This document outlines a seminar on pancreatitis that covers its definition, anatomy, physiology, types, causes, pathophysiology, signs and symptoms, diagnostic studies, complications, management, and nursing care. Pancreatitis is defined as an inflammation of the pancreas that can lead to its self-digestion by activated enzymes or structural damage. It is commonly caused by gallstones or alcohol and can be acute, presenting suddenly, or chronic, resulting from irreversible organ damage. Diagnostic tests include blood tests, imaging, and endoscopy. Complications involve organ failure, infection, or pancreatic cancer. Treatment focuses on fluids, nutrition, pain control, and treating the underlying cause surgically if needed. Nursing care addresses pain,

1. SEMINAR
ON
P
ANCREATITIS

2. Definition
Anatomy and physiology of pancreas
Types of pancreatitis
Main causes of pancreatitis
Pathophysiology
Sign and symptoms
Diagnostic studies
Complications
Medical management
Surgical management
Nursing management
Research abstract 2

3. Inflammation of the pancreas that can lead to digestion of the
pancreas by its own enzymes and/or irreversible structural damage to
the organ.
Or
Pancreatitis is a painful inflammatory condition in which the
pancreatic enzymes are prematurely activated resulting in auto
digestion of the pancreas.
3
DEFINITION

4. ANATOMY
4

5. 5

6. PHYSIOLOGY
8

7. Acute pancreatitis:Epidemiology
 Incidence about 50 per 100,000 population per year
 80%have mild disease
 40%with severe disease dev. infected pancreatic
necrosis
 The mortality ass. with infected necrosis is about 40%
 This usually occurs in the absence of local
complications
Source: Surgical Tutorco.uk 9

8. CONSENSUS CLASSIFICATION
(Revisionof theAtlanta 1992classification)
10

9. Types of
Pancreatitis

10. • Sudden inflammation of the pancreas due to something
that has triggered the digestive enzymes to become
activated inside the organ (there will be a high amylase
and lipase level in the blood).
• It comes on quickly and if treated promptly it can be
reversed. Typically there is limited structural damage to
the pancreas because it can be reversed with proper
treatment 12

11. Chronic inflammation of the pancreas (can be from
repeated episodes of acute pancreatitis but most
commonly due to years of alcohol abuse) that has
led to irreversible damage to the structure of
pancreas.
13

12. PHASES


EARLYPHASE
Occurs within1s
tweek
Involves early inflammation with

variable degree ofpancreatic
edema & ischemia
Leads toresolution / permanent

necrosis & liquefaction
Severity isentirely based onclinical
parameters
LATE PHASE
Begins after the first week,
can extend toweeks or
months
Characterized by increasing
necrosis, infection
Imaging becomes more
I
important for detecting local
complications & directing
treatment
14

13. Grades of Severity:
Mild acutepancreatitis
▸ No organ failure
▸ No local or systemic complications
Moderately severe acute pancreatitis
▸ Organ failure that resolves within 48 h (transient organ failure)
and/or
▸ Local or systemic complications without persistent organ failure
Severe acute pancreatitis
▸ Persistent organ failure(>48 h)
–Single organ failure
–Multiple organ failure
15

14. CAUSES OF PANCREATITIS
ACUTE PANCREATITIS
Main causes gallstones and high alcohol consumption
16

15. CHRONIC PANCREATITIS
Main cause is heavy-long term alcohol
consumption
17

16. 18

17. 19

18. PATHOPHYSIOLOGY

19. 21

20. 22

21. 23

22. 24

23. Fox's sign : The sign is named after George Henry Fox.

24. DIAGNOSTIC STUDIES

25. Abdominal ultrasound
Computerized tomography (CT) scan.
Endoscopic ultrasound (EUS).
Magnetic resonance cholangiopancreatography (MRCP)
Endoscopic retrograde cholangiopancreatography (ERCP),
CT–guided needle aspiration
Abdominal x-rays:
Upper GI series:
Serum amylase
Serum bilirubin:
Alkaline phosphatase:
Serum albumin and protein
Serum calcium:
CBC:
Serum glucose 27

26. Baseline CT scanning is indicated in the following situations:(1) the
diagnosis is in doubt;(2) severe pancreatitis is suspected because of high
fever (higher than 38.8° C[102°F]), distension and leukocytosis;
CT Severity Index (Balthazar Score) in Acute Pancreatitis
Helpful in assessing complications related to acute pancreatitis or as a
follow-up study in patients who are clinically deteriorating

