Pancreatitis

Inflammation of pancreas (make insulin and digestive juices/enzymes)

History Taking:

Ap ko kis mislay sy hasptal ana pada?

Drd kis qisam ka hy?

Drd ki shedadtay kya hy 0 sy 10 k scale py ktna number daingy jahng 0 ka matlab hy bilkul b drd nhe hy
or 10 ka matlb hy drd ap k bardasht sy bahr hy.

Ye dard kb sy horaha hy?

Hath ki madad sy chu k dikhayain kis jaga drd hy?

Jb drd shuru hota hy tou kitny arsy rhta hy?

Kya krny ya khany sy drd ma izafa hota hy?

Kis cheez s drd ma aram hota hy?

Kya ya drd pait k elawa jisam k dusry hissu ma phalta hy?

Kya pait ka drd shuru hony sy phly ap ko dusry alamat nazar aaty hn jase k malti, oulti, sr drd wagaira?

Pathophysiology:

1. Damage to pancreas( trauma, tumor, alcohol consumption, gall stone, blocked pancreatic duct)
2. Enzymes of pancreas released and become activated while still in the pancreas rather than
duodenum and start irritating the pancreatic cells causing inflammation
3. The above process leads to epigastric pain, nausea, vomiting, elevated blood sugar, lipase and
amylase.

Acute pancreatitis:

 Occurs suddenly
 Short term condition
 Goes away in several days with treatment
 Most common cause; gall stones
Sign and Symptoms:

 Pain in upper abdomen, may radiate to back

 Fever (due to inflammation and infection)
 Nausea and vomiting
 Swollen or tender abdomen

Chronic pancreatitis:

 Long-lasting condition
 Pancreas does not heal, instead get worsen over time
 Most common cause; heavy alcohol use

Sign and Symptoms:

 Weight loss
 Nausea vomiting (mostly after meals)
 Dull epigastric pain radiating to back
 Tripod position(Relief)
 Steatorrhea(fat malabsorption) leads to greasy, foul smelling stool
 Diarrhea
 Elevated lipase and amylase levels (secreted more than usual as pancreas is inflamed)

Diagnostic Tests:

 History & Physical examination( abdominal distention, epigastric pain, left upper quadrant
tenderness)
 Lab tests: high amylase and lipase levels, high blood glucose & high levels of lipids
 CBC- Anemia, Leukocytosis (Inflammation)
 Stool tests(to check for fat malabsorption)
 LFTs (ALT,AST, Bilirubin increased)
 Ultrasound
 CT scan
 MRI scan
 Endoscopic ultrasound
 Pancreatic function test
 Endoscopic Cholangio-pancreatography (ERCP) is also used to treat symptoms

Treatment:
 NPO(give rest to pancreas)
 Antibiotics
 Atropine( decrease pancreatic secretions)
 Peritoneal lavage(removes toxic factors)
 Symptomatic treatment
 Pain(morphine)
 Vitamin supplements for mal-absorption
Surgical Management:

 Cholecystectomy( if gallstones cause pancreatitis)

 Endoscopic Cholangio-pancreatography (ERCP)

Nursing Diagnosis:

 Acute pain related to obstruction of pancreatic or biliary duct as evidenced by grimacing/

reports of pain.
 Risk for fluid volume deficit related to vomiting/third spacing or ascites formation.
 Imbalanced nutrition i.e. less than body requirements related to nausea vomiting, decrease oral
intake as evidenced by weight loss, reports of inadequate food intake.
 Risk for infection r/t change in PH of secretions/immunosuppression.
 Knowledge deficit related to unfamiliarity with information resources as evidenced by statement
of misconception.
Nursing Interventions:

 Monitor vital signs(inflammation of pancreas causes fever)

 Assess and manage pain
 NPO (give pancreas rest)
 Keep patient in semi fowler position to decrease abdominal pressure
 Monitor labs (lipase, amylase and glucose levels)
 Assess fluid and electrolyte balance
 Assess abdomen for ascites
 Monitor I/O
 Nasogastric suction to remove toxic secretions
 Administer medications as ordered by the physician( antibiotics, analgesics, antacids,
antipyretics)
 Administer vitamins A, D, E, and K if have mal-absorption (prescribed by doctor)
 Blood sugar monitoring(Chronic pancreatitis may cause diabetes)
Teaching Plan:

 Low fat and low caloric diet such as; veg, fruits, salmon, brown rice, oatmeal, sweet potato, low
fat yogurt etc.
 Small frequent diet
 Increase fluid intake
 Quit smoking and alcohol
 Exercise to reduce obesity
 Adhere to the therapeutic regimen(do not stop medicines abruptly or without physicians order)
 Encourage lifestyle changes (healthy diet, exercise, alcohol and smoking cessation)