Pancreatitis is inflammation of the pancreas that can be acute or chronic. Acute pancreatitis has a sudden onset of abdominal pain and is often caused by gallstones or alcoholism. Chronic pancreatitis results in permanent destruction of the pancreas through progressive inflammation and fibrosis. The nursing care plan focuses on managing the patient's acute pain, risk for infection, imbalanced nutrition due to decreased intake, and providing health education on risk factors, diet, and symptoms of diabetes.

1. PANCREATITIS
DR EVA VELIKOSHI-INDONGO
(DIP NURSING/MIDWIFERY, RN/RM/RT, BNSC (HSM),
NED (NDP), MNSc, PhDNSc (UNAM), MBChB (ZAMBIA)
March 2020
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2. Outline
• Definition
• Anatomy of the pancreas
• Pathophysiology
• Clinical manifestations
• Diagnosis
• Treatment
• Nursing care of patient with pancreatitis
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3. 1. Introduction
Definition: Inflammation of the pancreas
• Can be acute or chronic
• Acute- sudden onset of abdominal pain emergency
• Chronic- gradual damage, associated with fibrosis development
• Affects people of all ages, mortality worse with increasing age
• Mortality due to complications
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4. 2. Anatomy and physiology of pancreas
• Anatomy:
• Size 15cm
• Location: Concavity of duodenum
• Parts: Head, neck, body, tail
• Pancreatic ducts (duct of Wirsung) joins the CBD at ampulla of Vater
duodenum
• Accessory duct duodenum
• Exocrine (acinar cell) pancreatic juice
• Endocrine (Islet of Langerhans): glucagon(A cells), insulin (B) and
somatostatin (D). 4

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6. 6
• Physiology: Exocrine function

7. Endocrine funtion: Islet of Langerhans
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8. 3. Acute pancreatitis
• Reversible parenchymal injury associated with inflammation
Pathophysiology
• Inappropriately activated enzymes leak into pancreatic parenchyma auto-
digestion mainly by trypsin.
• Not well understood
• Causes: 80% cases associated with gall stones and alcoholism
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9. • Gall stones: Obstruction of the CBD at Ampulla of Vater
Obstruction of pancreatic juice and bile reflux of bile into main
pancreatic duct enzymes activation digestion of the gland
immune response vasodilation, ↑permeability, edema, necrosis,
blood vessels damage (haemorrhage).
• Alcohol: 1) May stimulate enzymes secretion
2) increases pancreatic secretion and contraction of sphincter of
Oddi
3) Direct toxic effect on acinar cells
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10. Other causes
• Viral infections (e.g. CMV, Mumps)
• Drugs (AZT, steroids, diuretics, valporic acid)
• Metabolic (hyperlipidemia, hypocalcemia)
• Scorpion bite
• Trauma (blunt abdominal trauma)
• Operations (pancreas instrumentation procedures)
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11. 4. Clinical manifestations
• Sudden severe abdominal pain after a meal/alcohol intake
• Radiates to the back
• Exacerbated by walking/lying supine
• Relieved by sitting or bending forward
• Nausea/vomiting, May present with fever, hypotension
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13. Physical examination:
• tenderness in epigastric area
• Reduced or absent bowel sounds and guarding (peritonitis)
• Severe pancreatitis: Bruising and discoloration of the left flank due to
hemorrhagic pancreatitis
 Retroperitoneal bleeding: Cullen sign and Grey Turner’s Syndrome
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• Cullen sign Grey Turner sign

15. Diagnosis
• History and physical examination
• Investigations:
• Pancreatic enzymes:
- Serum lipase - may stay elevated for up to 12 days (specific and sensitive)
- Serum amylase - usually returns to normal within a few days of treatment
• WBC- > ↑12 000 (leukocytosis) may inflammation or infection
• Hematocrit - ↑ indicates hypovolemia
• Creatinine and electrolytes- abnormalities may indicate ARF
• Serum glucose - monitor for hyperglycemia due to lack of insulin secretion
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16. - Abdominal scan- US, CT, MRI
• Serum calcium
• Lipids profile (triglycerides)
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17. Prognosis
• Complete recovery
• Progression to chronic pancreatitis
• Severity is based on Ranson Criteria
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18. Complications
• Shock (recall immune response to inflammation)
• Acute renal failure
• Multi-organ failure
• Pancreatic abscess
• Pancreatic pseudocyst
• Chronic pancreatitis
• Duodenal obstruction
• Pancreatic Ca
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Management
• Medical: as an emergency
• Resuscitative phase:
- IV fluids prevent hypovolemia/shock
- Breathing airway patency, oxygen administration
- Pain analgesics pref. opiods,
- Decrease HCl secretion: H2 inhibitors Cimetidine (Tagamet),
Ranitidine
- Keep NBM/NPO to rest the pancreas
• Surgical – if abscess or obstruction

