PANCREATITIS

Adult Health Nursing

Year II, Semester III

Prepared by Yasir Mumtaz

Nursing Instructor
JCN

INTRODUCTION
Thepancreasis

a large gland behind thestomachand

next to the small intestine. The pancreas does two
main things:

It

releases powerfuldigestive enzymesinto the small

intestine to aid the digestion of food.

It

releases the hormonesinsulinand glucagon into the

bloodstream. These hormones help the body control
how it uses food for energy.

DEFINITION
Pancreatitisis

a disease in which the pancreas

becomes inflamed.

Pancreatic

damage happens when the digestive

enzymes are activated before they are released into
the small intestine and begin attacking the pancreas.

TYPES
There are two forms ofpancreatitis:
1.

Acute

2.

Chronic

.Acute

pancreatitis.Acute pancreatitis is a sudden

inflammationthat lasts for a short time. It may range from
mild discomfort to a severe, life-threatening illness. Most
people with acute pancreatitis recover completely after
getting the right treatment. In severe cases, acute
pancreatitis can result in bleeding into the gland, serious
tissue damage, infection, andcystformation. Severe
pancreatitis can also harm other vital organs such as the
heart,lungs, andkidneys.

TYPES
Chronic

Cont

pancreatitis.Chronic pancreatitis is longlastinginflammation of the pancreas. It most often

happens after an episode of acute pancreatitis. Heavy
alcohol drinking is another big cause. Damage to the
pancreas from heavy alcohol use may not cause
symptoms for many years, but then the person may
suddenly develop severe pancreatitis symptoms.

SIGN & SYMPTOMS

OF ACUTE PANCREATITIS:
Upperabdominal

painthat radiates into the back; it

may be aggravated by eating, especially foods high in
fat.

Swollen
Nausea

and tenderabdomen
and vomiting

Fever
Increasedheart

rate

SIGN & SYMPTOMS

OF CHRONIC PANCREATITIS:
The

symptoms of chronic pancreatitis are similar to

those of acute pancreatitis. Patients frequently feel
constant pain in the upper abdomen that radiates to
the back. Other symptoms areweight losscaused by
poor absorption (malabsorption) of food. This
malabsorption happens because the gland is not
releasing enough enzymes to break down food. Also,
diabetes may develop if theinsulin-producing cells of
the pancreas are damaged.

CAUSES
In

most cases, acute pancreatitis is caused bygallstones

or heavy alcohol use. Other causes include medications,
infections, trauma, metabolic disorders, and surgery. In
up to 15% of people with acute pancreatitis, the cause is
unknown.

In

about 70% of people, chronic pancreatitis is caused by

long-time alcohol use. Other causes include gallstones,
hereditary disorders of the pancreas,cystic fibrosis, high
triglycerides, and certain medicines. In about 20% to 30%
of cases, the cause of chronic pancreatitis is unknown.

RISK FACTORS
Pancreatitis can happen to anyone, but it is more
common in people with certain risk factors.
Risk factors of acute pancreatitis include:
1.

Gallstones

2.

Heavy alcohol drinking

.Acute

pancreatitis may be the first sign of gallstones.

Gallstones can block the pancreatic duct, which can
cause acute pancreatitis.

RISK FACTORS

Cont

Risk factors for chronic pancreatitis include:

1.

Heavy alcohol drinking for a long time

2.

Certain hereditary conditions, such as cystic fibrosis

3.

Gallstones

4.

Conditions such as hightriglyceridesandlupus

5.

People with chronic pancreatitis are usually men

between ages 30 and 40, but chronic pancreatitis also
may occur in women.

DIAGNOSTIC TESTS
To diagnose acute pancreatitis, you should measure levels in theblood
of two digestive enzymes,amylaseandlipase. High levels of these
two enzymes strongly suggest acute pancreatitis.
Other

tests include;

1.

Pancreatic function testto find out if the pancreas is making the

right amounts of digestive enzymes

2.

Glucose tolerance testto measure damage to the cells in the

pancreas that makeinsulin

3.

Ultrasound,CT scan, andMRI, which make images of the pancreas

so that problems may be seen

4.

ERCPto look at the pancreatic and bile ducts using X-rays

5.

Biopsy, in which a needle is inserted into the pancreas to remove a

small tissue sample for study

TREATMENT
The

treatment of pancreatitis is supportive and

depends on severity.Morphinegenerally is suitable for
pain control. There is a claim that morphine may
constrict thesphincter of Oddi, but this is
controversial. There are no clinical studies to suggest
that morphine can aggravate or cause pancreatitis or
cholecystitis.

