ACUTE
AND CHRONIC
PANCREATITIS
TERM 2: SESSION 11 - NUR149
THE PANCREAS
•
It is a gland about six inches long,
located in the upper abdomen, across
the back of the belly, behind the
stomach.
•
Has two functions: endocrine and
exocrine.
•
Composed of scattered islets of
Langerhans (endocrine function)
FUNCTIONS OF THE PANCREAS
EXOCRINE FUNCTION:
ENDOCRINE FUNCTION:
• Secretion of pancreatic enzymes into the
• Islets of Langerhans which composed alpha (20%)
GI tract through the pancreatic duct.
secretes glucagon, beta (90%) secretes insulin,
• Enzymes high in protein and
electrolytes.
• Alkaline due to high concentration of
sodium bicarbonate.
• This neutralizes stomach acids in the
duodenum.
• Enzymes are amylase (aids in
carbohydrate digestions, trypsin aids in
protein digestions, lipase for fats.
delta cells (5%) secrete somatostatin
• Glucagon – glycogen synthesis (stored glucose);
stimulates fats and proteins for conversion in liver
for additional glucose (Gluconeogenesis)
• Insulin – lowers glucose and promotes glucose
storage
• Somatostatin –growth inhibiting hormone and
insulin and glucagon inhibitor
CONTROL OF CARBOHYDRATES
METABOLISM
•
Glucose is formed through metabolism of ingested carbohydrates and also
by gluconeogenesis (fats - lipogenesis and protein).
•
It usually stored in liver, muscles and other tissues for future use.
•
Normal glucose levels: 100mg/dl (5.5 mmol/L).
•
Insulin moderates the glucose level in the bloodstream
•
Increased glucose levels are due to glucagon, epinephrine,
adrenocorticosteroids, growth hormone, and thyroid hormone.
PANCREATITIS
Inflammation of the pancreas
ACUTE PANCREATITIS
●
Acute inflammation of the pancreas.
●
Most common in middle-aged men and women
●
Considered to be a medical emergency
●
Autodigestion of the pancreas
●
A mild, self-limited disorder to a severe, rapidly fatal disease that does not
respond to any treatment .
●
Mild acute pancreatitis = edema & inflammation confined in the pancreas
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
●
Severe abdominal pain (due to distention of the pancreas, peritoneal irritation, and obstruction of
the biliary tract)
●
Abdominal guarding and rigid or board-like abdomen (ominous sign of peritonitis)
●
Bruising in the flank (Grey Turner’s spots) or umbilicus region (Cullen’s sign
●
Bowel sounds may be decreased or absent.
●
Paralytic ileus may occur and causes marked abdominal distension.
●
Shock (hemorrhage in the pancreas), toxemia from activated pancreatic enzymes and
hypovolemia due to massive fluid shift into the retroperitoneal space
COMPLICATIONS
LOCAL COMPLICATIONS
SYSTEMIC COMPLICATIONS
●
●
Pseudocyst – accumulation of fluid,
pancreatic enzymes, tissue debris,
●
Pulmonary (pleural effusion,
atelectasis, pneumonia, and ARDS)
and inflammatory exudates
●
Cardiovascular (hypotension)
surrounded by a wall.
●
Tetany (due to hypocalcemia)
Abscess – collection of pus due
extensive necrosis in the pancreas.
Requires immediate surgical
drainage to prevent sepsis.
ASSESSMENT
●
Increased serum amylase and lipase levels
●
Elevated urinary amylase levels
●
Elevated WBC
●
Hypocalcemia
●
Hyperglycemia and glucosuria
●
Elevated serum bilirubin
●
Hematocrit and hemoglobin levels
MEDICAL MANAGEMENT
●
NPO
●
Enteral/parenteral nutrition
●
Nasogastric suction for nausea and
vomiting to decrease painful abdominal
distension and paralytic ileus.
●
Histamine-2 (H2) antagonists & proton
pump inhibitor.
●
Analgesia
●
Antiemetics
DIAGNOSTIC TESTS & SURGICAL
MANAGEMENT
●
X-ray studies of the abdomen
●
Laparotomy
and chest
●
Pancreatectomy
●
Ultrasound
●
Contrast-enhanced CT-scan
●
Paracentesis
●
ERCP to determine if the pancreas
is resolving
NURSING MANAGEMENT
●
Relieve pain and discomfort
●
Improve breathing pattern
●
Improve nutritional status
●
Maintain skin integrity
●
Promote home and community-based care
CHRONIC PANCREATITIS
●
An inflammatory disorder characterized by progressive destruction of the pancreas.
●
Cells are replaced by fibrous tissue with repeated attacks of pancreatitis pressure
within the pancreas increases. The result is obstruction of the pancreatic and
common bile ducts and the duodenum.
●
There is atrophy of the epithelium of the ducts, inflammation, and destruction of the
secreting cells of the pancreas.
RISK FACTORS/CAUSES
●
Alcohol consumption and malnutrition (major cause)
○
Excessive and prolonged consumption of alcohol
○
Long-term consumption – hypersecretion of protein causing protein plugs and
calculi
○
Alcohol has direct toxic effect on the pancreatic cells
●
Age 37 to 40
●
Smoking
CLINICAL MANIFESTATIONS
●
Recurrent attack of severe upper abdominal and back pain with vomiting.
○
Opioids in large doses produces no relief
○
Disease progression aggravates the pain more
●
Some chronic pancreatic patients do not experience any pain.
●
Weight loss (major problem) will trigger another attack.
●
Malabsorption occurs late, stool becomes frequent, frothy, and foul-smelling due to impaired
fat digestion (steatorrhea)
●
Calcifications occurs due to disease progression, calcium stones form within the ducts.
ASSESSMENT AND DIAGNOSTIC
FINDIGNS
●
Endoscopic retrograde cholangiopancreatography (ERCP)
●
Magnetic resonances imaging, CT scans, and Ultrasound
●
Glucose tolerance test (evaluates islet of Langerhans cell function, increase level of
glucose – diabetes with pancreatitis)
●
Increased serum amylase levels
●
Steatorrhea
SURGICAL MANAGEMENT
●
Pancreaticojejunostomy (Rouxen- Y surgery)
●
Whipple resection (Pancreaticoduodenectomy)
●
Beger or Frey operations
●
○
Remove most of the head of the pancreas except for a shell of pancreatic tissue posteriorly.
○
Provide permanent pain relief and avoid endocrine and exocrine insufficiency.
Distal pancreatectomy (Endoscopic & laparoscopic)
Note: Patients who undergo surgery for chronic pancreatitis may experience weight gain and improved
nutritional status. However, morbidity and mortality after these surgical procedures are high because of
the poor physical condition of the patient before surgery and the concomitant presence of cirrhosis. Even
after undergoing these surgical procedures, the patient is likely to continue to have pain and impaired
digestion secondary to pancreatitis, unless alcohol is avoided completely.
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