Primary medical problem: PANCREATITIS
Rigas
Allie
PATHO
PT EDU--
INFLAMMATION OF THE PANCREAS that
 Triggers premature release of pancreatic
enzymes:
o L/T AUTO-DIGESTION
Where is it?
A gland located behind the stomach.
What does it do?
Produces digestive enzymes/hormones that aid in
digestion and regulation of blood sugar levels.
Your pancreas is a gland
located behind your stomach
that makes digestive juices
to help break down things
you consume and helps
maintain your blood sugar
level. Blood sugar is needed
by all the cells in your
body for energy and to do
their job properly.
ACUTE PANCREATITIS:
Digestive enzymes (Cytokines and Chemokines)
produced by the pancreas are activated prematurely
and begin to digest the pancreas itself.
 L/T inflammation and damage to pancreatic
tissue.
CB many possible factors:
o Gallstones
o Alcohol abuse
o High levels of triglycerides in the blood
o Infections
o Certain medications.
Inflammatory response
= L/T edema and ischemia
Immune cells: neutrophils, monocytes, and
macrophages
 Release more pro-inflammatory mediators L/T
^^^ permeability of blood vessels
o L/T exacerbating inflamm response
 Edema
 Ischemia
 Necrosis
o = further tissue damage
Degree of injury is correlated with the severity of
the disease.
Inflammation can spread to nearby organs,
triggering:
 Systemic response
 L/T multi-organ dysfunction and failure
o More severe without prompt Tx
CHRONIC PANCREATITIS:
Chronic inflammation of the pancreas.
Often caused by chronic alcohol abuse.
Pancreatitis is inflammation
or swelling of the pancreas
happens as a response
reaction, just like when you
catch a cold your body
triggers various response
reactions like a fever,
coughing, or fatigue to help
fight off the infection. Our
bodies always want to return
us to something called
homeostasis, or a happy
healthy zone that is optimal
for everything to work how
it’s supposed to.
Pancreatitis is when the
pancreas becomes swollen,
causing symptoms such as:
o Severe abdominal pain
o Nausea
o Vomiting
o Fever
There are two types of
pancreatitis:
Acute pancreatitis (sudden
onset)
Chronic pancreatitis
(prolonged)
Early diagnosis and
management is important to:
o Prevent further damage
to the pancreas and
systemic complications
Treatment typically involves
hospitalization, supportive
care, pain management, and
The constant inflammation L/T: Fibrosis and scarring
of the pancreas-o Impairs its function- L/T—
Chronic pain
Malabsorption
Eventually diabetes
Body System(s)
addressing the underlying
causes of the condition.
How is each system impacted
1. Digestive
system
1. Pancreas produces enzymes that help break down food in
the small intestine.
Inflammation can L/T digestive problems:
a. Nausea
b. Vomiting
c. Diarrhea.
2. Endocrine
system
2. Pancreas also produces hormones:
Insulin and glucagon
Help regulate BG levels
Inflammation can cause problems with BG control L/T:
Hyper/Hypoglycemia
3. Cardiovascular
system
4. Respiratory
system
3. Severe cases of pancreatitis:
a. Inflammation can spread to other organs,
including:
i. Heart and blood vessels
b. L/T complications:
i. HYPOtension
ii. Dysrhythmias
iii. HF
4. Severe cases of pancreatitis, inflammation affect the
lungs L/T:
o Respiratory distress
o Pneumonia
o Acute respiratory distress syndrome (ARDS)
5. Nervous system
5. Rare
that
o
o
o
cases, severe pancreatitis can L/T complications
affect the nervous system:
Seizures
AMS/confusion
Coma
Tx—
ABDO PAIN RELIEF
IVF TO REPLENISH FLUID/LYTES
NPO WITH NG TUBE & SXN, and DECREASE GI MOTILITY
TX OR PROPHYLAXIS O’ INFECTION
ID UNDERLYING CAUSE & TX: AXBX, ANTICHOLINERGICS, PANCREATIC ENZYMES (LIPASE,
TRYPSIN, AMYLASE) WITH MEALS (CHRONIC PANCREATITIS); SX IF D/T BILIARY DISEASE
Priority assessments
What are the expected abnormal findings?
