cases)
 Pathophysiology
• Self-digestion of the pancreas by its own
proteolytic enzymes, principally trypsin
• Activation of the enzymes can lead to
vasodilation
• Increased vascular permeability, necrosis,
erosion, and hemorrhage
• Gallstones enter the common bile duct and
lodge at the ampulla of Vater, obstructing the
flow of pancreatic juice
 Clinical Manifestations
Severe abdominal pain
• midepigastrium
• acute in onset
• Occurring 24 to 48 hours after a very heavy
meal or alcohol ingestion
• Diffuse and difficult to localize
• unrelieved by antacids
 Clinical Manifestations
Abdominal Findings
• distention
• palpable abdominal mass
• Abdominal guarding - rigid or boardlike
abdomen
• ominous sign
 Clinical Manifestations
• Ecchymosis (bruising) in the flank
• Bruising around the umbilicus
• Nausea and vomiting
• Emesis - bile stained
• Fever, jaundice
• Mental confusion, and agitation
• Hypotension - hypovolemia and shock caused by
the loss of large amounts of protein-rich fluid
 Clinical Manifestations
• Tachycardia
• cyanosis
• cold, clammy skin
• Acute renal failure
• Respiratory distress and hypoxia
• diffuse pulmonary infiltrates, dyspnea,
tachypnea, and abnormal blood gas values
• Myocardial depression, hypocalcemia,
hyperglycemia
• Disseminated intravascular coagulation
 Assessment and Diagnostic Findings
• History of abdominal pain
• Physical examination
• Serum amylase 
• Serum lipase 
• Urinary amylase 
• White blood cell count 
• Hypocalcemia
• Transient hyperglycemia
• Glucosuria
• Serum bilirubin 
 Assessment and Diagnostic Findings
• X-ray studies of the abdomen and chest-
detect pleural effusions
• Ultrasound and contrast-enhanced CT scans-
identify an increase in the diameter of the
pancreas and to detect pancreatic cysts,
abscesses, or pseudocysts
• Paracentesis or peritoneal lavage - increased
levels of pancreatic enzymes
• ERCP- gallstone pancreatitis.
 Medical Management
• Relieving symptoms
• Preventing or treating complications
• Oral intake is withheld
• Parenteral nutrition
• Nasogastric suction
• Histamine- (H2) antagonists such as cimetidine
(Tagamet) and ranitidine (Zantac)
• Proton pump inhibitors such as pantoprazole (Protonix)
• Pain Management
• Intensive Care
• Respiratory Care
• Biliary Drainage
 Surgical Intervention
PURPOSES
• Diagnosis of pancreatitis (diagnostic
laparotomy)
• Establish pancreatic drainage
• Resect or débride a necrotic pancreas
 Postacute Management
• Antacids
• Oral feedings - low in fat and protein
• Caffeine and alcohol -eliminated
• Causative medications are discontinued
• Followup- ultrasound, x-ray studies, or ERCP -
to determine prognosis & assess for abscesses
and pseudocysts.
 Nursing Management
• Relieving Pain and Discomfort
• Improving Breathing Pattern
• Improving Nutritional Status
• Maintaining Skin Integrity
• Monitoring and Managing Potential
Complications
• Promoting Home and Community-Based Care
Chronic Pancreatitis
 Chronic Pancreatitis
Inflammatory disorder characterized by
progressive destruction of the pancreas,cells
replaced by fibrous tissue with repeated
attacks of pancreatitis
 Causes of chronic pancreatitis
• Long history of alcohol abuse(70% to 80%)
• Age (37 to 40 years)
• Smoking
 Clinical Manifestations
• Recurring attacks of severe upper abdominal and
back pain-unrelieved by opioids
• Vomiting
• Weight loss(More than 80% of patients)
• Anorexia or fear of eating
• Malabsorption
• Stools- frequent, frothy, and foul-smelling
• Steatorrhea
• Calcification of the gland
 Assessment and Diagnostic Findings
ERCP (the most useful study)
Imaging procedures, including magnetic
resonance imaging (MRI), CT scans, and
ultrasound-to detect pancreatic cysts
Glucose tolerance test- pancreatic islet cell
function
Serum amylase levels 
Laboratory analysis of fecal fat content
 Medical Management
GOALS
• Preventing and managing acute attacks
• Relieving pain and discomfort
• Managing exocrine and endocrine
insufficiency of pancreatitis
