PANCREATITIS

PRESENTED BY :
CAPT VEDHIKA A VIJAYAN
GUIDED BY :
LT COL PRIYA V
PANCREAS

• Elongated and tapered organ

• Pale grey gland weighing about 60gms and 12-15cm long
• Situated in epigastric and left hypochondriac region of abdominal cavity
 FUNCTIONS OF PANCREAS

EXOCRINE
ENDOCRINE • Pancreatic juices
• Islet of langerhens • Amylase
• Alpha cells • Lipase
• Beta cells • Trypsin
• Delta cels • Chymotrypsin
• Carboxypeptidase
PANCREATITIS

• Pancreatitis is inflammation of the pancreas

• Also described as autodigestion of pancreas
 ACUTE CHRONIC
PANCREATITIS PANCREATITIS

TYPES
ACUTE PANCREATITIS
• It is an acute inflammatory process of the pancreas.
• The degree of inflammation varies from mild edema to severe
hemorrhagic necrosis
• Acute pancreatitis is defined as an acute condition presenting with
abdominal pain and associated with raised pancreatic enzymes levels in
the blood or urine as a result of pancreatic inflammation
INCIDENCE

• Most common in middle age men and women

• Equally affect both genders
ETIOLOGY
 CLINICAL FEATURES
 The cardinal symptom of AP is epigastric or periumbilical pain that
radiates to the back
 Some patients may gain relief by sitting or leaning forward
 Nausea, repeated vomiting and retching are usually marked
accompaniments

 Tachypnea, tachycardia and hypotension may be present

Features of shock
 Hypovolemia and hypokalemia
 In gallstone pancreatitis mild icterus may be present
 Bleeding into fascial planes can produce bluish discoloration of the flanks
(GreyTurner sign) or umbilicus (Cullen sign)

 Usually muscle guarding in the upper abdomen

DIAGNOSTIC FINDINGS
PRIMARY TEST

Serum Amylase : Increased more than 200IU

Serum lipase : Elevated

Urinary amylase : Elevated

SECONDARY TESTS

Blood Glucose : Hyperglycemia

Serum Calcium : Hypocalcemia

Serum Triglcerides : Hyperlipedemia

RANSON PROGNOSTIC CRITERIA FOR NON-
GALLSTONE PANCREATITIS
• At presentation
 Age > 55 yrs
 Blood glucose level > 200 mg/dl
 White blood cell count > 16,000 cells/ mm3
 Lactate dehydrogenase level > 350 IU/L
 Aspartate Aminotransferase level > 250 IU/L
• After 48 hours of admission
 Hematocrit : decrease > 10%
 Serum calcium level < 8mg/dl
 Base deficit > 4 mEq/L
 Blood urea nitrogen level : increase > 5 mg/dl
 Fluid requirement > 6 L
 PaO2 < 60 mm Hg
** Ranson score ≥ 3 defines severe pancreatitis
MANAGEMENT
RELIIEF OF
PAIN

REMOVAL OF
PERCIPITATING PREVENTION OR
CAUSE ALLEVIATION OF
SHOCK

GOALS

PREVENTION REDUCTION OF
AND TREATMENT PANCREATIC
OF INFECTIONS CONTROL OF SECRETIONS
FLUID AND
ELECTROLYTE
IMBALANCE
CONSERVATIVE MANAGEMENT
• Foccussed on supportive care
• Pain management
• Correction of hypoivolemia using saline and colloids
• Continuous NG aspiration
• Keep the patient NPO
• Decreased Stimulation of pancreas
• Avoidance of alcohol or other percipitating factor
• Oxygen for hypoxic patients
PHARMACOLOGICAL THERAPY

• Morphine- Relive pain

• Nitroglycerine or papaverine : Relaxation of smooth muscles and relive pain
• Antispasmodics : decrease vagal stimulation, motility and pancreatic outflow ‘
• Carbonic anhydrase inhiblitor ( eg: Acetazolamide) reduction in volume and
bicarbonate concentration of pancreatic secretion
cntd…
• Antacids : neutrealization of gastric acidic content
• Histamine Receptor antagonist
• Proton pump inhibitors :Decrease Hcl content and stimulates pancreatic
secretion
• Prophylactic antibiotics
• Calcium to treat hypocalcemia
• Pancreatic enyme replacement
• MCT oil
SURGICAL MANAGEMENT

• Done in case
• Abscess
• Severe Peritonitis
• Acute pseudocyst
NUTRITIONAL THERAPY
“Rest the pancreas” by avoiding enteral nutrition is no longer acceptable
There are evidences for nutritional support in acute pancreatitis
Enteral nutrition should be commenced after initial fluid resuscitation and
• within the first 24 hrs of admission
Can be introduced through NG tube and increased in stepwise fashion in 2-
3 days
Delay in commencing enteral nutrition may contribute to the development
• of intestinal ileus and feeding intolerance
COMPLICATION
NURSING ASSESSMENT
• Past health history
• Medications
• Surgery or other treatment
• Vital monitoring
• Objective symptoms of the disease
NURSING DIAGNOSIS
• Acute pain related to inflammatory process at pancreas and surrounding tissues

• Ineffective breathing pattern related to reduced diaphragm movement or fluid

accumulation

• Fluid electrolyte imbalance related to altered metabolic process

• Infection related to inflammatory process

• Hyperthermia related to infective process

• Imbalanced nutrition less than body requirement

• Constipation related to decreased oral intake

• Disturbed sleeping pattern related to pain

• Activity intolerance related to pain

• Knowledge deficit related to prognosis

• Anxiety related to prognosis and disease progression