NCF - CHS - BSN 3B

PANCREATITIS
Problem in
Accessory Organ

Group 5
 INTRODUCTION
ACUTE
Described as autodigestion of the
pancreas by the exocrine enzymes
it produces, principally, trypsin.
Common causes of acute episodes
are biliary tract disease and long-
term alcohol use.
Two types:
Interstitial edematous
Necrotizing
CHRONIC
It is a progressive destruction of
the pancreas where the cells are
replaced by the fibrous tissue with
repeated attacks of pancreatitis
and pressure within the pancreas
increases. The result is obstruction
of the pancreatic and common bile
ducts and the duodenum.
 ACUTE
Approximately 200,000 cases of
acute pancreatitis occur in the US,
of which 80% are the result of
cholelithiasis and alcohol abuse
There is an increased incidence
associated with surgery on the near
pancreas, medications,
hypercalcemia and hyperlipidemia.
20% are idiopathic
Small incidence of hereditary
CHRONIC
Excessive and prolonged consumption
of alcohol accounts for approximately
70% - 80% of all cases of pancreatitis.
The incidence of pancreatitis is 50 times
greater in people with alcoholism than
those who do not abuse alcohol
 PANCREAS
-large, tadpole shaped gland that lies transversely in the upper
abdomen between spleen on the left.
-it is divided into: head, neck, body, tail
-plays an important role in DIGESTION and REGULATION of
blood sugar.

ANATOMY
 2 TYPES OF GLANDS:
1. EXOCRINE GLAND -secretes digestive enzymes
and helps in digestion process of the food that we
ingest.
2. ENDOCRINE GLAND - produces hormones that
control amount of sugar in your bloodstream.

ANATOMY
 GALLSTONES

Obstruction of the Pancreatic duct

Inappropriate Activation of Pancreatic Enzymes

PATHOPHYSIOLOGY
Autodigestion of Pancreatic Tissue

Inflammation and Edema

ACUTE PANCREATITIS
 PROLONGED USE OF ALCOHOL

Persistent Inflammation

Inappropriate Activation of Pancreatic Enzymes

PATHOPHYSIOLOGY
Autodigestion of Pancreatic Tissue

Inflammation and Edema

CHRONIC PANCREATITIS
 RISK FACTORS

Gallstones Medications
Alcohol Abuse GI Surgery
Smoking Family History

Diabetes
 SIGNS & SYMPTOMS

ACUTE CHRONIC
Pain in the mid epigastrium
Severe upper abdominal pain
Poorly palpable abdominal mass
and back pain accompanied
ecchymosis in the flank or
by vomiting
around the umbilicus
Weight loss
Nausea and vomiting
foul smelling stool
fever
steatorrhea
jaundice, agitation
dyspnea, cyanosis
hypotension, tachycardia
CASE SCENARIO
A 36 year old man presented to hospital with acute severe pancreatitis four
days after starting a course of Orlistat, a lipase inhibitor used in the treatment of
obesity. A diagnosis of drug related pancreatitis was made by exclusion of other
causes of pancreatitis; he was a teetotaller, had a normal serum calcium, had no
family history of pancreatitis or hyperlipidaemia, no history of trauma and had no
evidence of gallstones on Computerised Tomography scan (CT).

Patient name: Unknown

Age: 36 years old
Gender: Male
Chief Complaint: 24 hour history of central abdominal pain, two episodes of vomitting
and loose stool
Weight:130 kg
BMI: Greater than 40
CASE SCENARIO
Current Medications:
Past Medical History:
diltiazem
Type II Diabetes Mellitus
lisinopril
Hypertension
metformin
Asthma
glicazide
Obstructive Sleep Apnoea
orlistat.

Physical Examination and Diagnostic Findings

He was pyrexial and on examination was tender in the epigastrium.
His initial white cell count was 20 × 109/L and a C reactive protein of more than 300 mg/l, an
amylase of 136 iu/l, and a lactate dehydrogenase of 892 iu/l. a recent lipid profile was
normal and his corrected calcium was 2.41 iu/l.
CT scan showed appearances of acute pancreatitis affecting the distal body and tail of the
pancreas.
He was classified as having acute severe pancreatitis using the modified Glasgow Score 1984.
 The white blood cell count is usually elevated;

DIAGNOSTIC hypocalcemia is present in many patients and

correlates well with the severity of pancreatitis.
Hematocrit and hemoglobin levels are used to
TESTS monitor the patient for bleeding. Transient
hyperglycemia and glucosuria and elevated
serum bilirubin levels occur in some patients
Blood tests can with acute pancreatitis.

