Pancreatitis

Def

Pancreatitis (inflammation of the pancreas) is a serious disorder. The most basic classification system
used to describe or categorize the various stages and forms of pancreatitis divides the disorder into
acute or chronic forms.

Acute pancreatitis can be a medical emergency associated with a high risk for life-
threatening,complications and mortality,

chronic pancreatitis often goes undetected until 80% to 90% of the exocrine and endocrinetissue is
destroyed.

ACUTE PANCREATITIS

DEF

Acute pancreatitis is an inflammation of the pancreas that can develop quickly, . that may be mild or life
threatening

Mild acute pancreatitis is characterized by edema and inflammation confined to the pancreas. Minimal
organ dysfunction is present, and return to normal usually occurs within 6 months

CAUSES

• Alcoholism.

• Gallstones.

• Abdominal surgery.

• Certain medications.

• Cigarette smoking.

• Cystic fibrosis.

• Family history of pancreatitis.

• High calcium levels in the blood (hypercalcemia), which may be caused by

an overactive parathyroid gland (hyperparathyroidism)

Pathophysiology

• Auto digestion of the pancreas by its own proteolytic enzymes, principally trypsin, causes acute
pancreatitis. Long-term use of alcohol is commonly associated with acute episodes of
pancreatitis,

Gallstones enter the common bile duct and lodge at the ampulla of Vater, obstructing the flow of
pancreatic juice or causing a reflux of bile from the common bile duct into the pancreatic duct, thus
activating the powerful enzymes within the pancreas.
 • Normally, these remain in an inactive form ( trypsinogen to trypsin)until the pancreatic
secretions reach the lumen of the duodenum.

• Activation of the enzymes in pancreaascan lead to vasodilation, increased vascular

permeability, necrosis, erosion, and hemorrhage

• Spasm and edema of the ampulla of Vater, resulting from duodenitis, can probably produce
pancreatitis.,

Attacks of acute pancreatitis may result in complete recovery, may recur without permanent damage, or
may progress to chronic pancreatitis

Clinical manifestation

• dull abdominal pain,

• rigid abdomen,

• hypotension or shock, hypocalcemia

• respiratory distress from accumulation of fluid in the retroperitoneal space.

• The abdominal pain is generally located in the midline just below the sternum, with radiation to
the spine, back, and flank.

• palpable abdominal mass; and decreased peristalsis.

• Abdominal guarding is present.

• A rigid or board-like abdomen may develop and is generally an ominous sign;

• Ecchymosis (bruising) in the flank or around the umbilicus

• . Nausea and vomiting are common in acute pancreatitis.

• The emesis is usually gastric in origin but may also be bile-stained.

• Fever, jaundice, mental confusion

Diagnostic Findings

History and physical examination

• Serum amylase and lipase levels are used in making the diagnosis of acute pancreatitis. 90% of
the cases, serum amylase and lipase levels usually rise in excess of three times their normal
upper limit within 24 hours

• Serum amylase (normal: 80 to 180 U/dL) and serum lipase

• (normal: 0 to 160 U/L)

• Glucose, bilirubin, alkaline phosphatase, ,

• ALT, AST, cholesterol, and potassium are all elevated.

• Decreases are measured in serum albumin, calcium, sodium, and magnesium.

 • X-ray examination may show pleural effusion from local inflammatory reaction to pancreatic
enzymes

• Computed tomography and ultrasonography

Endoscopic retrograde cholangiopancreatography (ERCP) – IT is a technique that combines the use of

endoscopy and fluroscopy ( imaging technique that uses x ray ) to diagnose biliary and pancreatic ductal
systems.

Medical management

Intravenous fluids are administered, such as crystalloid, electrolyte, or colloid (such as albumin)
solutions, if the patient experiences hypovolemic shock.

Blood or blood products may also be ordered if the patient has significant blood loss from hemorrhage

• Nasogastric suction may be used to relieve nausea and vomiting, to decrease painful abdominal
distention and paralytic ileus,

• Histamine-2 (H2) antagonists (eg, cimetidine and ranitidine) may be prescribed to decrease
pancreatic activity by inhibiting HCl secretion.

• PAIN MANAGEMENT - Adequate pain medication is essential during the course of acute
pancreatitis to provide sufficient pain relief

• INTENSIVE CARE -Correction of fluid and blood loss and low albumin levels is necessary to
maintain fluid volume and prevent renal failure

.BILIARY DRAINAGE -Placement of biliary drains (for external drainage) and stents (indwelling tubes) in
the pancreatic duct through endoscopy has been performed to reestablish drainage of the pancreas.

