1. Inflammation of the Pancreas
Pancreatitis
Inflammation of the Pancreas

2. 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.

3. 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

4. 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

5. Progression of Disease
Autodigestion
Acute Inflammation of Pancreas
Necrosis of Pancreas
Digestion of vascular walls
Thrombus and Hemorrhage
Death

6. Precipitating Factors
Trauma
Use of alcohol *
Biliary tract disease
Viral or Bacterial disease
Cholelithiasis *
Peptic Ulcer Disease
*most common causes

7. 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

8. Acute Pancreatitis Clinical Manifestations
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

9. Acute Pancreatitis Diagnostic Studies
History and physical examination
Laboratory tests
Serum amylase- hallmark test
Serum lipase – also elevated
Blood glucose
Serum calcium
Triglycerides

10. Acute Pancreatitis Diagnostic Studies
Flat plate of abdomen
Abdominal/endoscopic ultrasound
Endoscopic retrograde cholangiopancreatography (ERCP)
Chest x-ray
CT of pancreas
Magnetic resonance cholangiopancreatography (MRCP)

11. Acute Pancreatitis
Can be a medical emergency associated with a risk for life-threatening complications

12. What do they die of?

13. Acute Pancreatitis Complications
Two significant local complications
Pseudocyst
Abscess

14. 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

15. Acute Pancreatitis Complications
Pancreatic abscess
A large fluid-containing cavity within pancreas
Results from extensive necrosis
Upper abdominal pain
Abdominal mass
High fever
Leukocytosis

16. Acute Pancreatitis Complications
Main systemic complications are?
Pulmonary
Cardiovascular
Electrolyte imbalance – Hypocalcemia

17. Acute Pancreatitis Goals of Care
Relief of pain
Prevention or alleviation of shock
Decrease respiratory failure
↓ of pancreatic secretions
Maintain Fluid/electrolyte balance

18. Treatment and Nursing Care
1. Pain management
IV morphine or Dilaudid
Antispasmodic agent
Bentyl
Pro-Banthine
Spasmolytics – Nitroglycerine
Positioning – sitting up and leaning forward
Why is it important to relieve pain?

19. Treatment 2. Prevention of Shock – hemodynamic stability
* Administer Blood, Plasma expanders, Albumin
* LR solution

20. What is the cause of shock?

21. 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

22. Treatment and Nursing Care
6. Correction of electrolyte imbalance/
hypocalcemia
7. Maintain Hydration / Nutrition

23. Treatment and Nursing Care
Surgical therapy – if related to gallstones
ERCP
Endoscopic sphincterotomy
Laparoscopic cholecystectomy

24. Treatment - Home Care Follow up care Dietary teaching
High-carbohydrate, low-fat diet
Abstinence from alcohol,
Patient/family teaching
* Signs of infection, high blood
glucose, steatorrhea

25. The End