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Pancreatitis ppt nitin 1st msc nursing
- 2. PRACTICE TEACHING ON PANCREATITIS SUBMITTED TO, Mrs. Sreelatha Mam Lecturer (MSN), SCON, Nahre. SUBMITTED BY, Mr. Holambe Nitin 1st year MSc Nursing SCON, Nahre. SUBMITTED ON 06/12/2018
- 3. INTRODUCTION: Pancreatitis (inflammation of the pancreas) is a serious disorder. The most basic classification system used to describe or categorize the various stages and forms of pancreatitis divides the disorder into acute or chronic forms.
- 4. Acute pancreatitis can be a medical emergency associated with a high risk for life-threatening complications and mortality, whereas chronic pancreatitis often goes undetected until 80% to 90% of the exocrine and endocrine tissue is destroyed.
- 5. Acute pancreatitis does not usually lead to chronic pancreatitis unless complications develop. However, chronic pancreatitis can be characterized by acute episodes.
- 6. Typically, patients are men 40 to 45 years of age with a history of alcoholism or women 50 to 55 years of age with a history of biliary disease (Hale et al. 2000).
- 7. ACUTE PANCREATITIS: Acute pancreatitis ranges from a mild, self-limiting disorder to a severe, rapidly fatal disease that does not respond to any treatment. Mild acute pancreatitis is characterized by edema and inflammation confined to the pancreas
- 8. CAUSES Excessive alcohol consumption of the most common cause in the United states Also commonly used by biliary tract Disease such as the cholelithiasis, acute and chronic cholecystitis. Less common cause of the bacterial and viral infection
- 9. CAUSES • Peptic ulcer diseases • Ischemic vascular diseases • Obstruction- • Choledocholithiasis (bile stone in duct), Tumors, Sphincter of Oddi stenosis.
- 10. CAUSES Trauma- Blunt abdominal trauma, Abdominal operations, ERCP {endoscopic retrograde cholangio - pancreatography) procedure Metabolic- Hypertriglyceridemia, Acute hypercalcemia. Vascular- Shock, vasculitis.
- 11. Toxins- Alcohol, Scorpion venom Drugs- Valproic acid, Azathioprine (6-MP), Metronidazole, Sulfonamides, Most diuretics Pentamidine, Tetracycline, Mesalamine, ACE inhibitors
- 12. PATHOPHYSIOLOGY: Self-digestion of the pancreas by its own proteolytic enzymes, principally trypsin, causes acute pancreatitis.
- 13. Eighty percent of patients with acute pancreatitis have biliary tract disease; however, only 5% of patients with gallstones develop pancreatitis.
- 15. Activation of the enzymes can lead to vasodilation, increased vascular permeability, necrosis, erosion, and hemorrhage
- 16. CLINICAL MANIFESTATIONS: Severe abdominal pain is the major symptom of pancreatitis that causes the patient to seek medical care. Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas that stimulate the nerve endings. Typically, the pain occurs in the midepigastrium.
- 18. Pain is frequently acute in onset, occurring 24 to 48 hours after a very heavy meal or alcohol ingestion. It is generally more severe after meals and is unrelieved by antacids.
- 19. Abdominal guarding is present. Nausea and vomiting are common in acute pancreatitis. The emesis is usually gastric in origin but may also be bile- stained. Fever, jaundice,
- 20. mental confusion, Hypotension is typical and reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity. The patient may develop tachycardia, cyanosis, and cold, clammy skin in addition to hypotension. Acute renal failure is common
- 21. Respiratory distress and hypoxia are common, dyspnea, tachypnea, and abnormal blood gas values. Myocardial depression, hypocalcemia, hyperglycemia, and disseminated intravascular coagulopathy (DIC) may also occur with acute pancreatitis
- 22. DIGNOSTIC EVALUATION; Serum amylase and lipase levels are used in making the diagnosis of acute pancreatitis. In 90% of the cases, serum amylase and lipase levels usually rise in excess of three times their normal upper limit within 24 hours (Tierney, McPhee & Papadakis, 2001)
- 23. Serum amylase usually returns to normal within 48 to 72 hours. Serum lipase levels may remain elevated for 7 to 14 days (Braunwald et al., 2001). Urinary amylase levels also become elevated and remain elevated longer than serum amylase levels
- 24. X-ray studies of the abdomen and chest may be obtained to differentiate pancreatitis from other disorders that may cause similar symptoms and to detect pleural effusions
- 26. Ultrasound and contrast-enhanced computed tomography scans are used to identify an increase in the diameter of the pancreas and to detect pancreatic cysts, abscesses. Hematocrit and hemoglobin levels are used to monitor the patient for bleeding The stools of patients with pancreatic disease are often bulky, pale, and foul- smelling. ERCP is rarely used
- 29. MEDICAL MANAGEMENT: Depending upon the severity of episode, management focuses on alleviation of symptoms and support of patient to prevent complication. All oral intake is withheld to inhibit pancreatic stimulation and secretion of pancreatic enzymes
- 30. Parenteral nutrition Nasogastric suction may be used to relieve nausea and vomiting Nasogastric suction may be used to relieve nausea and vomiting
- 31. Histamine-2 (H2) antagonists (eg, cimetidine [Tagamet] and ranitidine [Zantac]) Adequate pain medication Morphine and morphine derivatives Insulin Treatment Hyperglycemia.