27. 29
Commonly used scoring systems include:
•The Bedside Index of Severity in Acute
Pancreatitis (BISAP)
•The Ranson criteria
•The APACHE II score

29. CT Scan of acute pancreatitis
CT shows
significant
swelling
and
inflammation
of the
pancreas
31

30. Gall stone pancreatitis by ERCP
32

31. COMPLICATIONS
Pseudocyst.
Infection.
Kidney failure
Breathing problems
Diabetes.
Malnutrition.
Pancreatic cancer 33

32. 34

33. Fluids
Nutritional Support
Pain Control
Antioxidant therapies
35

34. 36

35. MANAGEMENT
 Mild pancreatitis
-Fasting
-Fluid restriction
-Analgesia
-Treat underlying
cause
-No role for antibiotic
 Severe pancreatitis
-Admission to ICU
-Monitoring
-Supportive therapy
-Nutritional support
-CTscan
-ERCP (in 72hours )
Enzymes to improve digestion
37

36. SURGICAL MANAGEMENT
Sphincterotomy. Cholecystectomy Stent placement
Balloon
dilatation
38

37. ERCP : Endoscopic retrograde cholangiopancreaticography 39

38. NURSING MANAGEMENT

39. NURSING DIAGNOSIS
• Ineffective Breathing Pattern related to severe pain and pulmonary
complications
•Acute Pain May be related to Obstruction of pancreatic, biliary ducts,
Chemical contamination of peritoneal surfaces by pancreatic exudate/
auto digestion of pancreas ,Extension of inflammation to
the retroperitoneal nerve plexus Possibly evidenced by Reports of pain
Self-focusing, grimacing, distraction/guarding behaviors, Autonomic
responses, alteration in muscle tone.
• Chronic Pain related to chronic and unrelenting insult to pancreas
41

40. • Deficient Fluid Volume related to vomiting, self-
restricted intake, fever, and fluid shifts
• Imbalanced Nutrition: Less Than Body Requirements
related to fear of eating, mal absorption, and glucose
intolerance
• Impaired skin integrity related to poor nutritional status,
bed rest, and multiple drains and surgical wound
• Anxiety related to surgical intervention
42

41. RESEARCH ABSTRACT
99 patients with pancreatitis are discussed, 95 of whom had pancreatitis
induced by cane spirits. One quarter of the patients had pancreatic
calcification (more Indians than Africans) and 13% had pancreatic
pseudocysts (32% Indians, 6% Africans). Over 50% of the African patients
were in the lower dietary group, consuming meat less than twice weekly.
Pancreatic function tests (secretin-cholecystokinin) disclosed a low
bicarbonate and amylase secretion in 84 patients and a lowered
concentration associated with a large volume of secretion in 15 patients.
Triple-lumen intestinal perfusion with sucrose or glucose revealed a
diminished absorption of both sugars in pancreatitis with diabetes and
other groups tested. Water and sodium absorption were increased, and
potassium secretion was increased in pancreatitis with diabetes. 43

42. SUMMARIZATION
44
Definition
Anatomy and physiology of pancreas
Types of pancreatitis
Main causes of pancreatitis
Pathophysiology
Sign and symptoms
Diagnostic studies
Complications
Medical management
Surgical management
Nursing management
Research abstract

44. REFERENCES
Banks,P. Classification of acute pancreatitis—2012:Revisionof the Atlanta
classification and definitionsby internationalconsensus, 2012;P 62:102–111.
Kumar,V.,Abbas,AK.,Fausto, N.& Mitchell, R.,Basic Pathology 7thed. ElsevierLtd,
Philadelphia. 2007;1121.
Lichtman, MA., Shafer, JA., Felgar, RE.& Wang, N.,LichtmansAtlas of
Hematology.McGraw Hill.Canada. 2007;P215-216.
Surgical-Tutor.Acute Pancreatitis . Cited on26thMarch2013http://www.surgical-
tutor.org.uk/default-home.htm
Williams,NS.et al. Bailey & LovesShortPractice of Surgery25thed.
Edward Arnold Ltd, GreatBritain.2008;P 816-820.
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