Pancreatitis Definition of terms 2 types of Pancreatitis 1.

Acute Pancreatitis - is a severe, life threatening disorder associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues - Enzymes (those that leaked out) cause AUTODIGESTION of the pancreas - occurs when the pancreas suddenly becomes inflamed but recovers quickly 2. Chronic Pancreatitis - progressive destruction of the pancreas - damage to the pancreas occurs slowly and symptoms may be persistent and sporadic. The condition does not disappear is permanently impaired. Incidence: - In the US the rate is 270 cases per 100,000, which accounts for more than 200.000 hospital admissions each year. - Gallstones and alcohol abuse are the most common causes of acute pancreatitis, accounting for 80% of cases. - Estimated a prevalence of 12 cases per 100,000 women and 45 cases per 100,000 men. - The average age at diagnosis is 35 to 55 years. - Chronic Pancreatitis ranges from 1.6 to 23 cases per 100,000 per year worldwide. - 15-20% of cases of acute pancreatitis run a serious clinical course with pancreatic necrosis and the development of multiple organ failure. or

Risk Factors P enetrating peptic ulcers A lcoholism (most common cause) N eurogenic factor C ontraceptive pills R enal failure and transplation E ndoscopic examination A bnormal organ structure T ract biliary disease (also a common cause) I - ncreased cholesterol T hyroid problem I - nfection S urgical trauma

Sign and Symptoms Acute Pancreatitis Symptoms Severe epigastric pain -radiating to the back; left flank or shouler - occurs 24 to 48 hours after eating or ingesting ROH - worsened by lying supine Hypoactive bowel sounds

Nausea and vomiting some people do vomit but vomiting does not relieve the symptoms

Fever, chills Pseudocyst @ upper abdomen; tender to touch Cullens sign (discoloration of the abdomen & periumbilical area) Turners sign (bluish discoloration of the flanks) Tachycardia a rapid heartbeat may be due to the pain and fever

Chronic Pancreatitis Symptoms Pain is less common - the pain is usually constant and may be disabling; however; the pain often goes away as the condition worsen. Inability to produce insulin (diabetes) Inability to digest food (weight loss and nutritional deficiencies) Bleeding ( low blood count or anemia) Liver problems (jaundice) Steatorrhea

Pathophysiology
Risk Factors: (P) (A) (N) (C) (R) (E) (A) (T) (I) (T) (I) (S)

Edema and Swelling

Obstruction of the pancreas, pancreatic duct, cystic duct, common bile duct

(+) Pain Abdominal pain Location: LUQ with radiation on the back Precipitated by: - Eating a big meal - Drinking ROH, fatty meal and when the pt. lies on back - Pain is relieved by resting on his knees and upper chest

Decreased pancreatic enzymes in the duodenum Malnutrition Steatorrhea Vit ADEK deficiency

Bile obstruction Jaundice pruritus

Pancreatic enzymes trapped in the pancreas

AUTODIGESTION

(+)Pain
Nausea & vomiting Decreased bowel sound

Damages the pancreatic tissues

Destroy Islet of Langerhands and beta cells

Hyeperglycemia DM

Bleeding Cullens sign -discoloration of the abdomen & periumbilical area Turners sign - Bluish discoloration of the flanks

Hypovolemic shock

Diagnostic Exam Blood test o Serum Amylase - pancreatic enzyme responsible for digesting carbohydrates o Serum Lipase - pancreatic enzyme that, along with bile from the liver digests fats o CBC CT-scan with contrast dye Ultrasound ERCP (Endoscopic Retrograde Cholangiopancreatography)

Surgical Management Laparoscopic gallbladder surgery Paracreatectomy Open gallbladder surgery Endoscopic retrograde cholangiopancreatogram Medical Management P ain management A ntacids to neutralize gastric secretion N GT suctioning to decrease stomach distention and suppresses pancreatic secretion C imetidine to decrease hcl R eplacement of fluids (IVF) E eliminate pancreatic secretion by placing the client initially on NPO A ntibiotic such as Clindamycin or Gentamycin T otal Parenteral Nutrition I nsulin T rasfusion of blood I ncease caloric intake

S surgery (laparotomy, paracreatectomy) Nursing Management 1. Pain related to distention of the pancreas and peritoneal irritation oddi Withhold oral fluids to decrease formation and secretion of secretin Use nasogastic suctioning to remove gastric secretion and relieve Maintain patient on bed rest to decrease metabolic rate abd Administer Demerol as ordered; it is the drug of choice Avoid morphine sulfate because it causes spasm of the sphincter of

abdominal distention secretion of pancreatic enzyme 2. Imbalanced nutrition: less than body requirements related to inadequate dietary intake, impaired absorption, reduced food intake Monitor laboratory test results, and daily weights Provide mouth care; patient should receive nothing by mouth during the attack Monitor serum glucose level and give insulin as prescribed Administer fluids, parenteral nutrition as prescribed

3. Impaired skin integrity related to poor nutritional status Assess fluid and electrolyte status by noting skin turgor and moistness of mucous membrane Weigh daily; measure intake and output Turn to sides every 2 hours Administer intravenous fluid, blood, electrolytes and albumin to maintain volume and prevent shock