ACUTE PANCREATITIS Race as a risk factor:

→ Black people have a two- to three-fold elevated

CRITICAL CARE NURSING pancreatitis risk compared to whites.
1ST SEMESTER – GROUP 3-BSN408
Transcribed by: Jenna Mae Dantis
Mortality of the disease
The mortality depends on the subtype of acute pancreatitis.
Acute Pancreatitis
Mild, edematous pancreatitis shows a mortality of only 1%,
Acute pancreatitis is defined as the inflammation of the pancreas
whereas the severe, necrotizing form is associated with a
by enzyme-mediated digestion.
death toll of up to 25%. Characteristically, 20–30% of
patients with acute pancreatitis experience recurrent
Etiology of the disease
pancreatitis attacks and of these 10% develop chronic
The etiology of pancreatitis is caused by a lot of factors but pancreatitis.
the most common are the following:

A. Gallstones — Gallstones (including microlithiasis) Pathophysiology of the Disease

are the most common cause of acute pancreatitis
accounting for 40 to 70 percent of cases.

Note: Only 3 to 7 percent of patients with gallstones develop

pancreatitis. The mechanism by which the passage of
gallstones induces pancreatitis is unknown.

Two factors have been suggested as the possible initiating

event in gallstone pancreatitis:
1. Reflux of bile into the pancreatic duct due to
transient obstruction of the ampulla during passage
of gallstones.
2. Obstruction at the ampulla secondary to stone(s) or
edema resulting from the passage of a stone.

