This file offers information regarding the chronic pancreatitis disease, as well as a case study of a chronic pancreatitis patient in a soap format. Please go over all of the slides to get a complete picture of the situation. If any queries or suggestions please drop down in the comment section. Thank you!

1. Case study on
Chronic
Pancreatitis
Vasam viharika
PHARM D

2. • Introduction
• Etiology
• Pathophysiology
• Symptoms
• Diagnosis
• Management
• Subjective evidences
• Objective evidences
• Assessment
• Plan
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Contents
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3. What is chronic pancreatitis?
• Chronic pancreatitis is commonly defined as a
continuing, chronic, inflammatory process of
pancreas, characterized by irreversible
morphologic changes.
What causes chronic pancreatitis?
▪ Drinking a lot of alcohol over a long period of time
▪ An attack of acute pancreatitis that damages
pancreatic ducts
▪ Certain autoimmune disorders
▪ Hereditary diseases of the pancreas
▪ Cystic fibrosis
▪ Smoking
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4. 4
Pathophysiology Cystic fibrosis:
They lack CFTR protein which plays a role in movement of
chloride ions to help salt & water balance in epithelial cells
that lines pancreatic duct.
↓
↓Bicarbonate production
↓
Thick mucous in pancreatic ducts
↓
Blockage
↓
Digestive enzymes activate
↓
Damage pancreas.
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5. Early symptoms of chronic pancreatitis are
similar to acute pancreatitis.
• Pain in the upper belly that spreads into the
back
• Pain in the belly that gets worse when you
eat high fat foods or drink alcohol.
• Diarrhea or oily stools
• Nausea and vomiting
• Severe belly (abdominal) pain that may be
constant or that comes back
• Weight loss 5
What are the symptoms
of chronic pancreatitis?
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6. • Blood tests.
• CT scan.
• Abdominal ultrasound: This is an imaging
test done to look at organs in the abdomen.
• Endoscopic ultrasound : This test gives the
detailed images of the lining and walls of the
digestive tract and, nearby organs such as the
pancreas.
• Endoscopic retrograde
cholangiopancreatography (ERCP): Most
accurate visualisation of the pancreatic ductal
system.
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How is chronic
pancreatitis diagnosed?
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7. • Exact treatment will depend on the cause of
chronic pancreatitis
• Pain medicine
• Pancreatic enzyme supplements with every meal
• Insulin, if you develop diabetes
• Vitamin supplements, if needed.
• Feeding through a tube through the nose into
the stomach.
• IV fluids.
▪ https://www.healthline.com/health/chronic-pancreatitis
▪ https://pancreasfoundation.org/patient-information/chronic-
pancreatitis/
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How is chronic
pancreatitis treated?
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8. • A 32 years old patient with complaints of
abdominal pain and sneeze.
• One episode of generalised tonic clonic
seizures associated with tongue bite and drooling
with saliva was admitted in the hospital.
Past history
• Hx of diffuse abdominal pain and epigastric pain
since 20 days, recent admission for calcified
pancreatitis.
• Chronic pancreatitis since 2 years, yet not on
regular medication.
• DM-II
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Subjective evidences
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9. Investigations advised:
• T. Levetriacetam 500mg BID
• Insulin
Family history : Nothing significant
Allergies : Nil known drug allergies
Social history: Alcoholic
• CBP, RFT, Prothrombin time, ECG, INR, 2D
Echo, LFT, HbA1c, Ionised calcium, magnesium,
phosphorous, viral sneezing.
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Treatment history:
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10. Haematology
Blood pressure 130/80mmHg
Heart rate 80bpm
Respiratory rate 20/min
Temp 98F
GRBS 256mg/dl
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Objective evidences
Vitals
Hb 11.2 gms% (13-17)
RBC 4.1(million/mm3). (4.5-5.5)
WBC 5.8x109/L (4.0-10.0)
Platelets 353 × 109/L (150-400)
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11. Sr. Mg 2.0mmol/L (0.7-1.0mmol/L)
Sr. phosphate 4.62 mg/dL (0.8-1.44)
Sr. calcium 1.26 mg/dL (2.12-2.6)
Sr. amylase 304(U/L). <100U/L
Sr. lipase 55(U/L). <100U/L
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Biochemistry
▪ CT abdomen with pelvis- chronic calcified pancreatitis.
