1) Pancreatitis is inflammation of the pancreas that occurs when digestive enzymes start digesting the pancreas itself. 2) There are two main types - acute pancreatitis which is temporary and chronic pancreatitis which is lifelong. 3) Acute pancreatitis ranges from mild to severe and can be necrotizing, while chronic pancreatitis involves progressive destruction and scarring of the pancreas over many years. 4) Treatment focuses on pain relief, preventing complications, and managing any underlying causes or associated conditions like diabetes.

1. PANCREATITIS
Presented By:
Mr. Nandish. S
Asso. Professor
Mandya Institute of Nursing Sciences

3. Definition :
o Pancreas is an organ behind the stomach that produces digestive
enzymes and number of hormones.
o It is a serious disorder characterized by inflammation of pancreas.
o It happens when digestive enzymes start digesting pancreas itself.
o It is categorized into acute (temporary) and chronic (lifelong)

5. Acute Pancreatitis :
• It is an acute inflammatory process of pancreas.
• It is a mild, self limited disorder to severe, rapidly fatal disease that
does not respond to any treatment.
• The main types of acute pancreatitis are : Interstitial edematous
pancreatitis & Necrotizing pancreatitis.

6. Interstitial Pancreatitis affects majority of patients.
o It is mild and self limiting.
o The edema & inflammation is confined to pancreas itself.
o It is characterized by pancreatic or peripancreatic parenchymal
necrosis with diffuse enlargement of gland.

7. • In Necrotizing Pancreatitis, there is presence of tissue necrosis in
either pancreatic parenchyma or tissue surrounding the gland.
• It can be sterile or infected.
• If the parenchyma is involved, that is considered as marker of severe
disease.
• A more wide spread & complete enzymatic digestion of the gland
characterized by necrosis.

8.  Mild acute pancreatitis is characterized by edema & inflammation
confined to pancreas with minimal organ dysfunction.
 Severe acute pancreatitis is termed as necrotizing and
haemorrhagic. In this type, tissue become necrotic. Damage can
extend into retroperitoneal tissues.

9. Etiology :
• Family history / hereditary
• Cholelithiasis
• Pancreatic cancer
• Pancreatic duct obstruction
• Trauma (post surgical / abdominal)
• Penetrating duodenal ulcer
• Medications (corticosteroids, thiazide diuretics, sulfonamides, oral
contraceptives, NSAID’s)
• Hyperlipidemia - Hypercalcemia
• Infection (viral) - Obesity
• Alcoholism - Cigarette smoking

10. Pathophysiology:
Due to causative factors
Autodigestion of
Pancreas
Clinical features
Activation of pancreatic
enzymes Injury to pancreatic cells

12. Clinical Manifestations :
- Abdominal pain (located in the left upper quadrant & radiates to
back)
- Pain has sudden onset and described as severe, deep, piercing and
continuous which aggravates after eating.
- Vomiting
- Low grade fever
- Leukocytosis
- Hypotension
- Tachycardia
- Jaundice

13. - Abdominal tenderness & distension
- Decreased bowel sounds
- Hypovolemia
- Constipation
- Grey turner spots or sign : a bluish flank discoloration. It is an
uncommon abdominal manifestation, which is a classical sign of
acute necrotizing pancreatitis.
- Cullen’s sign : it is superficial oedema with bruising in
subcutaneous fatty tissue around peri-umbilical region.

15. Diagnostic studies :
History collection & Physical examination
Primary test – serum amylase, serum lipase, urinary amylase (all the
values are elevated due to pancreatic cell injury)
Secondary test – blood glucose, serum calcium, serum Triglycerides
Chest / abdominal X-Ray
Abdominal ultrasound
CT of abdomen
ERCP
MRCP

16. Treatment :
Aims :
- To relieve pain
- Prevention of shock
- Reduction of pancreatic secretions
- Control of fluid & electrolyte imbalance
- Treating the infections
- Removal of precipitating cause.

17. Conservative therapy :
Management depends on severity.
Treatment based on :
- Physiological monitoring
- Metabolic support
- Maintenance of fluids & electrolytes (by administering RL)
- Inj. Albumin is given if patient goes to shock.

18. Surgical :
- ERCP with sphincterotomy followed by laproscopic
cholecystectomy (if gallstones are present)
- Percutaneous drainage is performed if pseudocyst is present.
- Placement of indwelling tubes or stents to reestablish the pancreatic
drainage.
- Multiple tubes are used aftre pancreatic surgery. Triple Lumen tube
consists of ports that provide tubing for irrigation, air venting and
drainage.

