PANCREATITIS

Prepared by
Ms. Maira Shaheen
 LEARNING
OBJECTIVES
By the end of the session learners will be able
to:
• Review the anatomy and physiology of
Pancreas
• Discuss the causes, pathophysiology and
manifestation of the Acute Pancreatitis
• Discuss the diagnostic, medical and Nursing
management of the Acute Pancreatitis
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PANCREATITIS

Inflammation of the
Pancreas
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 PANCREATITIS,
ACUTE
Pancreatitis (inflammation of the pancreas) is a
serious disorder that can range in severity from a
relatively mild, self limiting disorder to a rapidly
fatal disease that does not respond to any
treatment.

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ETIOLOGY AND PATHOPHYSIOLOGY

Pancreatic Ducts
become obstructed

Hypersecretion of the exocrine

enzymes of pancreas

These enzymes enter the bile duct,

where they are activated and with
bile back up into the pancreatic
duct
Pancreatitis
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ETIOLOGY AND PATHOPHYSIOLOGY

Trypsinogen- (a proteolytic enzyme)

Normally released into the small intestine,
where it is activated to trypsin

In AP, activated to trypsin in the pancreas

causing autodigestion of pancreas

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 PROGRESSION OF DISEASE

• Autodigestion
Acute Inflammation of Pancreas

Necrosis of Pancreas

Digestion of vascular walls

Thrombus and Hemorrhage

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Death
 PRECIPITATING FACTORS
• Trauma
• Use of alcohol *
• Biliary tract disease
• Viral or Bacterial disease
• Cholelithiasis *
• Peptic Ulcer Disease

*most common causes

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 CLINICAL MANISFESTATION

Severe abdominal pain is the major symptom.

• Pain in the mid epigastrium may be accompanied
by abdominal distention; a poorly defined, palpable
abdominal mass; decreased peristalsis; and
vomiting that fails to relieve the pain or nausea.
• Pain is frequently acute in onset (24 to 48 hours
after a heavy meal or alcohol ingestion); may be
more severe after meals and unrelieved by antacids.
• Patient appears acutely ill.
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Hypotension related to hypovolemia and shock.
• May develop tachycardia, cyanosis, and cold,
clammy skin.
• Acute renal failure common.
• Respiratory distress and hypoxia.
• May develop diffuse pulmonary infiltrates, dyspnea,
tachypnea, and abnormal blood gas values.
• Myocardial depression, hypocalcaemia,
hyperglycemia, and disseminated intravascular
coagulation (DIC). 10
 ACUTE PANCREATITIS
DIAGNOSTIC STUDIES
History and physical examination
Laboratory tests
Serum amylase- hallmark test
Serum lipase – also elevated
Blood glucose
Serum calcium
Triglycerides

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 ACUTE PANCREATITIS
DIAGNOSTIC STUDIES

Abdominal/endoscopic ultrasound
Endoscopic retrograde
cholangiopancreatography (ERCP)
Chest x-ray
CT of pancreas
Magnetic resonance cholangiopancreatography
(MRCP)
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 MEDICAL MANAGEMENT:

During the acute phase, management is symptomatic

and directed toward preventing or treating
complications.
• Oral intake is withheld to inhibit pancreatic
stimulation and secretion of pancreatic enzymes.
• Parenteral nutrition (PN) is administered to the
debilitated patient.
• Nasogastric suction is used to relieve nausea and
vomiting and to decrease painful abdominal
distention and paralytic ileus.
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 CONTINUE…

Adequate pain medication, such as morphine, is

administered.
Antiemetic agents may be prescribed to prevent
vomiting.
• Correction of fluid, blood loss, and low
albumin levels is necessary.
• Antibiotics are administered if infection is
present.

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 NURSING MANAGEMENT
Relieving Pain and Discomfort
• Administer analgesics as prescribed. Current
recommendation for pain management is parenteral
opioids, including morphine, hydromorphone, or
fentanyl via patient controlled analgesia or bolus.
• Frequently assess pain and the effectiveness of
the pharmacologic interventions.
• Maintain patient on bed rest to decrease
metabolic rate and to reduce secretion of
pancreatic enzymes 15
 IMPROVING NUTRITIONAL
STATUS

• Assess nutritional status and note factors that

alter the patient’s nutritional requirements
(e.g., temperature elevation, surgery,
drainage).
• Monitor laboratory test results and daily
weights.
• Provide enteral nutrition or PN as prescribed.
Monitor serum glucose level every 4 to 6 hours.
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Introduce oral feedings gradually as symptoms
subside.
•Avoid heavy meals and alcoholic beverages.

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 MONITORING AND MANAGING
COMPLICATIONS
Fluid and Electrolyte Disturbances
• Assess fluid and electrolyte status by noting
skin turgor and moistness of mucous membranes.
•Weigh daily; measure all fluid intake and output.
•Assess for other factors that may affect fluid and
electrolyte status, including increased body
temperature and wound drainage.
• Observe for ascites, and measure abdominal
girth.
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Administer intravenous (IV) fluids and blood or
blood products to maintain volume and prevent
or treat shock.
• Report decreased blood pressure, reduced urine
output, and low serum calcium and magnesium.

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 1. PANCREATIC NECROSIS

• Transfer patient to intensive care unit for close

monitoring.
• Administer prescribed fluids, medications, and
blood products.
• Assist with supportive management, such as
mechanical ventilation.

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 2. SHOCK AND MULTIPLE
ORGAN FAILURE
• Monitor patient closely for early signs of
neurologic, cardiovascular, renal, and
respiratory dysfunction.
• Prepare for rapid changes in patient status,
treatment, and therapies; respond quickly.
• Inform family of status and progress of
patient; allow time with patient.

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 REFERENCE
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., &
Cheever, K. H. (2010). Brunner and Suddarth’s
textbook of medical-surgical nursing (12th ed.).
Philadelphia:Lippincott Williams & Wilkins.

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THANK YOU

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