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Objectives
Definitions
Pathophysiology
Etiology
Diagnostics
Clinical Manifestations
Complications
Goals of Care
Interventions
Summary
References
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• Understand the pathogenesis of pancreatitis
• Identify risk factors associated with pancreatic injury
• Explain diagnostic methods used to detect suspected cases of
pancreatitis
• Recognize clinical manifestations and complications of acute and
chronic pancreatitis
• Identify pharmacological and non-pharmacological treatment
options for management of the disease
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Pancreatitis: inflammation of the pancreas
Acute
Sudden inflammation of the
pancreas
Chronic
Prolonged or recurrent periods of
pancreatic inflammation and the
formation of scar tissue
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The pancreas is responsible for regulating
blood sugar and aiding in digestion.
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Image: Courtesy of BruceBlaus (License)
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Islet of Langerhans:
• Endocrine function
• Releases hormones such as insulin, glucagon,
somatostatin, and pancreatic polypeptides
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Acinar cells:
• Exocrine function
• Releases digestive enzymes such as amylase,
lipase, and proteases (trypsin and chymotrypsin)
Premature
activation of
digestive enzymes
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Pancreatic duct or
acinar cell injury
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Autodigestion of the
pancreas (activated
enzymes destroying
own tissue)
INFLAMMATION
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Risk factors of pancreatitis include:
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Cholelithiasis and
alcohol use are the two
most common causes of
acute pancreatitis
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Alcohol use is the most
common cause of
chronic pancreatitis
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Cholelithiasis (gallstones)
Alcohol use
Trauma
Cancer
Bacterial/viral infection
Biliary tract disease
Hypercalcemia
Hyperlipidemia
Cystic fibrosis
Systemic lupus erythematosus
Medications (e.g. valproic acid, some diuretics)
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Imaging Tests
• MRI, CT scan, and ultrasound to assess degree of inflammation and other abnormalities
• Endoscopic ultrasound assesses pancreatic and bile ducts for inflammation and blockage
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Stool Test assesses the level of fat malabsorption
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Pancreatic Function Test assesses pancreatic response to the hormone secretin
Laboratory Analysis
•  pancreatic enzymes
•  WBC count indicating inflammation and/or infection
•  blood glucose due to disruption in insulin production
•  bilirubin and alkaline phosphatase (if biliary tract obstructed from gallstones, pancreatic
edema or tumor)
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Grey Turner’s sign
Cullen’s sign
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Acute Pancreatitis
• Continuous epigastric pain and upper
abdominal pain, with radiation to the back
• Pain exacerbated by fatty meals, alcohol,
and lying down
• Abdominal guarding
• Decreased bowel sounds
• Nausea and vomiting
• Cullen’s sign
• Grey Turner’s sign
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Chronic Pancreatitis
• Worsening deep upper abdominal pain
• Weight loss
• Muscle wasting
• Diarrhea
• Steatorrhea
• Jaundice (if biliary tract involved)
• Symptoms associated with diabetes
mellitus
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Infection: pseudocysts can
rupture, cause infection, and
spread into the bloodstream
to develop sepsis
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Necrosis: damage to
pancreatic cells and
loss of blood supply
causes cell death
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Pseudocysts: fluid-filled
sacs developing on the
surface of the pancreas
(common in acute cases)
Cancer: chronic
pancreatitis can
progress into
malignancy
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Systemic Complications:
pulmonary edema, acute
kidney failure, splenic vein
thrombosis, gastrointestinal
bleeding
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Diabetes: develops
once the pancreas is
no longer able to
produce insulin
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1. Decrease metabolic stress
and pancreatic stimulation
2. Maintain adequate hydration
and nutrition
3. Manage and control pain
4. Prevent complications
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To inhibit secretion of gastric acid and prevent activation of
pancreatic enzymes
To break down fats, carbohydrates, and proteins
To manage and control pain
May be required for hyperglycemia and chronic pancreatitis
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Opioids
Insulin
For severe nutritional deficiencies
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Parenteral nutrition
H2-receptor antagonists,
proton pump inhibitors,
antacids
Pancreatic enzymes
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Intravenous fluids
PURPOSE
To maintain hydration; initial aggressive hydration may be
required in acute pancreatitis unless contraindicated
(renal/cardiovascular comorbidities)
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INTERVENTION
PURPOSE
For acute episodes; prevents stimulation of the pancreas and
allows time for it to rest
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INTERVENTION
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Maintain NPO status
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Maintain bedrest
Maintain client position
Insert nasogastric tube
To reduce metabolic stress and gastrointestinal stimulation
Keep knees flexed, leaning forward, or sitting upright to promote
comfort and alleviate pain
For biliary tract obstruction, removal of gastric juices, and/or
relief from nausea and vomiting
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Avoid alcohol
Stop smoking
Eat a low fat diet
Maintain hydration as pancreatitis can cause dehydration
Report clay-colored stools, jaundice, dark urine (signs of
biliary tract obstruction)
• Limit sugar intake; consume complex carbohydrates
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Discharge Teaching:
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• Pancreatitis is inflammation of the pancreas
• Cholelithiasis and alcohol use are the two most common causes of acute
pancreatitis
• Alcohol use is the most common cause of chronic pancreatitis
• Clinical manifestations commonly presented in clients include abdominal
pain with radiation to the back, nausea, and vomiting
• The primary goals of care are to manage symptoms during acute attacks and
enhance fluid and nutritional status
• Pancreatic enzymes are administered to promote digestion and absorption
of fats and protein
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1. Bauldoff G, Gubrud P, Carno M. (2019). LeMone and Burke’s MedicalSurgical Nursing: Clinical Reasoning in Patient Care. (7th edition). Pearson.
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2. Harding MM, Kwong J, Roberts D, Hagler D, Reinisch C. (2019). Lewis’s
Medical-Surgical Nursing: Assessment and Management of Clinical
Problems, (11th edition). Mosby.
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3. Ignatavicius DD, Workman ML, Rebar CR. (2023). Medical-Surgical Nursing:
Concepts for Interprofessional Collaborative Care. (10th edition). Elsevier.
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4. Perry A, Potter P, Ostendorf W, Laplante N. (2023). Clinical Nursing Skills and
Techniques. (10th edition). Mosby.
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