Gallstones are found in the ampulla of the vater of the

pancreas where the pancreatic duct and bile duct join
together to drain into the duodenum, which is the first part of
the small intestine. The gallstones cause the backflow of bile
and pancreatic juices into the pancreas.
B. Alcohol consumption can also cause damage to the
pancreas.
C. Hypertriglyceridemia – which is a medical condition
of high and elevated levels of triglyceride that
obstruct capillary circulation and harm pancreatic
acinar cells by ischemia destruction.
D. Other common etiology of acute pancreatitis
Post-endoscopic cholangiopancreatography (ERCP)
acute pancreatitis, trauma, anabolic steroids, mumps
virus, autoimmune diseases, hypercalcemia,
hyperlipidemia, and lastly, drug medications, as
certain medications can trigger acute pancreatitis.
(Gapp, 2023)
Gender predominance of Acute Pancreatitis:
→ There is no gender predominance found in
pancreatitis patients.
→ Male sex is more often associated with an alcoholic
etiology.
→ Women tend to have more often biliary pancreatitis.
→ The peak incidence of alcoholic acute pancreatitis in
woman is between 25 and 34 years and in men 10
years later.
The overall pancreatitis risk, which includes all etiologies,
increases continuously with age.
→ Typically, individuals are affected in their sixth
decade of life.
GROUP 3-BSN408
Brief Explanation:
There can be many causes of acute pancreatitis however the
two most common causes are alcohol and gallstones:
→ Alcohol results in the accumulation of increased toxic
metabolites within the pancreas as well as spasms in
the sphincter of Oddi.
→ Gallstones can sometimes migrate to the common
bile duct and block the sphincter of Oddi.
→ Since the sphincter vodal is a sphincter or the muscle
that opens the duct leading from the pancreas into
the GI tract, blocking the sphincter of oddi will result
in pancreatic secretions backing up increasing
pressure within the pancreas.
There are other rare causes of acute pancreatitis:
→ These include hypertriglyceridemia and
hypercalcemia, which are rare.
• Hypercalcemia can cause acute
pancreatitis via calcium, depositing in the
bile ducts and blocking the outflow of
pancreatic secretions.
→ It can be idiopathic which means we don’t know why.
→ gIp1 receptor antagonist can also cause acute
pancreatitis rarely as well.
All these potential causes result in pressure building up within
the pancreas, compressing pancreatic blood vessels, causing
tissue ischemia and death of pancreatic tissue.
Some of these causes can activate inactive proteases present with some signs of intra-abdominal
otherwise known as zymogens that the pancreas normally hemorrhage such as a Cullen sign, which is bruising
creates. in the periumbilical region or grade turner sign
→ Proteases are enzymes that digest protein. bruising along both flanks. This happens in less than
→ Normally they are supposed to be released into 1% of cases so it is very rare to have an acute
the digestive tract, however, if they’re activated pancreatitis.
inside the pancreas that will lead to:
• Tissue ischemia Diagnostics and Lab Purpose/ Findings
• Digestion of pancreatic tissue itself Studies
Blood Tests High amylase and lipase
• Digestion of pancreatic tissue will lead to the
levels—digestive enzymes
necrosis or death of pancreatic cells resulting made in your pancreas
in a massive systemic inflammatory
response. High blood glucose, also
• The inflammation will then result in more death called blood sugar
of pancreatic cells, more inflammatory
response, and this negative downward spiral High levels of blood fats lip,
of inflammation and pancreatic cell death calledids
Signs and Symptoms Signs of infection or
Since the pancreas is located retroperitoneal; somatic nerves inflammation of the bile ducts,
in the parietal peritoneum are directly stimulated by pancreas, gallbladder, or
inflammation and death of pancreatic cells that will result liver
in:
→ sudden severe epigastric pain with peritoneal Pancreatic cancer
findings which radiates the center of the back. Stool Test Fat malabsorption
Ultrasound Create a picture of the
The massive inflammatory response will also trigger the structure of an organ, which
release of inflammatory cytokines which through a series of can find gallstones.
complicated mechanisms will lead to general signs of Computed Tomography Create pictures of your
inflammation: (CT) scan pancreas, gallbladder, and
→ Fever bile ducts, which can show
→ Nausea pancreatitis or pancreatic
→ Vomiting cancer.
An inflamed pancreas will also irritate the adjacent Magnetic Resonance Creates pictures of your
intestines, causing: Cholangiopancreatography organs and soft tissues
→ an Isles which will lead to diminished bowel (MRCP) without x-rays which allow to
sounds as the bowels become quiet and stop look for causes of pancreatitis
undergoing peristalsis. Endoscopic Ultrasound Turn on an ultrasound
The inflamed blood vessels around the pancreas and in the attachment to create pictures
pancreas will leak fluid into the pancreas itself. That leakage of your pancreas and bile
of fluid and the rest of the systemic blood vessels will cause ducts
the patient to: Pancreatic Function Test To measure how your
→ become profoundly dehydrated, which results in (PFT) pancreas responds to
its subsequent signs and symptoms that may secretin, a hormone made by
happen but not always: the small intestine.
• Flat JVP
• Hypotension Treatment Modalities (Pharmacological, Procedural,
Surgical)
• Tachycardia
Pharmacological
• Oliguria Currently, there are no specific medications used to treat
acute pancreatitis, however, the goal of pharmacotherapy is
Complications of massive inflammatory response: to relieve pain and minimize complications that it may cause,
The two complications of the disease are usually detected on thus treatment is mainly supportive and may involve the
CT and may happen but not always. following:
→ IV Fluid Hydration
1. Pancreatic pseudocyst – first complication, because
of the release of inflammatory fluid into the • Cases of acute pancreatitis can often make
pancreas is the creation of a pancreatic pseudocyst, someone dehydrated. Therefore,
an enlargement of the pancreas due to fluid administration of fluids is very much
accumulation. important to avoid being dehydrated in
2. Pancreatic necrosis or abscess – Since the pancreas addition to fluids having a crucial role and
dies, it can easily become infected, and from an importance for healing.
abscess, note that rarely acute pancreatitis can also
GROUP 3-BSN408
 → Pain Relief Procedural
• Patients with acute pancreatitis may Endoscopic Retrograde Cholangiopancreatography (ERCP)
experience moderate to severe pain, thus It is a procedure in which a catheter with a small camera
pain relievers are given depending on the attached is inserted inside the bile ducts. The catheter enters
severity of pain. Pain medications may through the throat then through the esophagus and passes
include use of Nonsteroidal anti- through the stomach and finally into the bile ducts. The small
inflammatory drugs (NSAIDs) but should be camera attached sends an image through a monitor and
avoided if a patient has acute kidney through this way, gallstones can be located and be removed.
injury. Additional medication also includes Surgical
Meperidine for mild to moderate pain and Laparoscopic A minimally invasive surgical
Hydromorphone for severe pain. Cholecystectomy procedure, that helps
patient’s when gallstones
Common Drugs Used to Relief Pain for patients with Acute cause pain, infection, or
Pancreatitis: inflammation, which removes
1. Analgesics one’s gallbladder through
→ Acetaminophen (Tylenol, Feverall, Aspirin Free making small incisions
Anacin) together with the aid of a
→ is a peripherally acting drug of choice for mild to laparoscope, a small camera
moderate pain and elevation of body then is inserted through the
temperature. incision to locate the
2. Tramadol gallbladder, allowing for it
to be removed without doing
→ (Ultram, Ryzolt, Rybix) an open surgery.
→ is a centrally-acting analgesic for Nesecrotomy (Debridement If acute pancreatitis has
moderately severe pain. It inhibits the & Drainage) caused severe complications,
ascending pain pathways, altering the such as an infection that
perception of and response to pain. It also doesn’t respond to
inhibits the reuptake of norepinephrine and antibiotics, NYU Langone
serotonin. surgeons may perform a
3. Meperidine (Demerol) debridement and drainage
→ is a synthetic opioid narcotic analgesic for procedure to remove
the relief of severe pain. It has multiple infected pancreatic tissue or
actions similar to those of morphine. necrosis. This procedure also
4. Antibiotics allows doctors to drain any
→ Imipenem and cilastatin (Primaxin) fluid from the pancreas that
→ is a thienamycin derivative with greater has accumulated as a result
potency and broader antimicrobial of an infection. They may
spectrum than other beta-lactam create a new drainage
antibiotics. Cilastatin inhibits pathway in the pancreas to
dehydropeptidase activity and reduces restore normal function.
cilastatin metabolism. Imipenem-cilastatin is Pancreatic Cyst Gastronomy is a drainage procedure that
used for the treatment of multiple-organism an advanced endoscopist or
infections in which other agents either do surgeon may use if a
not provide wide-spectrum coverage or pancreatic pseudocyst—a
are contraindicated because of potential fluid-filled sac—develops in
toxicity. The 2 agents are generally the abdomen and causes
administered in a 1:1 ratio. symptoms such as pain, the
sensation of a full stomach, or
5. Ampicillin (Ampi, Omnipen, Penglobe, and vomiting. This may occur as a
Principen) complication of acute
→ has bactericidal activity against pancreatitis if inflammation
susceptible organisms. It is an alternative to and swelling cause the ducts
amoxicillin when the patient is unable to to become damaged. Our
take medication orally. experts usually perform this
6. Ceftriaxone (Rocephin) procedure using an
→ is a third-generation cephalosporin with endoscopic technique.
broad-spectrum gram-negative activity; it
has lower efficacy against gram-positive Nursing Management
organisms and higher efficacy against Assessment
resistant organisms. Ceftriaxone arrests Assessment of current nutritional status and increased
bacterial growth by binding to 1 or more metabolic requirements.
penicillin-binding proteins. → Reports of weight loss or changes in
appetite

