Pancreatitis

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Pancreatitis

• Cheryl McConnell RN MSN

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Factors Leading to Pancreatitis

• Alcohol intake usually 5 to 10 years
• Prior biliary disease
• Abdominal surgery or diagnostics
• Mostly middle aged men
• Trauma
• Recent viral infections
• Medications

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Pathophysiology

• Inflammation from an insult or injury
• Causes activation of pancreatic enzymes
• Enzymes autodigest and cause fibrosis
• Leads to thrombi and necrosis of tissue
• Fat necrosis occurs
• Fats bind to calcium
• Results in hypocalcemia

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More Patho

• Necrosis of blood vessels
• Fibers in blood vessels and ducts are dissolved
• Vasodilation starts due to vessel damage
• Results in bleeding and hemorrhage
• May be acute or chronic
• May be mild to necrotizing

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Signs and Symptoms of Acute Pancreatitis

• Abdominal pain sudden, intense, continuous mid
  epigastric or LUQ. May radiate to back
• Abd pain may be lessened in fetal or orthopneic
  positions
• Weight loss, nausea and vomiting
• Jaundice
• Cullens Sign

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More Acute S S

• Turners Sign
• Decreased bowel sounds to paralytic ileus
• Palpable abdominal tenderness
• May be able to palpate pancreas
• Ascites
• Fever, tachycardia, decreased blood pressure

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Even More S S

• May be shock like signs and symptoms
• Left pleural effusion, atelectasis, pneumonia

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Signs and Symptoms of Chronic Pancreatitis

• Abdominal pain intense, burning, gnawing, with
  periods of exacerbation
• Abdominal tenderness
• Ascites
• Steatorrhea
• Jaundice

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More S S of Chronic

• Dark urine
• Signs and symptoms of diabetes
• Dyspnea
• Orthopnea
• Weight loss

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Diagnostics

• Elevated amylase, lipase, and urine amylase
• Elevated glucose, bilirubin, alkaline phosphatase
• Elevated WBCs
• Hypocalcemia
• Hypomagnesia

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More Diagnostics

• Abdominal ultrasound
• ERCP (endoscopic retrograde cholangionpancreatogra
  phy)
• CT, MRI, CXR

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Clinical Management

• Non Surgical
• NPO during acute period
• IV fluids with electrolyte replacement
• NGT to suction
• Pain control Demerol, Talwin, Toradol NO
  MORPHINE
• Antacids
• H2 Antagonists

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Clinical Management Continued

• Anticholinergics (Bentyl, Pro-Banthine) to
  decrease vagal stimulation and therefore
  decreases enzyme production
• Comfort measures
• Nutrition TPN, then high carbohydrate, high
  protein diet.
• No high fat foods

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Clinical Management - Surgical

• Exploratory laparotomy for obstructions\
• I D if abscess or pseudocyst
• Cholecystectomy if biliary disease
• Pancreaticojejunostomy to relieve pain
• Partial pancreatectomy for pain relief
• Vagotomy with gastric antrectomy to decrease
  enzyme production

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Post Operative Care

• Same as for any abdominal surgery
• Immaculate skin care to prevent pancreatic
  enzymes from excoriating the tissues
• Enterostomal therapy consult

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Complications

• Multisystem failure
• ARDS
• Coagulation defects DIC
• Renal failure
• Death

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Discharge Planning

• Home health followup
• May need rehab facility
• Family/patient education
• Diet
• Financial and social services
• Pancreatic replacement therapy
• (Pancrease)