PANCREATITISAdult Health Nursing

Year II, Semester III

Prepared by Yasir MumtazNursing Instructor

JCN

INTRODUCTION The pancreas is a large gland behind the 

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

It releases powerful digestive enzymes into the small intestine to aid the digestion of food.

It releases the hormones insulin and glucagon into the bloodstream. These hormones help the body control how it uses food for energy.

DEFINITION Pancreatitis is 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.

TYPESThere are two forms of pancreatitis:

1. Acute

2. Chronic Acute pancreatitis. Acute pancreatitis is a sudden 

inflammation that 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, and cyst formation. Severe pancreatitis can also harm other vital organs such as the heart, lungs, and kidneys.

TYPES Cont…

Chronic pancreatitis. Chronic pancreatitis is long-lasting inflammation 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: Upper abdominal pain that radiates into the back; it may be aggravated by eating, especially foods high in fat.

Swollen and tender abdomen Nausea and vomiting Fever Increased heart 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 are weight loss caused 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 the insulin-producing cells of the pancreas are damaged.

CAUSES In most cases, acute pancreatitis is caused by 

gallstones 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 FACTORSPancreatitis 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 high triglycerides and lupus

5. People with chronic pancreatitis are usually men between ages 30 and 40, but chronic pancreatitis also may occur in women.

DIAGNOSTIC TESTSTo diagnose acute pancreatitis, you should measure levels in the blood of two digestive enzymes, amylase and lipase. High levels of these two enzymes strongly suggest acute pancreatitis. Other tests include;

1. Pancreatic function test to find out if the pancreas is making the right amounts of digestive enzymes

2. Glucose tolerance test to measure damage to the cells in the pancreas that make insulin

3. Ultrasound, CT scan, and MRI, which make images of the pancreas so that problems may be seen

4. ERCP to 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. Morphine generally is suitable for pain control. There is a claim that morphine may constrict the sphincter 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 mild acute pancreatitis is 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.

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.

MILD ACUTE PANCREATITIS

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 as hypovolemic shock.

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 cause—gallstones, discontinuing medications, cessation of alcohol, etc. If the cause is gallstones, it is likely that an ERCP procedure 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. Fluids and electrolytes are replaced intravenously. 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 72–96 hours of treatment.

COMPLICATIONS Early complications include shock, infection, 

systemic inflammatory response syndrome, low blood calcium, high blood glucose, and dehydration. Blood loss, dehydration, and fluid leaking into the abdominal cavity (ascites) can lead to kidney failure. Respiratory complications are often severe. Pleural effusion is usually present. Shallow breathing from pain can lead to lung collapse. Pancreatic enzymes may attack the lungs, causing inflammation. 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 pressure.

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 I.V. fluids and parenteral nutrition as ordered.

Assess the patient’s 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-diseases-pancreatitis

http://allnurses.com/general-nursing-student/nsg-dx-for-124647.html

http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-pancreatitis.html