The document discusses pancreatitis, including: 1. The pancreas is an organ that secretes enzymes and hormones. It can become inflamed due to premature activation of enzymes within the pancreas. 2. Pancreatitis can be acute or chronic. Acute pancreatitis ranges from mild to severe and is often caused by gallstones or alcohol use. Chronic pancreatitis involves permanent damage from long-term inflammation. 3. Symptoms include abdominal pain, vomiting, and digestive issues. Diagnosis involves blood tests, imaging, and procedures like ERCP. Treatment focuses on pain relief, antibiotics, nutrition, and treating complications which can include infections.

1. Medical case presentation
on
SUBMITTED TO :
SUBMITTED BY:
MRS. NIDHI JOSEPH MA’AM
(TUTOR)
MS. SHRUTI SHARMA
(Bsc.HONORS NURSING 2ND
YEAR)

3. Pancreas is a retroperitoneal gland 12-20cm long
and 2.5cm thick, lies to posterior to greater
curvature of stomach .The pancreas consists of
a head, a body and a tail is usually connected to
duodenum by two duct. The head is the
expanded portion of the organ near duodenum
,superior to and to the left of the head are the
control body and tapering tail.
ANATOMY OF
PANCREAS

4. Pancreatic juices secreted by the
exocrine into small ducts, that form two
larger duct i.e, pancreatic duct and
accessory duct where turn into small
intestine .Pancreatic duct is larger of the
two duct .Pancreatic duct join to the
common bile duct from liver and gall
bladder and enters duodenum as dilated
common duct called hepatopancreatic
ampulla.

5. The pancreas is both an endocrine
and an exocrine gland.
 ENDOCRINE PANCREAS
 EXOCRINE PANCREAS
Physiology of pancreas

6. ENDOCRINE PANCREAS
Distributed throughout
gland group of cells
called islets of
langerhans .The
pancreatic cells have no
duct so hormone diffuse
directly into blood. It
secrets hormone insulin
and glucagon which
control blood glucose
level.
EXOCRINE PANCREAS
Consists large number of
lobules made of small
alveoli, wall of which
consists of number of
secretory cells. Lobules
drained by tiny duct and
unit to form pancreatic
duct ,which extend whole
land of gland and open into
duodenum before enter
duodenum pancreatic duct
join common bile duct to
form hepatopancreatic
ampulla . Function of
exocrine pancreas is to
pancreatic juices
containing enzymes for the
digestion of
carbohydrates,protein ,fats
etc.
ENDOCRINEPANCREAS
EXOCRINEPANCREAS

8. Pancreatitis is a serious disorder. It is a condition
characterized by inflammation of the pancreas .The
pancreas is a pale grey gland behind the stomach and is
situated in epigastric and left hypochondriac region of the
abdominal cavity .Although the mechanism causing
pancreatic inflammation are unknown, pancreatitis is
commonly described as auto digestion of the pancreas. It is
believed that the pancreatic duct becomes temporarily
obstructed ,accompanied by hypersecretion of the exocrine
enzymes of the pancreas .These enzymes enter the bile duct
,where they are activated and together with bile ,back up
into the pancreatic duct, causing pancreatitis.

9. ACUTE PANCREATITIS
Protolytic enzymes produced by
pancreas are secreted in inactive
form ,which are not activated until
they reach the intestine ;this
protect the pancreas from digestion
by its own enzymes .If there
pancreatic enzymes are activate
while still in pancreas ,pancreatitis
results .It is of two types:
ACUTE PANCREATITIS
CHRONIC PANCREATITIS

10. SEVERE ACUTE
PANCREATITIS
Termed as necrotizing and
hemorrhagic pancreatitis.
In this the tissue become
necrotic and damage
extend into retroperitoneal
tissues.
MILD ACUTE PANCREATITIS
Characterized by edema
and inflammation confined
to pancreas with minimal
organ dysfunction

11. It occurs after acute pancreatitis .It is an inflammatory
condition or disorder characterized by progressive
anatomic and functional dysfunction of pancreas. The
inflammation of pancreas does not heal in this condition
and leads to permanent damage.
CHRONIC PANCREATITIS

12.  Family history of
pancreatitis
 Cholelithiasis
 Pancreatic cancer
 Pancreatic duct
obstruction
 Abdominal trauma
 Hyperlipidemia
 Hypercalcemia
 Infection
 Alcoholism
 Cigarette smoking
 Obesity
ETIOLOGY OF
PANCREATITIS