19. Nutritional Therapy :
- Initially patient is kept on NPO Status.
- NG tube is placed to perform abdominal decompression by
suctioning.
- When the food allowed, small & frequent diet is given.
- The diet must be rich in carbohydrate, bland with no stimulus
(caffeine)
- Supplementary fat soluble vitamins are given.
- if required, jejunostomy feeding is initiated.

20. Drug Therapy:
Name of drug Action
Meperidine, Morphine Pain relief
Nitrgoglycerin or Papaverine Smooth muscle relaxant
Antispasmodics (dicyclomine,
propantheline bromide)
Decrease vagal stimulation &
pancreatic outflow
Carbonic anhydrase inhibitor Reduce volume & alkalinity of
pancreatic secretion
Antacids Neutralization of gastric secretion
Ranitidine, Cimetidine Decrease HCl secretion

21. Nursing :
- Acute pain, abdomen, related to distension of pancreas.
- Imbalanced nutrition, less than body requirement related to anorexia
& dietary restriction.
- Deficient fluid volume, related to nausea, vomiting & NG
Suctioning or aspiration.
- Impaired comfort related to presence of NG tube.
- Ineffective therapeutic regimen management, related to lack of
knowledge on preventive measures & dietary restrictions.
- Risk for complications, related to late treatment or delayed in
implementation of proper interventions.

22. Chronic Pancreatitis :
o It is a progressive destruction of the pancreas with fibrotic
replacement of pancreatic tissue.
o It may lead to stricture and calcification in pancreas.

23. Types / Classification :
There are 2 major types.
- Chronic obstructive pancreatitis
- Chronic calcifying pancreatitis

24. 1) Chronic obstructive Pancreatitis :
- It is associated with biliary disease.
- The most common causes are :
 Inflammation of Sphincter of Oddi
 Cancer of Ampulla of Vater, duodenum or pancreas.

25. 2) Chronic Calcifying Pancreatitis :
 It occurs mainly in the head of Pancreas.
 It is also called as Alcohol induced pancreatitis.
 Here, pancreatic duct is obstructed with protein precipitates. These
block the pancreatic duct and eventually calcify.

26. Clinical Manifestations :
- Abdominal pain (recurrent attacks at interval of months or years)
- Pain is heavy, burning and cramplike.
- Malabsorption with weight loss
- Constipation
- Mild jaundice
- Dark urine
- Diabetes Mellitus
- Stool become foul and fatty.

27. Diagnostic studies :
History collection & Physical examination
Secretin stimulation test
Blood glucose level , HbA1C
Stool examination (steatorrhoea, fatty stool)
Chest / abdominal X-Ray
Abdominal ultrasound
Arteriography
CT of abdomen
ERCP
MRCP

28. Treatment :
It is identical to that of acute pancreatitis.
It focuses on –
Prevention of further attacks
Relief of pain
Control of pancreatic insufficiency (both endocrine & exocrine)
through enzyme replacement

29. Non Surgical Management :
 It is indicated for patients who refuse surgery, is a poor surgical risk
and in minimal symptoms.
 Removal of pancreatic duct stones through ERCP, stricture
correction with stenting and draining of cyst are effective modes in
managing pain.
 Pain management involves initiating Non Opioid Analgesics
(Monotherapy) in the beginning. If it is ineffective, combination
therapy is instituted with peripherally acting & centrally acting
medications. Cessation of smoking & alcoholism is recommended
before starting opioids.

30.  Large, frequent doses of analgesics are implemented to get rid of
pain.
 An endoscopic ultrasound guided placement of celiac nerve block is
an another option to reduce chronic unrelieved pain.
 Yoga & other mindfulness based therapies are effective non
pharmacologic methods for pain reduction.
 Diabetes mellitus is treated with modified diet, insulin or oral
antidiabetic agents.
 Pancreatic enzymes (pancreatin & pancre-lipase contain amylase,
lipase & Trypsin) are used to replace deficient pancreatic enzymes.
 Bile salts are given (sometimes) to facilitate absorption of fat soluble
vitamins.

31. Surgical Management :
It depends on anatomic & functional abnormalities of the pancreas
including location of disease within pancreas, presence of diabetes,
exocrine insufficiency, biliary stenosis & pseudocyst.
1) Pancreaticojejunostomy (joining of pancreatic duct to jejunum)
2) Insertion of stent
3) Wide resection or removal of pancreas
4) Whipple resection (pancreaticoduodenectomy) – it is a complex
operation to remove head of pancreas, first part of small intestine,
gallbladder & bileduct.

32. Nursing
Management
…………… ?