Pancreatitis

PANCREATITIS
Acute and Chronic

Definition
• Acute pancreatitis is an acute inflammation of
the pancreas.
• The degree of inflammation varies from mild
edema to severe
Etiology of Acute Pnacreatitis
• Many factors can cause injury to the pancreas.
• most common cause is gallbladder disease (gallstones), which is more
common in women.
• The second most common cause is chronic alcohol intake, which is
more common in men.
• Smoking is an independent risk factor for acute pancreatitis.
Pathophysiology of Acute Pancreatitis
• The most common pathogenic mechanism is autodigestion of the pancreas.
• The etiologic factors injure pancreatic cells or activate the pancreatic
enzymes in the pancreas rather than in the intestine. This may be due to
reflux of bile acids into the pancreatic ducts through an open or distended
sphincter of Oddi.
• This reflux may be caused by blockage created by gallstones.
• Obstruction of pancreatic ducts results in pancreatic ischemia.
• The exact mechanism by which chronic alcohol intake predisposes a person
to pancreatitis is not known.
• It is thought that alcohol increases the production of the digestive enzymes
in the pancreas.
Clinical Manifestations
• Abdominal pain is the predominant manifestation of acute pancreatitis.
• The pain is due to distention of the pancreas, peritoneal irritation, and obstruction of the
biliary tract.
• LUQ pain, but it may be in the mid-epigastrium may radiate to the back because of the
retroperitoneal location of the pancreas.
• Pain has a sudden onset, is severe, deep, piercing, continuous or steady.
• The pain is aggravated by eating and frequently has its onset when the patient is recumbent.
• It is not relieved by vomiting.
• Pain may be accompanied by flushing, cyanosis, and dyspnea.
• nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice
Clinical Manifestations
• Abdominal tenderness with muscle guarding is common.
• Bowel sounds may be decreased or absent.
• Paralytic ileus may occur and causes marked abdominal distention.
• The lungs are frequently involved, with crackles present.
• Intravascular damage from circulating trypsin may cause areas of cyanosis or greenish
to yellow-brown discoloration of the abdominal wall.
• Other areas of ecchymoses are the flanks (Grey Turner’s spots or sign,
• a bluish flank discoloration) and the periumbilical area (Cullen’s
• sign, a bluish periumbilical discoloration).
• These result from seepage of blood-stained exudate from the pancreas and may occur
in severe cases.
Complications
• Some patients recover completely, others have recurring attacks, and
others develop chronic pancreatitis.
• complications of acute pancreatitis are pseudocyst and abscess.
• systemic complications of acute pancreatitis are pulmonary (pleural
effusion, atelectasis, pneumonia, and acute respiratory distress
syndrome [ARDS]) and cardiovascular (hypotension) complications
and tetany caused by hypocalcemia.
Diagnostic Studies
• The primary diagnostic tests for acute pancreatitis are serum amylase
and lipase
• Other findings include an increase in liver enzymes, triglycerides,
glucose, and bilirubin and a decrease in calcium.
• An abdominal ultrasound, x-ray, or contrast-enhanced CT scan can be
used to identify pancreatic problems.
Collaborative Care
Goals of collaborative care for acute pancreatitis include
• (1) relief of pain;
• (2) prevention or alleviation of shock;
• (3) reduction of pancreatic secretions;
• (4) correction of fluid and electrolyte imbalances;
• (5) prevention or treatment of infections; and
• (6) removal of the precipitating cause, if possible
Collaborative Care
• First, the patient is NPO (taking nothing by mouth).
• Second, NG suction may be used to reduce vomiting and gastric
distention and to prevent gastric acidic contents from entering the
duodenum.
• In addition, certain drugs may be used to suppress gastric acid
secretion
NURSING MANAGEMENT
ACUTE PANCREATITIS
NURSING DIAGNOSES
Nursing diagnoses for the patient with acute pancreatitis may
• include, but are not limited to, the following:
• Acute pain related to distention of pancreas, peritoneal irritation,
obstruction of biliary tract, and ineffective pain and comfort measures
• Deficient fluid volume related to nausea, vomiting, restricted oral
intake, and fluid shift into the retroperitoneal space
• Imbalanced nutrition: less than body requirements related to
anorexia, dietary restrictions, nausea, loss of nutrients from vomiting,
and impaired digestion

Pancreatitis

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PANCREATITIS

Acute and Chronic

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