[Alterations in Metabolic and Endocrine Functions]

PANCREATITIS
Predisposing factors:

Precipitating factors:
- Alcohol abuse
- Drugs (antihypertensives, diuretics, antimicrobials,
immunosuppresives, oral contraceptives)
- Biliary obstruction
- Hypercalcemia
- Hypertriglyceridemia
- Abdominal trauma
- Tumors
- Ischemia

- Genetic/ Family History

- Anatomical variants

Damage to pancreatic
cells
Elastase
Inflammation of the
parenchyma

Necrosis of blood vessels

and ductal fibers

Edema of the pancreas

and pancreatic duct
Hemorrhage
Activation of pancreatic
enzymes inside pancreas

Acute
Pancreatitis

Phospholipase A

Autodigestion of the
pancreas

Fat necrosis
Cell membrane

Further inflammation
of pancreas

Lipase

Fat Necrosis

Obstruction to the flow

of pancreatic enzyme

Chronic
Pancreatitis

Kalikrein

Edema
Vascular permeability
Smooth muscle contraction
Vasodilation

Hypoperfusion

Peripancreatic exudation or pancreatic ductal

leakage

Necrosis

Pseudocyst

Invasion of bacteria
Infected necrotic pancreas or abscess

Compresses nearby organs

Constant pain or deep ache in the

abdomen which felt in the back

Realease of toxic metabolites into peritoneal space

Ruptured due to trauma to the sac
Realease of toxic metabolites into blood
Hemorrhage
Death

SOURCES:

Shock
Pulmonary Insufficiency
Acute renal failure
Dissemenated Intravascular
Coagulation

Hypovolemia

Fisher, T. & Raton, B. (2015, March 16). MedlinePlus: Pancreatic Pseudocyst. Retrieved March 20, 2015, from
http://www.nlm.nih.gov/medlineplus/ency/article/000272.htm.
Freedman, S. (2013, October). The Merck Manual: Acute Pancreatitis. Retrieved March 2015, from

[Alterations in Metabolic and Endocrine Functions]

http://www.merckmanuals.com/professional/gastrointestinal_disorders/pancreatitis/acute_pancreatitis.html.
Gardner, T. (2014, December 8). Medscape: Acute Pancreatitis. Retrieved March 2015, from
http://emedicine.medscape.com/article/181364-overview.
Pancreatitis. (2015). In Encyclopdia Britannica. Retrieved from http://www.britannica.com/EBchecked/topic/441022/pancreatitis.

PANCREATITIS

Pancreatitis is a disease in which the pancreas becomes inflamed. Pancreatic damage happens
when the digestive enzymes are activated before they are released into the small intestine and begin
attacking the pancreas.[1]
There are two forms of pancreatitis: acute and chronic.
Acute pancreatitis.
Acute pancreatitis is a sudden inflammation that lasts for a short time. It may range from mild
discomfort to a severe, life-threatening illness. Most people with acute pancreatitis recover completely
after getting the right treatment. In severe cases, acute pancreatitis can result in bleeding into the gland,
serious tissue damage, infection, and cyst formation. Severe pancreatitis can also harm other vital organs
such as the heart, lungs, and kidneys.[2]
Chronic pancreatitis.
Chronic pancreatitis is long-lasting inflammation of the pancreas. It most often happens after an
episode of acute pancreatitis. Heavy alcohol drinking is another big cause. Damage to the pancreas from
heavy alcohol use may not cause symptoms for many years, but then the person may suddenly develop
severe pancreatitis symptoms.[3]
ETIOLOGY
Acute pancreatitis has many causes, such as alcohol abuse, cholelithiasis, abdominal trauma,
virus infection, drugs, and metabolic factors. The mechanisms by which these conditions trigger
pancreatic inflammation have not been identified.[4]
Acute pancreatitis is thought to result from inappropriate intrapancreatic activation of proteases,
which causes autodigestion of the pancreas. Exactly how this occurs is unknown.

[5]

It is thought that

alcohol-induced pancreatitis may include a physiochemical alteration of protein that results in plugs that

Pancreatitis. (2015). In Encyclopdia Britannica. Retrieved from http://www.britannica.com/EBchecked/topic/441022/pancreatitis..

