Pancreatitis
Acute Pancreatitis

Function of the
pancreas is to
release proteolytic
enzymes that assist
in the breaking
down food products
so that nutrients can
be absorbed.
Acute Pancreatitis
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
Acute Pancreatitis
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
Progression of Disease

Autodigestion
Acute Inflammation of Pancreas
Necrosis of Pancreas
Digestion of vascular walls
Thrombus and Hemorrhage
Death
Precipitating Factors
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Trauma
Use of alcohol *
Biliary tract disease
Viral or Bacterial disease
Cholelithiasis *
Peptic Ulcer Disease
*most common causes
Acute Pancreatitis
Clinical Manifestations

Severe Abdominal pain is predominant
symptom
 Pain located in LUQ and mid-epigastrium
 Commonly radiates to the back
 Sudden onset
 Severe, deep, piercing, steady
 Aggravated by fatty meal or lying recumbent
position
 Not relieved by vomiting
Acute Pancreatitis
Clinical Manifestations
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Cyanosis, Dyspnea
Bowel sounds decreased or absent
Low-grade fever, Leukocytosis
Hypotension, Tachycardia
Jaundice
Flushing
Abnormal lung sounds - Crackles
Discoloration of abdominal wall – Turner’s or
Cullen’s sign
SIGNS OF SHOCK
Acute Pancreatitis
Diagnostic Studies

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History and physical examination
Laboratory tests
 Serum amylasehallmark test
 Serum lipase – also elevated
 Blood glucose
 Serum calcium
 Triglycerides
Acute Pancreatitis
Diagnostic Studies
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Flat plate of abdomen
Abdominal/endoscopic ultrasound
Endoscopic retrograde
cholangiopancreatography (ERCP)
Chest x-ray
CT of pancreas
Magnetic resonance
cholangiopancreatography (MRCP)
Acute Pancreatitis
Can be a medical emergency
associated with a risk for lifethreatening complications
Acute Pancreatitis
Complications

Two significant local complications
 Pseudocyst

Abscess
Acute Pancreatitis
Complications

Pseudocyst
 Cavity surrounding outside of pancreas
filled with necrotic products and liquid
secretions
 Abdominal pain
 Palpable epigastric mass
 Nausea, vomiting, and anorexia
 Elevated serum amylase
Acute Pancreatitis
Complications

Pancreatic abscess
 A large fluid-containing cavity within pancreas
 Results from extensive necrosis
 Upper abdominal pain
 Abdominal mass
 High fever
 Leukocytosis
Acute Pancreatitis
Complications
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Main systemic complications are?
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Pulmonary
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Cardiovascular
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Electrolyte imbalance – Hypocalcemia
Acute Pancreatitis
Goals of Care
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Relief of pain
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Prevention or alleviation of shock
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Decrease respiratory failure
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↓ of pancreatic secretions
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Maintain Fluid/electrolyte balance
Treatment and Nursing Care
1. Pain management
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IV morphine or Dilaudid
Antispasmodic agent
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Bentyl
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Pro-Banthine
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Spasmolytics – Nitroglycerine
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Positioning – sitting up and leaning forward
Why is it important to relieve pain?
Treatment
2. Prevention of Shock – hemodynamic
stability
* Administer Blood, Plasma expanders, Albumin
* LR solution
What is the cause of shock?
Treatment and Nursing Care
3. Suppress pancreatic enzymes
* NPO
* NG suction
* Antacids, H2 receptor antagonists, antispasmotics
4. Decrease respiratory distress
* Oxygen; check O2 saturation levels
* Semi-fowlers position, knees flexed, position
changes
* C, DB; incentive spirometer
5. Antibiotics
Treatment and Nursing Care
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6. Correction of electrolyte imbalance/
hypocalcemia
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7. Maintain Hydration / Nutrition
Treatment and Nursing Care
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Surgical therapy – if related to gallstones
 ERCP
 Endoscopic sphincterotomy
 Laparoscopic cholecystectomy
Treatment - Home Care
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Follow up care
Dietary teaching
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High-carbohydrate, low-fat diet
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Abstinence from alcohol,
Patient/family teaching
* Signs of infection, high blood
glucose, steatorrhea