INSTITUT LATIHAN KEMENTERIAN KESIHATAN MALAYSIA

JOHOR BHARU

MHMS 2084

MEDICAL SCIENCE I

CASE STUDY:

PANCREATITIS

NUR AIN MUNIRAH BINTI MOHD ZAMRI

DPMH 1/2022(10)-0040

LECTURER

EN MOHD SHAHID BIN JAAFAR

DIPLOMA IN MEDICAL AND HEALTH SCIENCE

DATE OF SUBMISSION

(31ST OCTOBER 2022)

 TABLE OF CONTENTS

NO. CONTENTS PAGES

1. INTRODUCTION 1
2. ETIOLOGY 1-2
3. PATHOPHYSIOLOGY 2
4. CLINICAL MANIFESTATIONS 2
5. INVESTIGATIONS 3
6. MANAGEMENT 3-4
7. HEALTH EDUCATION 4
8. CONCLUSION 4
9. REFERENCES 5
 INTRODUCTION

A condition known as pancreatitis can develop when inflammation occurs within

the pancreas. The pancreas is a gland which located in the upper belly, nestled below
the stomach. As the pancreas is an organ which secretes digestive enzymes, insulin,
and also glucagon, this disease is associated with excessive or abnormal releases of
hormones. According to studies, people who consume a lot of alcohol and smoke have
a greater chance of developing acute or chronic pancreatitis. However, pancreatitis
can be prevented with the right interventions such as good lifestyle to reduce mortality.

Moreover, pancreatitis is still a serious public health concern all over the world,
even with the improvements in medical understanding and excellent therapies that
have been made in recent decades. Acute pancreatitis occurs 13 to 45 in 100,000
population-years, and chronic pancreatitis occurs 5 to 12 per 100,000 (Yadav &
Lowenfels, 2013). About 20% of people with acute pancreatitis get moderate to severe
cases, which kill 20–40% of them.

ETIOLOGY

Firstly, in most research and cases, excessive alcohol intake is associated with
the common aetiology of pancreatitis. Between 40 and 70 percent of all cases of
pancreatitis can be traced back to excessive alcohol usage (Herreros-Villanueva,
2013). Diseases of the biliary system, such as cholecystitis, cholelithiasis, and
cholangitis, are blamed for causing pancreatic inflammation by redirecting pancreatic
enzymes into the organ. Other than that, hyperlipidaemia or also known as high
cholesterol in blood can be associated with pancreatitis. In addition, pancreatitis can
be the result of penetrating trauma, such as a cut or a bruise, because this type of
injury can cause enzymes to seep out of the pancreatic ducts when they are damaged.
Calcium can be deposited in the ducts of the pancreas and activate trypsinogen in the
organ if there has been an abrupt spike in calcium levels, also known as
hypercalcemia. Inflammation of the pancreas cell can also be caused by infections
caused by bacteria and viruses, as well as by being pregnant. As a result of increasing
the viscosity of pancreatic secretion and delaying the emptying of the pancreas,
medications such as corticosteroids and thiazide diuretics can also have an impact on
the likelihood of developing pancreatitis (Minupuri et al., 2020). Idiopathic pancreatitis
describes circumstances in which the source of the pancreatitis cannot be determined.

1
This kind of pancreatitis can occur in some people. About twenty percent of all cases
of pancreatitis are caused by something called idiopathic pancreatitis.

PATHOPHYSIOLOGY

To begin, the oedema of the pancreas, which is generated by trauma such as a

blunt injury, is the first step in the pathophysiology of pancreatitis. In addition to that, it
is caused by an abnormally high production of pancreatic enzymes in the body. An
excessive amount of enzyme secretion might cause necrosis of the fat cells in the
pancreas and the cavity of the peritoneum. When a patient has a lot of alcohol in their
system, they can get this illness. As a consequence of this, an excessive inflammatory
response is triggered, which leads to the infiltration of inflammatory cells into the
pancreas. This happens as acinar cells in the pancreas continue to deteriorate. When
inflammation takes place, it has the potential to extend across the entire pancreas,
which can subsequently result in the formation of an inflammatory mass. In addition to
that, the presence of haemorrhage makes this condition significantly worse.
Pseudocysts, when left untreated, can eventually grow large enough to perforate the
pancreatic ducts. The infection will spread to the pseudocyst, which may then develop
into a pancreatic abscess.

CLINICAL MANIFESTATION

Patients may not have any symptoms at all in situations of pancreatitis that are
considered to be mild. When the condition is severe, patients will have pain in the
epigastric and umbilical regions, which may subsequently move to the back, shoulder,
or iliac fossa, and finally across the entire body. The pain in the abdomen is constant,
and it gets significantly worse whenever consume food or alcohol. In addition, fever,
nausea, and vomiting are the clinical signs of pancreatitis that are seen the most
frequently. After then, patients will notice that their mucosa membrane is dry, which is
an indication that they are becoming dehydrated. Patients who have pancreatitis
frequently experience shock. Instances such as tachycardia, hypotension,
tachypnoea, arrhythmia, and renal failure are all examples. During the physical
examination of the abdomen, there is rigidity of the abdominal wall as well as
discomfort around the epigastric region while doing deep palpation.