- 33. NURSING INTERVENTIONS relieving pain and discomfort improving breathing pattern improving nutritional status
- 34. COMPLICATION Fluid and electrolyte disturbances Necrosis of the pancreas Shock and multiple organ dysfunction Damage of the surrounding Organ colon and bowel due to inflammation. Infected Pancreatic Necrosis Pancreatic Abscess
- 35. CHRONIC PANCREATITIS: DEFINITION: Chronic pancreatitis is defined as the persistence of pancreatic cellular damage after acute inflammation and decreased pancreatic endocrine and exocrine function.
- 36. PATHOPHYSIOLOGY AND ETIOLOGY Alcohol abuse is the most common cause; less common causes are hyperparathyroidism, hereditary pancreatitis, malnutrition, and trauma to the pancreas.
- 37. With chronic inflammation, destruction of the secreting cells of the pancreas causes maldigestion and malabsorption of protein and fat and possibly diabetes mellitus if islet cells of the pancreas have been affected. As cells are replaced by fibrous tissue, obstruction of the pancreatic and common bile ducts and duodenum may result.
- 38. CLINICAL MANIFESTOTIONS: Pain is usually located in the epigastrium or left upper quadrant, frequently radiating to the back; similar to that observed in acute pancreatitis, but more constant and occurring at unpredictable interval. As the disease progresses, recurring attacks of pain will be more severe, more frequent, and of longer duration.
- 39. Weight loss, nausea, vomiting, and anorexia. Malabsorption and steatorrhea {fatty stool} occur late in the course often disease. Diabetes mellitus.
- 40. DIAGNOSTIC EVALUATION: Serum amylase and lipase may be normal to low because of decreased pancreatic exocrine function. Fecal fat analysis determines need for pancreatic enzyme replacement. Bilirubin and alkaline phosphatase may be elevated biliary obstruction occurs.
- 42. Secretin and cholecystokinin stimulatory test results are abnormal. Plain abdominal X-ray to determine diffuse calcification of the pancreas. CT scan identifies pancreatic structural changes, such as calcifications, masses, ductal irregularities, enlargement and pseudocysts. ERCP
- 44. MANAGEMENT Pain management. Correction of nutritional deficiencies, Pancreatic enzyme replacement. Treatment of diabetes mellitus. Endoscopic placement of pancreatic stent allowing free flow of pancreatic juices through distorted and irregular narrowed pancreatic duct
- 46. SURGICAL MANAGEMENT to reduce pain pancreatic secretions, correct structural Abnormalities and manage complications. Pancreaticojejunostomy - side-to-side anastomosis of pancreatic duct to jejunum to drain pancreatic secretions into jejunum
- 47. Drainage of pancreatic pseudocyst into nearby structures or by external drain. Resection of part of pancreas (Whipple procedure, distal pancreatectomy) or removal of entire pancreas (total pancreatectomy). Autotransplantation of islet cells.
- 50. COMPLICATIONS 1. Pancreatic pseudocyst. 2. Pancreatic ascites and pleural effusion 3. GI hemorrhage. 4. Biliary tract obstruction. 5. Pancreatic fistula.
- 51. Nursing Assessment Assess level of abdominal pain. Assess nutritional status. Assess for signs and symptoms of diabetes mellitus Asess current level of alcohol intake.
- 52. SUMMARY Introduction of the pancreatitis Acute Pancreatitis Etiology Pathophysiology Clinical Manifestations Diagnostic Evaluation Management
- 53. Chronic Pancreatitis Pathophysiology and Etiology Clinical Manifestations Diagnostic Evaluation Management Surgical Management
- 54. CONCLUSION: A process in which individual take the initiative, with or without help of others, to diagnose their learning goal, identify resources for learning, select and implement learning strategies, and evaluate learning outcomes. It purposes are to boost up the critical thinking and learning and learn permanently. It has more advantages than disadvantages. As everything is controversial, it is the deep and permanent method of learning
- 55. BIBLIOGRAPHY: Lippincott Williams and Wilkins Mnual of nursing practice ninth edition Page No. 737- 746 Levis Heitkemfer Medical Surgical Nursing Assesment and Management of clinical problems, elseweiar Publication Page no 1130 – 1140. Joice M. Black Medical Surgical Nursing Clinical Management for the positive outcomes 8th edition, elsweir publication, Page No: 610 – 615
- 56. Burnner and Suddharths testbook of Medical surgical Nursing Volume 1st, eleventh Edition Page No: 1133 – 1138 www.aallmedical.com
- 57. ASSIGNMENT: Write Assignment on how to management the pain & surgical Management