1. MONITOR FOR VS ALTERATIONS
INDICATORS FOR LIFETHREATENING
(SHOCK)
1. Shock d/t hemorrhage/perforation,
excessive FV shifting, or abdo sepsis
from pancreatic enzyme damage:
a. HYPOtension
b. Tachycardia
c. Fever
2. ASSESS LOC/ALTERATION
2. LOC alterations d/t drop in BP = poor
cerebral perfusion
3. ABDOMINAL
3. Abdo pain that may radiate to back:
Sudden onset
Severe, deep, stabbing,
continuous or steady
Abdo tenderness with
guarding
Rigid, board-like
appearance
HYPO-active or absent bowel
sounds
Anorexia
N/V
Ascites
4. SKIN
5. F/E STATUS: I/O’s
6. BG levels
4. Jaundice: yellowing of skin/sclera
Cullen’s sign: blueish periumbilical
color
Grey Turner’s sign: bluish flank
color
7. CARDIOVASCULAR
5. ^RF dehydration, hypovolemia
8. RESPIRATORY
6. Hyperglycemia may result d/t chronic
pancreatitis tetany
9. NUTRITIONAL STATUS
7. Dysrhythmias
10.
PAIN
8. Tachypnea may result d/t diaphragm
elevated, pain, pulmonary
infiltrates, effusion and atelectasis
9. Malnourished d/t inadequate dietary
intake, impaired pancreatic
secretions, and increased nutritional
needs
10.
d/t pancreatic inflammation,
abdo/back pain
Abnormal labs
1. WBC
How affected (high
or low)
1. Leukocytosis
(H)
> 10,000
2. Ca
2. HYPOcalcemia
(L)
< 9
How does the abnormal lab affect physical
assessment findings?
1. Fever, overall malaise/fatigue
2. Tetany: muscle spasms
(laryngospasm/bronchospasm = dyspnea);
muscle cramps; V; seizure; impaired
cardiac function (dysrhythmias)
3. Pancreatic
Enzymes
3. Amylase (H)
WNL: 30-110
(^ 2-3x)
3. Severe abdo or back pain; T; N/V;
anorexia
Lipase stays elevated longer than
amylase.
Lipase (H)
WNL: 10-150
4. BG
4. HYPERglycemia
(H)
5. K
5. HYPOkalemia
(L)
< 3.5
4. Urgency or frequency
Thirsty
Blurred vision
Weak/fatigue
5. Weak, fatigue, dizzy
Muscle cramps/spasms
C
Arrhythmias
Medication
Mechanism of Action
Expected outcome
1. Albumin
1. Plasma volume expander
1. Replace fluid volume
Prevent renal failure
2. Lactated Ringers
2. Correct F&E imbalances
2. Replenish blood
volume and return
lytes to WNL.
3. PPI
a. Omeprazole
(Prilosec)
3. Decrease hydrochloric
(HCl) acid secretions
(HCl secretions
stimulate pancreas)
3. Decrease triggering
factors of
inflammation
response.
4. AxBx
4. Eliminate growth of
pathogens causing
infection
5. Analgesics
4. Tx and prophylaxis of
infection d/t
necrotic tissue.
5. Pain relief
6. Anticholinergics
7. Pancreatic
enzyme
replacement
therapy (PERT)
6. Inhibits pancreatic
enzyme secretions
(Acute)
5. Pt will report
tolerable pain level.
6. Reduce tissue damage
CB pancreatic enzymes
7. Proteases digest
protein; amylases
digest carbs; lipase
digests fat.
(chronic)
7. Pt has improved
digestion and
absorption of food