Freedman, S. (2013, October). The Merck Manual: Acute Pancreatitis. Retrieved March 2015, from
http://www.merckmanuals.com/professional/gastrointestinal_disorders/pancreatitis/acute_pancreatitis.html.

Lewis, S. and et.al. Medical Surgical Nursing: Assessment and Management of Clinical Problems. Singapore: Mosby Elsevier Inc. .

[Alterations in Metabolic and Endocrine Functions]

(2008).
4

Gardner, T. (2014, December 8). Medscape: Acute Pancreatitis. Retrieved March 2015, from
http://emedicine.medscape.com/article/181364-overview.

block the small pancreatic ductules. Biliary pancreatitis occurs when edema or an obstruction blocks
the ampulla of Vater, resulting in reflux of bile into pancreatic ducts or direct injury to the acinar cells.
Other causes include the following:

Hyperlipidemia, which may occur secondary to nephritis, castration, or exogenous estrogen

administration, or as hereditary hyperlipidemia

Hypercalcemia arising as a result of hyperparathyroidism

Cholecystitis and cholelithiasis

Familial cases with no definite mechanism defined

Pancreatic tumor

Pancreatic trauma or pancreatic duct obstruction, such as penetrating or blunt external trauma,
intraoperative manipulation, or ampullar manipulation, and pancreatic ductal overdistention during
endoscopic retrograde cholangiopancreatography (ERCP)

Pancreatic ischemia during episodes of hypotensive shock, cardiopulmonary bypass, visceral

atheroembolism, or vasculitis

Drugs; although azathioprine and estrogens have been directly linked with the disease, many
other drugs are believed to have an association (e.g., antibiotics, anticonvulsants, thiazide diuretics,
sulfonamides, valproic acid)

Other general causes, such as pancreatic duct obstruction, obesity, duodenal obstruction, viral
infection (e.g., mumps), carcinoma, scorpion venom, ERCP, peritoneal dialysis, and factors still to
be determined.[1]

PATHOPHYSIOLOGY
Pancreatitis occurs when digestive enzymes produced in your pancreas become activated while
inside the pancreas, causing damage to the organ.[2]
During normal digestion, the inactivated pancreatic enzymes move through ducts in your pancreas
and travel to the small intestine, where the enzymes become activated and help with digestion.[3]

Pancreatitis. (2015). In Encyclopdia Britannica. Retrieved from http://www.britannica.com/EBchecked/topic/441022/pancreatitis.

[Alterations in Metabolic and Endocrine Functions]

2

Udan, J. (2002). Medical Surgical: Concepts and Clinical Application (First Edition). Philippines: Guiani Prints House.

Ibid

In pancreatitis, the enzymes become activated while still in the pancreas. This causes the pancreas to
undergo the process of inflammation. It is thought that alcohol increases the production of digestive
enzymes in the pancreas and/or increases the sensitivity to the hormone cholecystokinin (CKK). CCK
stimulates the production of pancreatic enzymes. Other and most common pathologic mechanism is
autodigestion of the pancreas that may lead to further damage to thepancreas. One possible cause is the
reflux of the bile acids into the pancreatic ducts through an open or distended sphincter of Oddi. This
causes the enzymes to irritate the cells of your pancreas, causing inflammation and the signs and
symptoms associated with pancreatitis.[1]
Regardless of the etiology, pancreatic enzymes (including trypsin, phospholipase A2, and elastase)
become activated within the gland itself. The enzymes can damage tissue and activate the complement
system and the inflammatory cascade, producing cytokines. This process causes inflammation, edema,
and sometimes necrosis. In mild pancreatitis, inflammation is confined to the pancreas. In severe
pancreatitis, there is significant inflammation, with necrosis and hemorrhage of the gland and a systemic
inflammatory response. After 5 to 7 days, necrotic pancreatic tissue may become infected by enteric
bacteria.[2]
Activated enzymes and cytokines that enter the peritoneal cavity cause a chemical burn and third
spacing of fluid; those that enter the systemic circulation cause a systemic inflammatory response that
can result in acute respiratory distress syndrome and renal failure. The systemic effects are mainly the
result of increased capillary permeability and decreased vascular tone, which result from the released
cytokines and chemokines. Phospholipase A2 is thought to injure alveolar membranes of the lungs.[3]
In about 40% of patients, collections of enzyme-rich pancreatic fluid and tissue debris form in and
around the pancreas. In about half, the collections resolve spontaneously. In others, the collections
become infected or form pseudocysts. Pseudocysts have a fibrous capsule without an epithelial lining.
Pseudocysts may hemorrhage, rupture, or become infected.[4]

Pancreatitis. (2015). In Encyclopdia Britannica. Retrieved from http://www.britannica.com/EBchecked/topic/441022/pancreatitis..

