PANCREATITIS

Definition
 A group of reversible lesions characterised by
inflammation of the pancreas

Incidence
 Male:female ratio is 1:3- in those with
gallstones and 6:1 in those with alcoholism
 The pancreas is a large gland behind the stomach and close to the
start of the small intestine called the duodenum. The pancreas has
two functions:
 Release the hormones glucagon and insulin into the body via the
blood stream. Glucagan and insulin are utilized for blood glucose
metabolism and regulating how the body uses and stores food or
nutrients for energy.
 Secrets digestive enzymes into the small intestine to help the
digestion of fat, carbohydrates, and proteins.
 Pancreatitis can be acute (sudden) and last for days, or chronic
pancreatitis, which does not heal and tends to get worse over
time.
 Normally during digestion, the pancreas releases inactivated
pancreatic enzymes which move through ducts in the pancreas
and then travel to the duodenum (small intestine). Once in the
small intestine, the enzymes activate and assist with digestion.
 Damage to the pancreas occurs when the digestive enzymes
that are usually released by the pancreas are activated inside the
pancreas instead of the small intestine and begin to attack the
pancreas. This attack inside the pancreas irritates the cells and
causes inflammation.
 When acute pancreatitis occurs over and over again, this
damage can lead to chronic pancreatitis from the scar tissue that
is formed. Once the pancreas is compromised by repeated
damage, digestion problems and diabetes can occur.
 Causes
 Gallstones (most common)
 Alcoholism
 Smoking
 Infection
 Abdominal injury
 Pancreatic cancer
 Abdominal surgery
 Some medications
 Cystic fibrosis
 ERCP – Endoscopic retrograde cholangiopancreatography (used to
treat gallstones)
 Family history of pancreatitis
 High triglyceride levels
Sign and Symptoms
Acute Pancreatitis
 Abdominal pain that worsens after eating
 Upper quadrant abdominal pain with radiation to the back
 Nausea and vomiting
 Tenderness to abdomen with touch
 Cullen’s Sign: bruising around umbilicus (1-2 days to appear)
 Grey Turner’s Sign: Bruising on the flanks (1-2 days to appear)
Chronic Pancreatitis
 Weight loss
 Steatorrhea: foul, oily stools
 Upper abdominal pain
Normal pancreas

Acute pancreatitis
Cullen sign – discolouration around umbilicus
Cullen sign
Grey-Turner sign- discolouration in the flanks
Lab investigation
 Full blood count: neutrophil leucocytosis

 Electrolyte abnormalities include hypokaemia, hypocalcemia

 Elevated LDH in biliary disease
 Glycosuria ( 10% of cases)
 Blood sugar: hyperglycaemia in severe cases
 Ultrasound look for stones in biliary tract diseases.
 Abdominal CT scan may reveal phlegmon(inflammatory
mass), pseudocyst or abscess(complications of acute
pancreatitis)
Lab investigation
Amylase and lipase
 Elevated serum amylase and lipase levels, in combination with
severe abdominal pain, often trigger the initial diagnosis of acute
pancreatitis.
 Serum lipase rises 4 to 8 hours from the onset of symptoms and
normalizes within 7 to 14 days after treatment.
 Marked elevation of serum amylase level during first 24 hours
 Reasons for false positive elevated serum amylase include
salivary gland disease (elevated salivary amylase) and
macroamylasemia.
 If the lipase level is about 2.5 to 3 times that of Amylase, it is an
indication of pancreatitis due to Alcohol or gallstone
 The degree of amylase/lipase elevation does not correlate with
severity of acute pancreatitis.
 Complications
 Infections: In acute pancreatitis, the pancreas is susceptible to
bacteria that can cause infections. Surgery may be needed to
remove damaged tissue.
 Pseudocyst: This is debris and fluid that can collect in pockets of
the pancreas. If this cyst-like pocket ruptures, infection and
bleeding can result.
 Diabetes: Due to damage of the insulin producing cells.
 Renal failure
 Respiratory problems
 Malnutrition: Due to damage of the digestive enzymes.
 Pancreatic Cancer
Pseudocyst of pancreas
Acute pancreatitis. The pancreas is enlarged (blue arrow) with
indistinct and shaggy margins.
There is peripancreatic fluid (red arrow) and extensive peripancreatic
infiltration of the surrounding fat (black arrow).
Management
 Iv fluid replacement(normal saline)
 Bowel rest (NG tube, NPO) in severe case
 Administration of meperidine/pethidine as pain killer.
 Antiemetic if necessary
 Monitor & correct electrolytes.
 Prevent infection by antibiotic prophylaxis.
 Determine & treat specific etiology(avoid alcohol)
 Indication to surgery if pancreatitis not respond to treatment.
 Initial treatment may include
hospitalization to stabilize the
condition. Other treatments may
include:
 NPO: nothing by mouth to allow the pancreas to rest.
 Pain medications: to control the pain that can be severe.
 IV fluids: to maintain hydration.
To treat the underlying cause of
pancreatitis:
 ERCP: to diagnose and repair issues with bile ducts.
 Surgery of pancreas: to remove bad tissue and fluid from the
pancreas.
 Cholecystectomy: gallbladder removal may be needed if
gallstones are problem in onset of pancreatitis.
 Treat alcohol dependence: Since drinking alcohol can cause
pancreatitis, sometimes within a few hours after drinking.
Abstaining from drinking alcohol is important.
Other treatments include:
 Enzyme supplements: to assist breaking down food into
usable nutrients for the body.
 Dietary changes: recommend low-fat, high nutrient meals.
 Nursing Intervention
 Maintain the nasogastric tube for drainage or suctioning.
 Restrict the patient to bed rest, and provide a quiet and restful environment.
 Place the patient in comfortable position that allows maximal chest expansion.
 Keep water and other beverages at bed side, and encourage the patient to drink plenty of
fluids.
 Provide I.V. fluids and parenteral nutrition as ordered.
 Assess the patient’s level of pain.
 Assess pulmonary status at least every 4 hours to detect early signs of respiratory
complications.
 Monitor fluid and electrolyte balance, and report any abnormalities.
 Emphasize the importance of avoiding factors that precipitate acute pancreatitis especially
alcohol.
 Stress the need for a diet high in carbohydrates and low in protein and fats.
 Caution the patient to avoid caffeinated beverages and irritating foods.
Thank you..