Details of Acute pancreatits

1. Presented By,
Dr. Dipali Dumbre
Ph. D Nursing
Medical Surgical Nursing
SCON

2. Definition
 Acute pancreatitis is an acute inflammatory process of
the pancreas.

3. Etiology
 Many factors can cause injury to the pancreas.
 Biliary tract disease
 Trauma (postsurgical, abdominal),
 Viral infections (mumps, HIV), penetrating duodenal
ulcer, cysts, abscesses, cystic fibrosis, Kaposi sarcoma,
 Certain drugs (corticosteroids, thiazide diuretics, oral
contraceptives, sulfonamides, NSAIDs)

5.  Metabolic disorders (hyperparathyroidism,
hyperlipidemia, renal failure), and vascular diseases.
 Pancreatitis may occur after surgical procedures on the
pancreas, stomach, duodenum, or biliary tract.
 Pancreatitis can also occur after ERCP (Endoscopic
Retrograde Cholangio-Pancreatography)
 In some cases, the cause is unknown (idiopathic).

6. Pathophysiology

7. Clinical Manifestations
 Abdominal pain is the predominant symptom of acute
pancreatitis.
 The pain is usually located in the left upper quadrant, but
it may be in the midepigastrium.
 It commonly radiates to the back because of the
retroperitoneal location of the pancreas.
 The pain has a sudden onset and is described as severe,
deep, piercing, and continuous or steady.
 It is aggravated by eating and frequently has its onset when
the patient is recumbent; it is not relieved by vomiting

8.  The pain may be accompanied by flushing, cyanosis, and
dyspnea.
 The pain is due to distention of the pancreas, peritoneal
irritation, and obstruction of the biliary tract.
 Nausea and vomiting
 Low-grade fever
 Leukocytosis

9.  Hypotension
 Tachycardia
 Jaundice.
 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.

10.  Grey Turner's signs :A bluish flank discoloration
 Cullen's sign: A bluish periumbilical discoloration.
 Shock may occur due to
 Hemorrhage
Toxemia from the activated pancreatic enzymes
Hypovolemia as a result of fluid shift into the
retroperitoneal space .

11. Diagnostic Studies
 History and physical examination
 Serum amylase
 Serum lipase
 Two-hour urinary amylase and renal amylase clearance
 Increased level of Blood glucose
 Increased level of Triglycerides

12.  Abdominal ultrasound
 Endoscopic ultrasound
 Contrast-enhanced CT (CECT) of the pancreas
 Magnetic resonance cholangiopancreatography (MRCP)
 Endoscopic retrograde cholangiopancreatography (ERCP)
 Chest x-ray

13. Collaborative Management
 Pain medication (e.g., morphine)
 NPO with NG tube to suction
 Albumin (if shock present)
 IV calcium gluconate (10%) (if tetany present)
 Lactated Ringer's solution
 ranitidine (Zantac) or omeprazole (Prilosec)
 Antibiotics (if necrotizing pancreatitis)

14.  If shock is present, blood volume replacements are used.
 Plasma or plasma volume expanders such as dextran or
albumin may be given.
 Fluid and electrolyte imbalances are corrected with
lactated Ringer's solution or other electrolyte solutions.
 Central venous pressure readings may be used to assist in
determination of fluid replacement requirements.
 Vasoactive drugs such as dopamine (Intropin) may be used
to increase systemic vascular resistance in patients with
ongoing hypotension.

15.  It is important to reduce or suppress pancreatic enzymes
to decrease stimulation of the pancreas and allow it to rest.
 This is accomplished in several ways.
 First, the patient is allowed to take nothing by mouth
(NPO).
 Second, NG suction may be used to reduce vomiting and
gastric distention and to prevent gastric acidic contents
from entering the duodenum.
 These measures suppress pancreatic secretion.

16.  Certain drugs may also be used for this purpose.
 Morphine: Relief of pain
 nitroglycerin or papaverine: Relaxation of smooth muscles
and relief of pain
 Antispasmodics:Decrease of vagal stimulation, motility,
pancreatic outflow (inhibition of volume and
concentration of bicarbonate and enzymatic secretion);
contraindicated in paralytic ileus
 Carbonic anhydrase inhibit or (acetazolamide
[Diamox]:Reduction in volume and bicarbonate
concentration of pancreatic secretion

17.  Antacids: Neutralization of gastric hydrochloric (HCl)
acid secretion and subsequent decrease in secretion,
which stimulates production and secretion of pancreatic
secretions
 Histamine (H2)-receptor : Decrease in HCl acid secretion
(HCl acid stimulates pancreatic activity)

18. Nutritional Therapy
 Initially the patient with acute pancreatitis is on NPO status to
reduce pancreatic secretion.
 Depending on the severity of the pancreatitis, enteral feedings
or parenteral nutrition may be initiated.
 If IV lipids are ordered, blood triglyceride levels need to be
monitored.
 In cases of moderate to severe pancreatitis, the patient may
require enteral feeding via a jejunal feeding tube.
 If severe nutritional deficiencies exist, parenteral nutrition may
be used .

19.  When food is allowed, small, frequent feedings are given.
 The diet is usually high in carbohydrate content because
that is the least stimulating to the exocrine portion of the
pancreas.
 Intolerance to oral foods is suspected when the patient
reports increasing abdominal girth or has elevations in
serum amylase and lipase levels.

20. Complication
 Pseudocyst : It is a cavity continuous with or surrounding
the outside of the pancreas. The pseudocyst is filled with
necrotic products and liquid secretions, such as plasma,
pancreatic enzymes, and inflammatory exudates.
 Pancreatic abscess: It is a large fluid-containing cavity
within the pancreas. It results from extensive necrosis in
the pancreas. It may become infected or perforate into
adjacent organs.

21.  The pulmonary complications are likely due to the
passage of exudate containing pancreatic enzymes from
the peritoneal cavity through transdiaphragmatic lymph
channels.
 Enzyme-induced inflammation of the diaphragm occurs
with an end result being atelectasis caused by reduced
diaphragm movement.
 Trypsin can activate prothrombin and plasminogen,
increasing the patient's risk for intravascular thrombi,
pulmonary emboli, and disseminated intravascular
coagulation.