2
 INVESTIGATIONS

There are a few investigative steps that need to be taken before arriving at a
diagnosis for any disease, including pancreatitis. First and foremost, the endoscopic
retrograde cholangiopancreatography (ERCP) is typically the first study performed
when diagnosing pancreatitis This endoscopic treatment is for the management of
pancreaticobiliary problems, such as cholelithiasis and cholecystitis, which is the most
common adverse event associated with pancreatitis. Subsequently, endoscopic
ultrasound, often known as endosonographic, was first created with the purpose of
enhancing visualization of the pancreas. Inflammation and obstructions in the bile duct
and pancreatic duct should also be investigated as part of this procedure. On the other
hand, oral glucose tolerance test (OGTT) is essential for determining insulin sensitivity
and insulin resistance abnormalities. The secretin pancreatic function test, commonly
known as the secretin stimulation test, is the next test that will be performed. This test
is used to evaluate how well the pancreas is able to react to a hormone known as
secretin. Secretin is the hormone that allows the pancreas to secrete enzymes that
facilitate in the digestion of food. Full blood count, BUSE, liver function test, and renal
profile are all useful blood tests in the diagnosis of pancreatitis. In addition to testing
for elevated levels of white blood cells, renal function, and liver enzymes, all of these
blood tests are looking for evidence of increased levels of pancreatic enzymes. Lastly,
magnetic resonance imaging (MRI) can assist assess pancreatic necrosis.

MANAGEMENT

When patients with pancreatitis fall, monitoring for shock and respiratory
failure is the first and most crucial step in treatment. As a practitioner of medical
care, the most important thing you can do is alleviate the patient's discomfort by
performing intubation, endotracheal intubation, and cardiac resuscitation (CPR).
Electrolyte imbalance can be prevented by filling an intravenous line with 0.9%
normal saline. In addition, analgesics should be prescribed whenever possible. Most
commonly used analgesics include intramuscular (I/M) pethidine HCl 100 mg, oral
(PO) tramadol 50–100 mg, and oral (PO) paracetamol 1000 mg on demand (PRN).
Nursing care is also required, including monitoring of vital signs every 3 to 4 hours
and pain relief. In addition to the intake and output charts, monitoring patients for
problems, maintaining good hygiene, and eating a diet high in nutrients and low in fat

3
are also essential. Endoscopic retrograde cholangiopancreatography (ERCP) is
necessary to treat pancreatitis caused by disorders of the biliary system by
unblocking the bile ducts. In a nutshell, surgical intervention is the last resort.
Pancreatic abscesses require incision and drainage, whereas severe necrosis
necessitates a laparotomy, and gallstones necessitate a cholecystectomy.

HEALTH EDUCATION

Patients suffering from pancreatitis need to cut back significantly on their alcohol
consumption as this is the primary factor that leads to the development of the
condition. The second step is for patients to be informed that they should avoid taking
any drug, including laxatives, that can cause pancreatitis. In addition, the patient is
required to make it to the hospital on the scheduled date for more treatment and to
take the medication that has been prescribed to them. When it comes to diet, cutting
back on foods that are high in fat can help reduce the amount of fat that is circulating
in the blood, which the pancreas can then digest. Patients should not make smoking
or using drugs a regular part of their practise and should not use drugs themselves. In
general, leading a healthy lifestyle, which includes eating well, being physically active,
and getting sufficient rest, will strengthen the immune system.

CONCLUSION

The mortality rate associated with pancreatitis has been estimated to range
anywhere from 10 to 20 percent on average. Pancreatic oedema, on the other hand,
has a death rate of less than 5%, whereas the mortality rate associated with
pancreatic haemorrhage can reach over 50%. It would appear that within the first
week of symptoms appearing, pancreatitis is responsible for approximately 75% of
deaths. Patients who have pancreatitis have a higher risk of developing a variety of
consequences, including respiratory failure, pancreatic haemorrhage, pancreatic
abscess, and pancreatic pseudocyst. This is because there are multiple treatments
and late treatments available. Patients may also have septicaemia, renal failure, and
hypovolemic shock as a result of the condition. Last but not least, various conditions
such as diabetes mellitus, intestinal blockage, and obstructive jaundice have been
linked to pancreatitis

4
 REFERENCES

Adams, D. B. (2017). Pancreatitis. John Wiley & Sons.

Contributors, W. E. (2021, September 16). Pancreatitis. WebMD.
https://www.webmd.com/digestive-disorders/digestive-diseases-
pancreatitis#091e9c5e80008133-1-1
Herreros-Villanueva, M. (2013). Alcohol consumption on pancreatic diseases. World
Journal of Gastroenterology, 19(5), 638. https://doi.org/10.3748/wjg.v19.i5.638
Minupuri, A., Patel, R., Alam, F., Rather, M., & Baba, R. H. (2020). Steroid-Induced
Pancreatitis: Establishing an Accurate Association Poses a Challenge.
Cureus, 12(8). https://doi.org/10.7759/cureus.9589
Nabeeha Mohy-ud-din, & Morrissey, S. (2019, February 19). Pancreatitis. Nih.gov;
StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538337/
Ouyang, G., Pan, G., Liu, Q., Wu, Y., Liu, Z., Lu, W., Li, S., Zhou, Z., & Wen, Y.
(2020). The global, regional, and national burden of pancreatitis in 195
countries and territories, 1990–2017: a systematic analysis for the Global
Burden of Disease Study 2017. BMC Medicine, 18(1).
https://doi.org/10.1186/s12916-020-01859-5
Yadav, D., & Lowenfels, A. B. (2013). The Epidemiology of Pancreatitis and
Pancreatic Cancer. Gastroenterology, 144(6), 1252–1261.
https://doi.org/10.1053/j.gastro.2013.01.068