give clues about Serum amylase and lipase levels are

how the immune elevated within 24 hours of the onset of the
symptoms. Serum amylase usually returns
system, pancreas to normal within 48 to 72 hours, but serum
and related organs lipase levels may remain elevated for a
longer period, often days longer than
are working. amylase
 X-ray studies of the abdomen and
DIAGNOSTIC chest may be obtained to
differentiate pancreatitis from other
TESTS disorders that can cause similar
symptoms and to detect pleural
effusions.
Imaging Studies of
pancreas shows Ultrasound studies, contrast-enhanced
the extent of CT scans, and magnetic resonance
imaging (MRI) scans are used to
inflammation,
identify an increase in the diameter of
causes and the pancreas and to detect pancreatic
complications cysts, abscesses, or pseudocysts.
 Peritoneal fluid, obtained through
DIAGNOSTIC paracentesis or peritoneal lavage, may
contain increased levels of pancreatic
TESTS enzymes. A stool test is another type
of pancreas function test that checks for
reduced levels of enzymes and excess
Other tests can level of fat in stool.
include: ERCP is rarely used in the diagnostic
evaluation of acute pancreatitis,
because the patient is acutely ill;
however, it may be valuable in the
treatment of gallstone pancreatitis.
DIAGNOSTIC
TESTS
Criteria for
Predicting Severity
of Pancreatitis
 CT scan uses a contrast dye to make
DIAGNOSTIC the parts show up. Patient will either
drink the dye in a solution or it will be
TESTS injected into vein. Consider allergies to
seafood and advice increased fluid
intake after procedure.
Nursing
considerations and During MRI stud ask patient to remove
preparations: metal objects, including wristwatches,
keys and jewelry. Also if he has any
implanted metal devices or prostheses,
such as vascular clips, shrapnel,
pacemakers, joint implants, filters, and
intrauterine devices.
 NURSING DIAGNOSIS
& INTERVENTION
Acute pain and discomfort r/t edema, distention of
the pancreas, and peritoneal irritation
Administer Meperidine (Demerol) as ordered. This is the drug of choice
Avoid morphine sulfates
Withhold oral fluids
Use nasogastric suctioning; avoid tension on tube and use water-soluble lubricant around nares,
provide frequent oral hygiene and care
Maintain patient on bed rest
Assist the pt.to assume position of comfort , turn and reposition every 2hrs
Report unrelieved pain or increasing intensity of pain
Use nonpharmacologic intervention for relieving pain
Provide explanations about treatment; patient may have clouded sensorium from pain, fluid
imbalances, and hypoxemia.
 NURSING DIAGNOSIS
& INTERVENTION
Imbalanced nutrition: Less than body requirements r/t inadequate
dietary intake, impaired absorption and increased metabolic
demands
Monitor laboratory test results, daily weights, and anthropometric measures.
Assess nutritional status and increased metabolic requirements (note increased body
temperature, restlessness, increased physical activity) and fluid lost through diarrhea
Provide mouth care, patient should NPO during an attack
Administer fluids, electrolytes, and parenteral nutrition as prescribed
Monitor serum glucose level, and give insulin as prescribed
Avoid oral feedings gradually as symptoms subside
Avoid heavy meals, alcoholic beverages, excessive use of coffee, and spicy food
Provide high carbohydrates, low protein and low-fat diet when tolerated
 NURSING DIAGNOSIS
& INTERVENTION
Ineffective breathing pattern r/t severe pain, pulmonary
infiltrates, pleural effusion and atelectasis

Maintain patient in semi-Fowler's position

Change position frequently
Administer anticholinergic medications as prescribed
Assess respiratory status frequently
Teach patient in techniques of coughing and deep breathing
exercise in every 2 hrs
 NURSING DIAGNOSIS
& INTERVENTION
Impaired skin integrity r/t poor nutritional status, bed
rest, multiple drains and surgical wound

Assess the wound, drainage sites, and skin carefully for signs of infection,
inflammation and breakdown
Carry out wound care as prescribed, and take precautions to protect
intact skin from contact with drainage
Consult with an enterostomal therapist as needed
Turn patient every 2 hours; use of specialty beds may be indicated
Surgical wound may be irrigated and repacked every 2 to 3 days
 PHARMACOLOGIC
MANAGEMENT

CIMETIDINE (TAGAMET)

Histamine H2 receptor antagonist

(H2RA) that reduces the amount of
acid in your stomach

ANTIBIOTICS

Treat and prevent bacterial infections

ANALGESIC

to relieve pain
 SURGICAL
SURGICAL
MANAGEMENT
MANAGEMENT

Pancreaticojunostomy

Surgical procedure connecting the pancreas to

the jejunum (part of the small intestine) to
restore digestive function.
Treatment for chronic pancreatitis or pancreatic
cancer obstructing the pancreatic duct.
 SURGICAL
SURGICAL
MANAGEMENT
MANAGEMENT

Pancreaticoduodenectomy

Surgical procedure aimed at creating a direct connection

between the pancreatic duct and the jejunum, a part of the
small intestine.
To restore proper drainage of pancreatic fluids when the
pancreatic duct is obstructed or damaged.
Commonly performed to alleviate symptoms of chronic
pancreatitis or to manage complications of pancreatic cancer.
 SURGICAL
SURGICAL
MANAGEMENT
MANAGEMENT

Total pancreatectomy

Surgical procedure involving the complete removal of

the pancreas, a vital organ responsible for producing
digestive enzymes and insulin.
Treatment option for severe pancreatic diseases such
as cancer, chronic pancreatitis, or trauma that cannot
be managed with other treatments.
THANK
YOU