▪ HbA1C : 7.9mmol/mol
▪ BUN : 88mg/dl (11-21mg/dl)
▪ Sr. creatinine : 1.83mg/dl (0.74 to 1.35 mg/dL)
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12. ▪ Abdominal pain and Epigastric pain are the
main symptoms of pancreatitis.
▪ Elevation of GRBS (256mg/dl) is due to
decrease in insulin secretion ( inflammation of
pancreas).
▪ HbA1C levels are elevated.
▪ Decreased RBC levels indicates the patient is
anaemic.
▪ Elevation of sr. electrolytes and BUN levels are
observed which may be due to improper
functioning of kidneys.
▪ Decreased calcium levels are observed due to
calcification.
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Assessment
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13. ▪ CT abdomen with pelvis shows chronic calcified
pancreatitis confirms the diagnosis.
▪ Serum magnesium levels are found to be high
which is the most common cause of renal failure.
▪ Increased serum phosphate levels are also a cause
of pancreatitis and renal failure.
▪ Elevated amylase levels indicates inflammation of
pancreas.
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Assessment
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14. Generic name Dose Roa Day 1 Day 2
Inj
Pantoprazole
40mg iv ✓ ✓
Inj
Levetiracetam
5ml iv ✓ ✓
Inj NS 1000ml iv ✓ ✓
Inj Tramadol
Hcl
50mg/ml iv ✓ ✓
Ondansetron 4mg oral ✓ ✓
T. Ceftriaxone - oral ✓ ✓
T. Paracetamol 650mg oral ✓ ✓
Inj.
Pheneramine
maleate
2ml iv ✓ ✓
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Medication chart
▪ Inj.Pantoprazole is given to inhibit
the pancreatic secretion and to reduce
the inflammation of the pancreas.
▪ Inj.Levetriacetam is prescribed to
treat the seizures as the patient had an
episode of tonic-clonic seizures.
▪ Inj.Tramadol Hcl is prescribed to
reduce the abdominal pain.
▪ Ondansetron decreases the increased
amylase levels and also to reduces the
inflammatory damage
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15. ▪ T. Ceftriaxone is an antibiotic prescribed to get
rid of infection in the pancreas (most commonly
prescribed).
▪ T. Paracetamol which is a mild pain killer
given to reduce the abdominal pain.
▪ Inj. Pheniramine maleate is prescribed for
difficulty in breathing and allergic conditions
like running nose.
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Assessment
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16. ▪ Increase in serum creatinine levels in pancreatitis is
strongly associated with pancreatic necrosis.
▪ Elevated sr. creatinine and BUN levels directly affects the
kidneys may be caused due to diabetes.
▪ So, these levels should be strictly monitored.
▪ The presence of elevated sr. magnesium and sr. phosphate
levels shows that the kidneys are not functioning properly. As
a result, medication must be prescribed.
▪ Prothrombin time, ECG, INR, 2D Echo, are advised but not
performed.
▪ Patients BP is found to be slightly high. So, medication should
be prescribed or levels should be monitored regularly.
▪ As the patient has calcified pancreatitis, an ESWL procedure
to remove the calcium deposits should be performed.
▪ Multivitamins should be prescribed to the patient.
▪ Pancreatitis is a rare adverse effect of levetiracetam. So,
the medication should be changed or should be closely
monitored when the drug is administered.
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Communication
with doctor
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17. • Don’t drink alcoholic drinks.
• Drink plenty of water.
• Don’t smoke.
• Steer clear of caffeine.
• Pancreatitis patients should stick to a healthy
diet that’s low in fat and to eat high protein,
nutrient-dense diets that include fruits,
vegetables, whole grains, low fat dairy, legumes,
and other lean protein sources.
• Healthy fats such as avocado, olive oil, fatty fish,
nuts and seeds may be consumed with careful
portion control.
• Eat smaller and more frequent meals.
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Communication with
patient
Life style modifications
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