Pancreatitis

PRESENTED BY:

Daniel Justin Junio BS Pharmacy

Definition
The Pancreas is a long, flat gland that
sits tucked behind the stomach in the
upper abdomen. The pancreas
produces enzymes that help digestion
through creating digestive enzymes.
These enzymes are released into the
small intestine, where they aid in the
digestion of proteins, fats, and
carbohydrates.

The pancreas produces hormones,

including insulin, which regulates the
levels of glucose (sugar) in the blood.
CLASSIFICATION
Pancreatitis is a condition which causes
redness and swelling (inflammation) of the
pancreas.

The different types of Pancreatitis:

Acute Pancreatitis
When a person experiences onset pancreatitis suddenly and
may last for days. (Temporary)
Chronic Pancreatitis
When a person experiences onset pancreatitis over
many years. (Life-long)
 Pancreatitis
Epidemiology: Pancreatitis

In 2019, Pancreatitis incidents in In 2019, Pancreatitis incidents in In 2019, Pancreatitis incidents

USA has been recorded at India has been recorded at in China has been recorded at
228,699 people and will 618,862 people and will 493,765 people and will
increase in upcoming years. increase in upcoming years. increase in upcoming years.
 Pancreatitis
ETIOLOGY: Pancreatitis
Pancreatitis occurs when digestive enzymes become activated while still in the pancreas,
irritating the cells of your pancreas and causing inflammation.

The factors that may cause said activation are:

High calcium levels in the blood

Gallstones
Alcoholism

(hypercalcemia)
Pancreatic cancer
Certain medications
Abdominal surgery
High triglyceride levels in the
Cystic fibrosis
blood (hypertriglyceridemia)
Obesity
Physical Trauma or Infection
Pathophysiology: Acute Pancreatitis Pancreatitis

Pathophysiology: Chronic Pancreatitis Pancreatitis

Although the exact mechanism for the pathogenesis of chronic pancreatitis is

unknown several theories have been proposed:

Increased exposure Repetitive case of Increased

to Substrates having constant acute exposure to
(Fatty Foods) pancreatitis over long Inducers (Alcohol)
over a long period of periods of time causing over a long period
time Pancreatic Fibrogenesis of time

(Pancreatic cell death)

 A detailed history should be obtained from a patient
suffering from pancreatitis, covering all of their
symptoms experienced, the history should also include:

If the person has a history of Pancreatitis

If the person has diagnosed medical

conditions that may cause pancreatitis

The person’s full history of drug

consumption/use
DIAGNOSTICS

If the person’s family has a history of

& Pancreatitis

INVESTIGATIONS
 The patient should also consult with a
gastroenterologist in order to confirm the type and
severity of the Pancreatitis . The certain tests may
be carried out by professionals include:

Blood test
Abdominal ultrasound
Cardiac Computed Tomography (CT) scan
Cardiac Magnetic Resonance Imaging (MRI)
Endoscopic ultrasound
DIAGNOSTICS
Stool tests
&

INVESTIGATIONS
 Pancreatitis

NON-PHARMACOLOGIC TREATMENT

Lifestyle-related management (After Treatment)

Limit or stop intake of alcohol
Stop Smoking
Limit fatty food intake as it may cause gallstones to worsen
Keep attention to weight as appropriate and Exercise
Eat a healthy, balanced diet, with vegetables and fruit
Drink more water
Vitamin and mineral supplementation for enzyme correction
NON-PHARMACOLOGIC TREATMENT : SURGICAL INTERVENTION
(ACUTE)

Percutaneous drainage

Percutaneous drainage is a
procedure in which a catheter
is inserted through the skin
into a pseudocyst (a fluid-
filled sac that forms outside
the pancreas) to drain the
fluid and relieve pressure on
the pancreas.

NON-PHARMACOLOGIC TREATMENT : SURGICAL INTERVENTION

(ACUTE)
Endoscopic Retrograde
Cholangiopancreatography (ERCP)

In patients with pancreatitis, ERCP can be

used to identify the cause of the
inflammation, such as a blocked bile duct or
gallstones.

ERCP can also be used to treat certain

complications of pancreatitis, such as
removing gallstones or stenting a blocked
bile duct.

NON-PHARMACOLOGIC TREATMENT : SURGICAL INTERVENTION

(ACUTE/CHRONIC)

Pancreaticoduodenectomy
or Whipple procedure

An operation to remove the head

of the pancreas, the first part of
the small intestine (duodenum),
the gallbladder and the bile duct.
The remaining organs are
reattached to allow you to digest
food normally after surgery.
NON-PHARMACOLOGIC TREATMENT : SURGICAL INTERVENTION
(ACUTE)

Pancreatic necrosectomy

Using a combination of
endoscopic ultrasound (EUS) and
live X-ray images, the doctor
inserts a stent from the stomach
to the pancreas and using a
variety of tools inserted through
the endoscope, the doctor will
then remove the dead pancreatic
tissue.
NON-PHARMACOLOGIC TREATMENT : SURGICAL INTERVENTION
(CHRONIC)

Total pancreatectomy

Total pancreatectomy is a major

surgery that involves removal of
the entire pancreas. This
procedure is typically reserved for
severe cases of chronic
pancreatitis that are unresponsive
to other treatments and that result
in significant pain, malnutrition, and
other debilitating symptoms.
 PHARMACOLOGIC TREATMENT

Pain medications

Antibiotics
NSAIDS

Opioid Analgesics
Antispasmodics
 Case Study

Bill Jones is a 48-year-old man who presents to the ED shortly

Atrial fibrillation
after midnight on a Friday night because of intense mid-
epigastric pain radiating to his back. He states that the pain
started shortly after dinner the night before but has
progressively worsened, and he began vomiting around midnight
tonight.