 Nonsurgical Management
• Endoscopy -to remove pancreatic duct stones,
correct strictures, and drain cysts
• Management of abdominal pain and discomfort
• Avoiding alcohol and foods that have produced
abdominal pain and discomfort in the past
• Diabetes mellitus-treated with diet, insulin, or
oral antidiabetic agents
• Pancreatic enzyme replacement
 Surgical Management
GOALS
• Relieve persistent abdominal pain and
discomfort
• Restore drainage of pancreatic secretions
• Reduce the frequency of acute attacks of
pancreatitis and hospitalization
 Pancreaticojejunostomy
• also referred to as Roux-en- Y
• Anastomosis or joining of the pancreatic duct
to the jejunum
• Allows drainage of the pancreatic secretions
into the jejunum
• Pain relief occurs within 6 months in more
than 85% of the patients
 Whipple resection
• Pancreaticoduodenectomy
• Limited resection of the head of the pancreas
with a pancreaticojejunostomy
• Gallbladder removel
• T-tube placement to collect the bile
postoperatively
Pancreatic PseudoCyst
 Pancreatic PseudoCyst
• Fluid collections walled off by fibrous tissue
are called pancreatic pseudocysts
• most common type of pancreatic cyst
CAUSES
• local necrosis in acute pancreatitis
• congenital anomalies
• secondary to chronic pancreatitis
• trauma to the pancreas
 Assessment and Diagnostic Findings
• Ultrasound
• CT scan
• ERCP- define the anatomy of the pancreas and
evaluate the patency of pancreatic drainage
A pancreatic pseudocyst as seen on CT
 Management
• Drainage into the GI tract or through the skin
and abdomen
• Application of skin ointment
• Skin Care
• Suction apparatus
• Expert nursing attention
• Consultation with a WOC nurse
Cancer of the Pancreas
 Cancer of the Pancreas
INCIDENCE
• fourth leading cause of cancer death in men in
the United States
• fifth leading cause of cancer death in women
• beyond the sixth decade of life
• incidence increases with age
• slight male preponderance
 RISK FACTORS
• Cigarette smoking
• Exposure to industrial chemicals or toxins in
the environment
• A diet high in fat, meat, or both
• Diabetes mellitus
• Chronic pancreatitis
• Hereditary pancreatitis
• Metastasis from other tumors
 Clinical Manifestations
• Pain, jaundice, or both(more than 80% of patients)
• rapid, profound, and progressive weight loss
• vague upper or midabdominal pain or discomfort that
is unrelated to any GI function and is often difficult to
describe
• Relief may be obtained by sitting up and leaning
forward
• Formation of ascites
• Symptoms of insulin deficiency: glucosuria,
hyperglycemia, and abnormal glucose tolerance
• Diabetes - an early sign of carcinoma of the pancreas
 Assessment and Diagnostic Findings
• Spiral (helical) CT- 85% to 90% accurate in the diagnosis and staging
of pancreatic cancer
• MRI,ERCP - diagnosis of pancreatic carcinoma
• Endoscopic ultrasound (EUS) – useful in identifying small tumors
and in performing fine-needle aspiration biopsy
• GI x-ray - deformities in adjacent organs
• Percutaneous fineneedle aspiration biopsy - diagnose pancreatic
tumors and resectibility
• Percutaneous transhepatic cholangiography - identify obstructions
of the biliary tract
• Tumor markers (eg, cancer antigen [CA] 19-9, carcinoembryonic
antigen [CEA], DU-PAN-2
• Angiography, CT scans, and laparoscopy - determine whether the
tumor can be removed surgically
• Intraoperative ultrasonography - determine metastatic disease to
other organs
 Medical Management
Resection of tumor if resectable
Radiation and chemotherapy (5-fluorouracil
[5-FU, Adrucil], leucovorin [Wellcovorin], and
gemcitabine [Gemzar])
Intraoperative radiation therapy (IORT) during
surgery
Biliary stenting – to relieve jaundice
 Nursing Management
• Pain management and attention to nutritional
requirements- patient-controlled analgesia
• Skin care
• Specialty mattresses are beneficial and protect
bony prominences from pressure
• End-of-life preferences
• Teaching Patients Self-Care
• Referral to hospice care