SURGICAL INTERVENTION

• diagnostic laparotomysurgery may be performed to assist in the diagnosis of pancreatitis (to

establish pancreaticm drainage, or to resect or debride a necrotic pancreas

• Multiple sump tubes are used after pancreatic surgery. Triple-lumen tubes consist of ports that
provide tubing for irrigation, air venting, and drainage.

• NURSING DIAGNOSES

• • Acute pain related to inflammation, edema, distention of the pancreas, and peritoneal
irritation

• • Ineffective breathing pattern related to severe pain, pulmonary infiltrates, pleural effusion,
atelectasis, and elevated diaphragm

• • Imbalanced nutrition, less than body requirements, related to reduced food intake and
increased metabolic demands

• • Impaired skin integrity related to poor nutritional status, bed rest, and multiple drains and
surgical wound

• PAIN MANAGEMENT
Adequate pain medication is essential during the course of acute pancreatitis to provide sufficient
pain relief and minimize restlessness, which may stimulate pancreatic secretion further. Morphine
and morphine derivatives are often avoided because it has been thought that they cause spasm of
the sphincter of Oddi; meperidine (Demerol) is often prescribed because it is less likely to cause
spasm of the sphincter . Antiemetic agents,may be prescribed to prevent vomiting.

INTENSIVE CARE

• Correction of fluid and blood loss and low albumin level albumin levels is necessary to maintain
fluid volume and prevent renal failure.

• POSTACUTE MANAGEMENT

• Antacids may be used when acute pancreatitis begins to resolve. Oral feedings low in fat and
protein are initiated gradually.

• Caffeine and alcohol are eliminated from the diet. If the episode of pancreatitis occurred during
treatment with thiazide diuretics, corticosteroids, or oral contraceptives, these medications are
discontinued.

• Follow-up of the patient may include ultrasound, x-ray

• studies, or ERCP to determine whether the pancreatitis is resolving and to assess for abscesses
and pseudocysts.

• CHRONIC PANCREATITIS

def

• Chronic pancreatitis is an inflammatory disorder characterized by progressive anatomic and

functional destruction of the pancreas. As cells are replaced by fibrous tissue with repeated
attacks of pancreatitis, pressure within the pancreas increases. The end result is mechanical
obstruction of the pancreatic and common bile ducts and the duodenum

• ETIOLOGY AND INCIDENCE.

• The major cause of chronic pancreatitis in men is excessive alcohol ingestion that causes
repeated attacks of acute pancreatitis.

• chronic obstructive biliary disease tha leads to persistent inflammation of the pancreatic ducts.

• prolonged malnutrition, cancer of the pancreas or duodenum,

• prolonged use of enteral feedings,

• The usual age for chronic pancreatitis to develop is between ages 45 and 60.

• PATHOPHYSIOLOGY.

• Chronic pancreatitis is a continuous, progressive disease that replaces functioning pancreatic

tissue with fibrotic tissue as a result of inflammation.

• Pancreatic ducts become obstructed, dilated, and finally atrophied. The acinar, or enzyme-
producing, cells of the pancreas ulcerate in response to inflammation.
 • The ulceration causes further tissue damage and tissue death, and it may cause cystic sacs filled
with pancreatic enzymes to form on the surface of the pancreas.

• The pancreas becomes smaller and hardened, and progressively smaller amounts of pancreatic
enzymes are produced.

Clinical manifestation

• Midline abdominal pain Chronic pancreatitis is characterized by recurring attacks of severe

upper abdominal and back pain, accompanied by vomiting.

• Low-grade fever , Nausea and vomiting

• steatorrhea.

• calcification of the gland may occur, and calcium stones may form within the ducts.

• Dm, weight loss , constipation,

Surgical management

• Pancreaticojejunostomy (also referred to as Roux-en-Y)

• with a side-to-side anastomosis or joining of the pancreatic duct to the jejunum allows drainage
of the pancreatic secretions into the jejunum. Pain relief occurs by 6 months in more than 80%
of the patients who undergo this procedure, but pain returns

• Complication

• Pseudocyst

• Pleural effusion

• Pancreatic cancer

• Pancreatic ascitis

• PAIN MANAGEMENT

Adequate pain medication is essential during the course of acute pancreatitis to provide sufficient pain
relief and minimize restlessness, which may stimulate pancreatic secretion further. Morphine and
morphine derivatives are often avoided because it has been thought that they cause spasm of the
sphincter of Oddi; meperidine (Demerol) is often prescribed because it is less likely to cause spasm of
the sphincter . Antiemetic agents,may be prescribed to prevent vomiting.

INTENSIVE CARE

• Correction of fluid and blood loss and low albumin level albumin levels is necessary to maintain
fluid volume and prevent renal failure.