Freedman, S. (2013, October). The Merck Manual: Acute Pancreatitis. Retrieved March 2015, from
http://www.merckmanuals.com/professional/gastrointestinal_disorders/pancreatitis/acute_pancreatitis.html.

Gardner, T. (2014, December 8). Medscape: Acute Pancreatitis. Retrieved March 2015, from
http://emedicine.medscape.com/article/181364-overview.

[Alterations in Metabolic and Endocrine Functions]

4

Fisher, T. & Raton, B. (2015, March 16). MedlinePlus: Pancreatic Pseudocyst. Retrieved March 20, 2015, from
http://www.nlm.nih.gov/medlineplus/ency/article/000272.htm.

With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic
pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning
pancreas can cause digestion problems and diabetes.[1]

CLINICAL MANIFESTATION
Signs and symptoms of pancreatitis may vary, depending on which type you experience.
Acute pancreatitis signs and symptoms include:

Upper abdominal pain

Abdominal pain that radiates to your back Abdominal pain that feels worse after eating

Nausea

Vomiting

Tenderness when touching the abdomen

Chronic pancreatitis signs and symptoms include:

Upper abdominal pain

Losing weight without trying

Oily, smelly stools (steatorrhea)

The following uncommon physical findings are associated with severe necrotizing pancreatitis:

Cullen sign (bluish discoloration around the umbilicus resulting from hemoperitoneum)

Grey-Turner sign (reddish-brown discoloration along the flanks resulting from retroperitoneal
blood dissecting along tissue planes); more commonly patients may have a ruddy erythema in the
flanks secondary to extravasated pancreatic exudate.

Erythematous skin nodules, usually no longer than 1 cm and typically located on extensor skin
surfaces; polyarthritis.[2]

Complications
Pancreatitis can cause serious complications, including:

Infection. Acute pancreatitis can make your pancreas vulnerable to bacteria and infection.
Pancreatic infections are serious and require intensive treatment, such as surgery to remove the
infected tissue. [3]

Pseudocyst. Acute pancreatitis can cause fluid and debris to collect in cyst-like pockets in your
pancreas. A large pseudocyst that ruptures can cause complications such as internal bleeding and
infection.[4]

Gardner, T. (2015, April 1). Medscape: Acute Pancreatitis. Retrieved April 15, 2015, from http://emedicine.medscape.com/article/181364-

[Alterations in Metabolic and Endocrine Functions]

overview.
2

Ibid

Ibid

Fisher, T. & Raton, B. (2015, March 16). MedlinePlus: Pancreatic Pseudocyst. Retrieved March 20, 2015, from
http://www.nlm.nih.gov/medlineplus/ency/article/000272.htm.

Breathing problems. Acute pancreatitis can cause chemical changes in your body that affect your
lung function, causing the level of oxygen in your blood to fall to dangerously low levels.[1]

Diabetes. Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead
to diabetes, a disease that affects the way your body uses blood sugar.[2]

Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if
the kidney failure is severe and persistent.[3]

Malnutrition. Both acute and chronic pancreatitis can cause your pancreas to produce fewer of
the enzymes that are needed to break down and process nutrients from the food you eat. This can
lead to malnutrition, diarrhea and weight loss, even though you may be eating the same foods or the
same amount of food.[4]

Pancreatic cancer. Long-standing inflammation in your pancreas caused by chronic pancreatitis

is a risk factor for developing pancreatic cancer.[5]

Jaclyn Mae T. Alviola

MSN Student

Freedman, S. (2013, October). The Merck Manual: Acute Pancreatitis. Retrieved March 2015, from
http://www.merckmanuals.com/professional/gastrointestinal_disorders/pancreatitis/acute_pancreatitis.html.

[Alterations in Metabolic and Endocrine Functions]

2

Ibid

Ibid

Gardner, T. (2014, December 8). Medscape: Acute Pancreatitis. Retrieved March 2015, from
http://emedicine.medscape.com/article/181364-overview.

Ibid