20. Chronic Pancreatitis
• Progressive, irreversible, permanent destruction of the pancreas with chronic
inflammation and fibrosis
• Results in irreversible impairment in pancreatic function
• Common in middle aged males 50years of age
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21. Pathophysiology
• Cause not well understood
• Pancreas becomes destroyed and replaced by fibrotic tissue
• Strictures and calcifications can also occur obstruction
• Ducts maybe obstructed with protein precipitates, block the
pancreatic duct and eventually calcify
• Persistent heavy alcohol use and long term smoking
Also long-standing duct obstruction by tumor or gallbladder stone
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22. Clinical manifestation
• Recurrent or persistent abd and back pain
• Vomiting
• Attacks may be triggered by alcohol intake or food intake
• May present as pancreatic insufficiency or diabetes mellitus
• Malabsorption (90% exocrine function loss) steatorrhea
• Wt loss due to anorexia (food intake may trigger pain)
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23. Diagnosis
• Based on signs/symptoms, laboratory studies, and imaging
• Investigations:
• Serum amylase/lipase (specific and sensitive)
• Serum Alkaline phosphatase
• FBC- Mild leukocytosis
• Elevated ESR
• U/S
• ERCP Endoscopic Retrograde Cholangiopanceatography
• Visualize pancreatic/common bile duct
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24. Management
• Focus is on chronic care and health promotion
• Dietary control- low protein and fats diet
• No alcohol
• Control of diabetes
• Taking pancreatic enzymes
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25. Nursing care plan
Problems and risks:
• Acute pain
• Risk for deficient fluid volume
• Imbalanced nutrition: less than body requirements
• Risk for infection
• Deficient knowledge
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26. 1) Pain due to obstruction of biliary and pancreatic duct as well as
by inflammation.
• Assess and manage pain
- Assess pain frequency and intensity
- Administer medications as prescribed
 analgesics (opiods e.g. Pethidine), antacids (H2 blockers e.g.
Cimetidine/Tagamet), PPI (Omeprazole), sedatives (e.g. valium)
• Provide alternative comfort measures (back rub), pain diverting
activities (TV, radio)
• Bed rest
• Keep patient NBM till pain lessens 26

27. 2 ) Deficient fluid volume secondary to decreased intravascular
fluid exudation (inflammatory process) and vomiting.
• Give IV hydration fluids as prescribed
• Monitor skin turgor and mucous membranes hydration status
• Intake and output chart, including vomitus/gastric aspirate
• Urine output chart
• BP, pulse
• Monitor laboratory studies (Hb and Hct, electrolytes, creatinine,
urinalysis, electrolytes (Na, K,))
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28. 3) Imbalanced nutrition related to decreased/inadequate oral
intake.
• Maintain NPO status and gastric suctioning in acute phase
• Provide frequent oral care
• Assess bowel sounds return indicate readiness to feed
• Small frequent meals  resume oral intake with clear liquids/sips
• Continue with high-protein, high-carbohydrate diet low fat as indicated
(Prevent Malnutrition)
• Replacement enzymes (Pancreatin (Dizymes), pancrelipase (Viokase))
• Insulin replacement prn
• Parenteral nutrition - inhibit stimulation of pancreatic enzymes 28

29. 4) Risk of infection related to nutritional deficiencies and
tissue destruction.
• Assess and monitor vitals TPR, Pulse
• Assess abdomen: increased abdominal pain, rigidity and
rebound tenderness (Peritonitis)
• Assess bowel sounds sluggish/absent bowel sounds
peritonitis
• Report abnormalities
• Administer antibiotic therapy as indicated
• Prepare for surgical intervention as necessary. 29

30. 5) Deficient knowledge due to absence or deficiency of cognitive
information related to specific topic.
• Educate patient and his/her family on his condition and prognosis
• Educate on risk/causative factors: excessive alcohol intake,
gallbladder disease, hyperlipidemia, some drugs (Zidovudine,
sulfonamides, oral contraceptives etc)
• Diet: low fat and low protein
• Encourage cessation of alcohol and smoking, assist with rehabilitation
• Educate on signs and symptoms of Diabetes Mellitus (3Ps)
**** WHAT HEALTH EDUCATION ARE YOU GOING TO GIVE TO
THIS PATIENT? [10 marks]****
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31. Summary
• Anatomy of the pancreas
• Pathophysiology
• Clinical manifestations
• Diagnosis
• Treatment
• Nursing care of patient with pancreatitis
• **Health education**
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32. THE END…
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