13. PATHOPHYSIOLOGY
Surgical trauma ,tumour head of pancreas
Autoimmune process
Sphincter of oddi dysfunction
Obstruction to secretory pancreatic duct
Gall
stones
Alcoho-
lism

14. Premature activation of
enzymes in the pancreas
and release of trypsin
Inactivation of auto
digestion of pancreatic
cell
Release of
chymotrypsin, elastase
,phospholipase

15. Destruction of blood
vessels
Destruction of blood
wall
Release of inflammatory
marker into systemic
circulation
Severe
hemmorhagic
shock

16. Multiorgan
dysfunction

17. CLINICAL
MANIFESTATIONS
 Abdominal pain
 Vomiting
 Fever
 Discoloration of
abdominal wall
 Sign of shock
 Abdominal
distention
 Hypotension
 Hypovolemia
 Constipation
 Jaundice

18.  Steatorrhea : The excretion of abnormal
quantities of fat with the faeces owing to
reduced absorption of fat by the intestine.
 Dyspnea
 Weakness
 Abdominal bloating
 Food malabsorption
 Foul fatty stool
 Fatigue
 Epigastric or umbilical pain radiate to
back as well as flank and lower abdomen
 Swollen or tenderness
 Nausea

19.  History taking
 Physical examination
 Lab tests
a) COMPLETE BLOOD
COUNT
b)SERUM BILIRUBIN
c) SERUM AMYLASE AND
LIPASE
d) SERUM CALCIUM
e) KIDNEY FUNCTION TEST
f) LIVER FUNCTION TEST
g) GLUCOSE TOLERANCE
TEST
h) LDH (Lactic acid
dehydrogenase)
DIAGNOSTIC EVALUATION

20. Imaging tests
a)X-RAY
b)CT SCAN
c)ULTRASONOGRAPHY
d)MRI (MAGNETIC RESONANCE IMAGING)
 Other important procedures
a)ERCP (Endoscopic retrograde
colangiopancreatography)
b) MRCP (Magnetic resonance
colangiopancreatography)

21.  Analgesics
 Antibiotics
 Maintain volume status, electrolyte balance and
nutritional status
 Vitals signs should be checked properly
 Maintain pancreatic rest
 Treat complications: like pancreatic abscess, infection
and necrosis
 Give oral rehydration solution to keep hydrated and to
maintain electrolyte balance
MEDICAL MANAGEMENT

22.  Laparotomy
 Pancreaticojejunostomy
 Subtotal pancreatectomy
 Frey’s procedure
 Cholecystectomy
SURGICAL MANAGEMENT

23. A laparotomy is a
surgical
procedure
involving small
incisions through
the abdominal
wall to gain
access into the
abdominal cavity.
It is also known
as a celiotomy.
laparotomy

24. The Puestow
procedure is a
surgical
technique used
in the treatment
of chronic
pancreatitis. It
involves a side-
to-side
anastomosis of
the pancreatic
duct and the
jejunum.
Pancreaticojejunostomy

25. Subtotal
pancreatectomy
is the surgical
removal of all or
part of
the pancreas.
Subtotal pancreatectomy

26. Frey’s procedure

27. Cholecystectomy
is the surgical
removal of the
gallbladder.
Cholecystectomy
is a common
treatment of
symptomatic
gallstones and
other gallbladder
conditions.
Cholecystectomy

28. Relieve pain and discomfort :The current recommendation for pain
management in this population is parenteral opioids including
morphine or fentanyl via patient-controlled analgesia or bolus.
Improve breathing pattern: The nurse maintains the patient in a
semi-Fowler’s position and encourages frequent position changes.
Improve nutritional status: The patient receives a diet high in
carbohydrates and low in fats and proteins between acute attacks.
Maintain skin integrity : The nurse carries out wound care as
prescribed and takes precautions to protect intact skin from contact
with drainage.
NURSING MANAGEMENT

29. Pancreatitis can cause serious complications, including:
Pseudocyst. Acute pancreatitis can cause fluid and debris
to collect in cystlike pockets in your pancreas. ...
Infection. ...
Kidney failure. ...
Breathing problems. ...
Diabetes. ...
Malnutrition. ...
Pancreatic cancer
COMPLICATIONS

30.  Dietary changes
 Maintain healthy weight
 Stop alcohol intake
 Smoking cessation
HEALTH EDUCATION