GROUP 3-BSN408
 → History of recent alcohol consumption or
high-fat meal intake
Assessment of respiratory status.
→ And lung sounds as the patient is at risk
for pleural effusion and ARDS
Assessment of fluid and electrolyte status.
→ Weigh your patient daily to monitor
fluid balance.
Assessment of sources of fluid and electrolyte loss.
→ Signs of dehydration, such as dry mucous
membranes, decreased skin turgor, or
low urine output.
Assessment of abdomen for ascites.
→ Presence of abdominal distension
→ Complaints of severe abdominal pain,
typically located in the upper abdomen
or radiating to the back
Diagnosis
This is based on the assessment data but possible nursing
diagnosis includes:
• Acute pain related to edema, distention of the
pancreas, and peritoneal irritation.
• Imbalanced nutrition: less than body requirements
related to inadequate dietary intake, impaired
pancreatic secretions, and increased nutritional
needs.
• Ineffective breathing pattern related to splinting
from severe pain, pulmonary infiltrates, pleural
effusion, and atelectasis.
Planning and Goals
→ Relief of pain and discomfort.
• Investigate verbal reports of pain, noting
specific location and intensity (0–10 scale).
Note factors that aggravate and relieve
pain.
• Withhold food and fluid as indicated.
• Administer medication as indicated.
• Encourage adequate rest periods. Provide a
quiet, restful environment.
→ Improvement in nutritional status.
• Enteral or parenteral nutrition support may
be necessary to meet the patient’s nutritional
needs and promote healing.
• Weigh daily, or as indicated and evaluate
changes.
• Assist the patient in selecting food and fluids
that meet nutritional needs and restrictions
when the diet is resumed.
• Administer IV fluids, as prescribed, using
infusion pumps.
→ Improvement in respiratory function.
• Observe the rate and characteristics of
respirations, and breath sounds. Note the
occurrence of cough and sputum
production.
• Observe for signs of infection:
- Fever and respiratory distress in
conjunction with jaundice
- Increased abdominal pain, rigidity
and rebound tenderness,
GROUP 3-BSN408
diminished and absent bowel
sounds
- Increased abdominal pain and
tenderness, recurrent fever (higher
than 101°F), leukocytosis,
hypotension, tachycardia, and
chills.
→ Improvement in fluid and electrolyte status.
• Measure I&O including vomiting, gastric
aspirate, and diarrhea. Calculate 24-hr
fluid balance..
• Note poor skin turgor, dry skin, mucous
membranes, and reports of thirst.
• Administer fluid replacement as indicated
(saline solutions, albumin, blood, blood
products, dextran).
• Replace electrolytes (sodium, potassium,
chloride, calcium as indicated).
Intervention
Relieve pain and discomfort. The current recommendation
for pain management in this population is parenteral opioids
including morphine, hydromorphone, or fentanyl via patient-
controlled analgesia or bolus.
Improve breathing pattern. The nurse maintains the patient
in a semi-Fowler’s position and encourages frequent position
changes.
Improve nutritional status. The patient receives a diet high
in carbohydrates and low in fats and proteins between acute
attacks.
Maintain skin integrity. The nurse carries out wound care as
prescribed and takes precautions to protect intact skin from
contact with drainage.
Evaluation
→ Relieved pain and discomfort.
→ Improved nutritional status.
→ Improved respiratory function.
→ Improved fluid and electrolyte status
Discharge
(A prolonged period is needed to regain the strength of a
patient who has experienced pancreatitis and to return to
the previous level of activity.)
• Teaching. Teaching needs to be repeated and
reinforced because the patient may have difficulty
in recalling many of the explanations and
instructions are given.
• Prevention. The nurse instructs the patient about
the factors implicated in the onset of pancreatitis
and about the need to avoid high-fat foods, heavy
meals, and alcohol.
• Identification of complications. The nurse should
give verbal and written instructions about the signs
and symptoms of pancreatitis and possible
complications that should be reported promptly to
the physician.
 • Home care. The nurse would be able to assess the most%20common%20causes%20of,geographic%20regions%20and
patient’s physical and psychological status and %20socioeconomic%20strata.
adherence to the therapeutic regimen NYU Langone. (n.d.). Surgery & Endoscopic Procedures for Pancreatitis.
https://nyulangone.org/conditions/pancreatitis/treatments/surgery-
Documentation endoscopic-procedures-for-
 Client’s description of response to pain and pancreatitis#:~:text=If%20acute%20pancreatitis%20has%20led,to
%20cause%20severe%20tissue%20damage.
acceptable level of pain.
 Prior medication use. Tang, J.C.F. (2021). Acute Pancreatitis Medication.
 Caloric intake. https://emedicine.medscape.com/article/181364-medication#3
 Individual cultural or religious restrictions and
personal preferences. Vera, M. (2023, April 30). 6 pancreatitis nursing care plans.
https://nurseslabs.com/pancreatitis-nursing-care-plans/#h-nursing-
 Respiratory pattern, breath sounds, and use of interventions-and-actions
accessory muscles.
 Laboratory values.
 Use of respiratory aids or supports.
 Plan of care.
 Teaching plan.
 Response to interventions, teaching, and actions
performed.
 Attainment or progress toward desired outcomes.
 Modifications to plan of care.
 Long-term needs.