The

treatment that is received for acute pancreatitis

will depend on whether the diagnosis is for the mild
form of the condition, which causes no complications,
or the severe form, which can cause serious
complications.

MILD ACUTE PANCREATITIS

The

treatment of mildacute pancreatitisis

successfully carried out by admission to a general
hospital ward. Traditionally, people were not allowed
to eat until the inflammation resolved but more recent
evidence suggests early feeding is safe and improves
outcomes. Because pancreatitis can cause lung
damage and affect normal lung function, oxygen is
occasionally delivered through breathing tubes that
are connected via the nose.

MILD ACUTE PANCREATITIS

The

tubes can then be removed after a few days once

it is clear that the condition is improving. Dehydration
may result during an episode of acute pancreatitis, so
fluids will be provided intravenously. The pain
associated with even mild or moderate cases of acute
pancreatitis can be severe, which means that a
narcotic pain killer may be required.

SEVERE ACUTE PANCREATITIS

Severe

pancreatitis is associated with organ failure,

necrosis, infected necrosis, pseudocyst and abscess. If
diagnosed with severe acute pancreatitis, people will
need to be admitted to a high dependency unit or
intensive care unit. It is likely that the levels of fluids
inside the body will have dropped significantly as it
diverts bodily fluids and nutrients in an attempt to
repair the pancreas. The drop in fluid levels can lead
to a reduction in the volume of blood within the body,
which is known ashypovolemicshock.

SEVERE ACUTE PANCREATITIS

Hypovolemic

shock can be life-threatening as it can

very quickly starve the body of the oxygen-rich blood
that it needs to survive. To avoid going into
hypovolemic shock, fluids will be pumped
intravenously. Oxygen will be supplied through tubes
attached to the nose and ventilation equipment may
be used to assist with breathing. Feeding tubes may be
used to provide nutrients, combined with appropriate
analgesia.

SEVERE ACUTE PANCREATITIS

As with mild acute pancreatitis, it will be necessary to treat the

underlying causegallstones, discontinuing medications,
cessation of alcohol, etc. If the cause is gallstones, it is likely
that anERCPprocedure or removal of the gallbladder will be
recommended. The gallbladder should be removed during the
same hospital admission or within two weeks of the pancreatitis
so as to limit the risk of recurrent pancreatitis. If the cause of
pancreatitis is alcohol, cessation of alcohol consumption and
treatment for alcohol dependency may improve the pancreatitis.
Even if the underlying cause is not related to alcohol
consumption, doctors recommend avoiding it for at least six
months as this can cause further damage to the pancreas during
the recovery process.

SEVERE ACUTE PANCREATITIS

Oral

intake, especially fats, is generally restricted

initially but early enteral feeding within 48 hours has
been shown to improve clinical outcomes.Fluidsand
electrolytesare replacedintravenously. Nutritional
support is initiated via tube feeding to surpass the
portion of the digestive tract most affected by secreted
pancreatic enzymes if there is no improvement in the
first 7296 hours of treatment.

COMPLICATIONS

Early complications includeshock, infection,

systemic inflammatory response syndrome, low blood
calcium, high blood glucose, anddehydration. Blood loss,
dehydration, and fluid leakinginto theabdominal cavity(
ascites) can lead tokidney failure. Respiratory
complications are oftensevere.Pleural effusionis usually
present. Shallow breathing from pain can lead to
lung collapse. Pancreatic enzymes may attack the lungs,
causinginflammation. Severe inflammation can lead to
intra-abdominal hypertension and
abdominal compartment syndrome, further impairing renal
and respiratory function and potentially requiring
management with an open abdomen to relieve the

NURSING DIAGNOSIS
Acute

pain related to irritation and edema of the

inflamed pancreas
2) Diarrhea related to decrease in pancreatic secretions
resulting in steatorrhea
3) Deficient fluid volume related to vomiting,
decreased fluid intake, diaphoresis, fluid shifts

NURSING INTERVENTIONS
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
Assess

I.V. fluids and parenteral nutrition as ordered.

the patients level of pain.

NURSING INTERVENTIONS
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.

REFERENCES
http://

www.webmd.com/digestive-disorders/digestive-disease
s-pancreatitis
http://

allnurses.com/general-nursing-student/nsg-dx-for-124
647.html
http://

nursingfile.com/nursing-care-plan/nursing-intervention