Pancreatitis
 Case Study
Additional info:

Alcohol withdrawal seizures 8 months ago during which he suffered a

Atrial fibrillation
small subdural hematoma.

Father died at age of 56 from an MVA; mother is 72 years old and has
Type 2 DM and “cholesterol issues,” for which she is taking an unknown
medication.

One sister, also with “cholesterol issues,” taking an unknown

medication. The sister has a remote history of pancreatitis as well.

Pancreatitis
 Case Study
Additional info:

He is also divorced with three children. Employed as a groundskeeper at

Atrial fibrillation
a golf course. Denies any smoking.

He states that he used to consume six beers per day until 8 months ago
when he had a withdrawal seizure but now drinks only on weekends a
total of about six beers; he reports sharing a couple of pitchers with two
friends last night with dinner.

Drinks at least two cups of coffee each morning.

Pancreatitis
 Case Study
Additional info:

He takes medication of Valproic acid 250 mg twice daily since his seizure Advil
200 mg OTC several doses per day PRN
Atrial fibrillation

He has mentioned that the drug Phenytoin makes his “heart pound.”

He states that he has been feeling well until last night. He hurt his back 2 weeks
ago at work but the Advil has helped relieve the pain. He has vomited
approximately six times since midnight tonight.

No complaints of diarrhea or blood in the stool or vomit. No knowledge of any prior

history of uncontrolled blood sugars or cholesterol.

Pancreatitis
 Case Study
·Physical Examination:

General - The patient is restless and in moderate distress but otherwise is a well-
appearing, well-nourished male who looks his stated age.
Atrial fibrillation

Vital Signs - BP 98/55, P 122, RR 30, T 38.9°C; Wt 89 kg, Ht 5'10''

HEENT (Head, Ears, Eyes, Nose, And Throat Examination)- PERRLA (Pupils equal,
round and reactive to light); EOMI (Extra ocular movements intact); oropharynx is
pink and clear; oral mucosa (mouth) is dry

Skin - Dry with poor skin turgor

Pancreatitis
 Case Study
·Physical Examination:

Neck/Lymph Nodes - Supple; no bruits (no sound), lymphadenopathy (swelling of

lymph nodes), or thyromegaly (enlarged thyroid)
Atrial fibrillation

Cardiac - Sinus tachycardia; no MRG (Murmurs, Rubs, or Gallops/Abnormal heart

sounds)

Lungs - Bilateral basilar rales (bubbling/crackling sound from the lungs)

Pancreatitis
 Case Study
·Physical Examination:

Abdomen - Moderately distended (enlarged) with active but diminished bowel sounds; (+)
guarding; pain is elicited Atrial
on light palpation of left upper and midepigastric region.
fibrillation
No rebound tenderness, masses, or hepatosplenomegaly (Enlarged Liver/Spleen).

Extremities - Extremities are warm and well perfused. Good pulses present in all extremities.
No clubbing (bulbous enlargement of the ends of one or more fingers), palmar erythema
(red palms in hand), or spider angiomata (red dots with protursion of spider-like legs

Rectal - Normal sphincter tone; no BRBPR (bright red blood per rectum/bleeding in rectum)
or masses; stool is guaiac negative (no blood in stool); prostate normal size.

Pancreatitis
 Case Study
Neurological - A & O × 3 (Alert and Oriented to person, place and time); neuro exam
benign; CN (Cranial Nerve) II–XII intact; strength is equal bilaterally in all extremities.
Normal tone and reflexes. No asterixis (still have the ability to move).
Atrial fibrillation
Other Tests - He is negative for serum ketones, ASA, acetaminophen, viral hepatitis
titers, and HIV

Chest X-Ray - AP view of chest shows the heart to be normal in size. The lungs are clear
without any infiltrates, masses, effusions, or atelectasis. No notable abnormalities.

Abdominal Ultrasound - Non-specific gas pattern; no dilated bowel. Questionable

opacity/ abnormality of common bile duct. Cannot rule out gallstone/ obstruction.

Pancreatitis
 Case Study
Laboratory Test:

Atrial fibrillation

Pancreatitis
Case Study: Findings
Experienced alcohol withdrawal seizures (tonic-clonic Intense mid-epigastric pain radiating to his back
seizures) 8 months ago which he suffered a small subdural and vomiting
hematoma (bleeding in the head).