Contents by:
Dantis, Jenna Mae M.
Deypalan, Judiel
Dimapilis, Aaron Miguel P.
Diomampo, Bea Kate
Dupitas, Kobe Audrey G.
Espenida, Sophia E
Fajardo, Ellaine L.
Fernando, Rae Matthew S.
Ferrer, Albert Justin R.
Flores, Anne Gabrielle C.

References:

Belleza, M. (2023, July 21). Pancreatitis.

https://nurseslabs.com/pancreatitis/#h-nursing-management

Cleveland Clinic (2023, January 12). Pancreatitis.

https://my.clevelandclinic.org/health/diseases/8103-pancreatitis

De Pretis, N., Amodio, A., & Frulloni, L. (2018). Hypertriglyceridemic

pancreatitis: Epidemiology, pathophysiology and clinical management.
United

European Gastroenterology Journal, 6(5), 649–655.

https://doi.org/10.1177/2050640618755002

Diagnosis of Pancreatitis | NIDDK. (2022, November). National Institute

of Diabetes and Digestive and Kidney Diseases.
https://www.niddk.nih.gov/health-information/digestive-
diseases/pancreatitis/diagnosis

Fagniez P., Rotman N. (n.d.). Acute Pancreatitis. National Center for

Biotechnology Information.
https://www.ncbi.nlm.nih.gov/books/NBK6932/

Gapp, J. (2023, February 9). Acute pancreatitis. StatPearls - NCBI

Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK482468/#:~:text=The%20
GROUP 3-BSN408