Lab Results:
Patient has:
The sister has a remote history of pancreatitis

Hyponatremia
Is an alcoholic and drinks caffeine Low CO2 rate

High Serum Creatinine level
Maintenance medicine of Valproic Acid and Advil (Ibuprofen)

High amounts of Glucose & Triglycerides
Intense mid-epigastric pain radiating to his back and vomiting Hypocalcemia

High amounts of Amylase and lipase
Vomited six times at midnight after 2 weeks at work Low Albumin levels but normal prealbumin levels

Blood clotting faster than normal (APTT Test)
Skin has poor turgor, Dehydrated Exceptionally high amounts of alcohol level found in

blood
Bilateral basilar rales, fluid in lungs, ARDS

Phenytoin causes palpitation

Case Study: Assessment
We can assess the patient by using these tests:

Tests: Physical & Laboratory Tests:

Blood test (HIV, ASA, Acetaminophen, Lab General

Vital Signs
tests)
HEENT (Head, Ears, Eyes, Nose, And Throat Examination)
Abdominal ultrasound Skin
Cardiac Computed Tomography (CT) scan Abdomen
Cardiac Magnetic Resonance Imaging (MRI) Extremities
Rectal
Endoscopic ultrasound
Neurological
Stool tests

Pancreatic Function Tests Serum Ketone Test

C-Reactive Protein test Anti-Skin Antibody (ASA) Test
Chest X-Ray

Case Study: Resolution

The first line of treatment for acute pancreatitis involves supportive care, pain management,
and addressing the underlying cause.

For Non - Pharmacologic Treatment:

One of the underlying causes found causing acute pancreatitis is the consumption of Valproic
Acid, that is used as maintenance for the hematoma it must be replaced by asking the patient's
physician with another drug in order for the pancreas to heal.

The mechanism of action is unknown as of how it causes pancreatitis

One of the underlying causes found causing acute pancreatitis is the consumption of Alcohol.
Alcohol changes enzyme function and is one of the leading inducers for pancreatitis. Stopping
is a must for it may cause further development into chronic pancreatitis.

 Case Study: Resolution

The first line of treatment for acute pancreatitis involves supportive care, pain management,
and addressing the underlying cause.

For Non - Pharmacologic:

Fasting: it is done to give the pancreas time to rest and heal, patients are advised to stop eating and
drinking for a period of time, typically 24-48 hours.

Pain management: pain is managed with medications, such as antacids, antispasmodics, NSAIDS
and opioids, depending on the severity of the pain.

IV fluids: to maintain hydration and electrolyte balance, patients are typically given intravenous (IV)
fluids and electrolytes.

Case Study: Resolution

The first line of treatment for acute pancreatitis involves supportive care, pain management,
and addressing the underlying cause.

For Non - Pharmacologic:

Correction of electrolyte imbalances: imbalances of sodium, potassium, calcium, and magnesium

can occur in acute pancreatitis and should be corrected.

Nutrition support: once the patient is able to tolerate oral intake, a low-fat diet is usually
recommended. If oral intake is not possible, a feeding tube or intravenous nutrition may be
necessary.

Case Study: Resolution

Pharmacological Treatment is considered as supportive as there is no medication that can
treat acute pancreatitis. This treatment will involve pain management and treating the
symptoms for Pancreatitis.

For Pharmacologic Treatment:

Pain Management:

NSAIDs (Nonsteroidal Anti-inflammatory drugs) - It is primarily used to reduce pain and

inflammation. Ex: Paracetamol, Aspirin, Mefenamic Acid, Etc.)

Opioid analgesics such as Tramadol or Meperidine may be given to the patient if the pain becomes
way too severe for NSAIDs to treat.

Case Study: Resolution

Pharmacological Treatment is considered as supportive as there is no medication that can
treat acute pancreatitis. This treatment will involve pain management and treating the
symptoms for Pancreatitis.

For Pharmacologic Treatment:

Pancreatic Treatments:

Antispasmodics - These are medication that relieves, prevents, or lowers the incidence of muscle
spasms and help to relax the smooth muscle in the digestive tract.

Antibiotics - If there is a bacterial infection present, antibiotics may be prescribed. However, there
is no data found in the tests that indicate any infection, therefore it is not needed for this treatment.

Case Study: Monitoring

Consult a Gastrologist for Pancreatic Monitoring and follow up testing to ensure proper recovery.

Imaging Tests Such as CT Scan, MRI Scan and Laboratory Testing must be performed again as a
follow up procedure to assess the severity of the pancreatitis and monitor for complications

Absolute cease of Alcohol consumption to reduce occurrences of Pancreatitis and as it may

further complicate the Acute Pancreatitis into becoming Chronic Pancreatitis

Adhering to Lifestyle changes to reduce occurrences of Pancreatitis such as proper diet and
exercise.

The patient must be frequently monitored of their fluid levels and electrolyte balance to ensure
proper hydration and electrolyte levels.

Thank
You for
Listening!
Daniel Justin Junio
BS Pharmacy