PANKREATITIS

dr. Maulina Debbyousha, Sp. PD

PANCREATITIS
Proses peradangan akut pada pankreas dengan
terkait lolosnya enzim pankreas ke jaringan
sekitarnya.
Faktor etiologi utama adalah alkoholisme &
penyakit saluran empedu.
Juga dapat terjadi dari komplikasi penyakit yang
disebabkan oleh virus atau bakteri, ulkus
peptikum, trauma.

KLASIFIKASI
Pankreatitis akut

1.

Pankreatitis akut tipe intertisial

- Pankreatitis akut tipe nekrosis
2.

Pankreatitis kronis

ETIOLOGI
Alkohol
Batu empedu
Pasaca bedah
Pasca ERCP
Trauma (terutama tumpul)
Metabolik; hipertrigliseridamia, hiperkalsemia,
gagal ginjal
Infeksi
Berhubungan dengan obat-obatan
Penyakit jaringan ikat

PANKREATITIS AKUT
Indikator beratnya pankreatitis : gagal organ yakni
adanya renjatan, insufisiensi paru (PaO2 60
mmhg, gangguan ginjal (kreatinin >2 mg/dl),
PSMBA (>500ml/24 jam)
-PANKREATITIS INTERTISIAL
Pankreatitis intertisial dapat dibedakan
dari
pankreatitis nekrosis dengan
memakai CT
Scan abdomen

Patogenesis
CA OF THE PANCREAS

POSTOPERATIVE CARE

Monitor

vital parameters. Check vital signs, ABG,

intake and output. Be alert to signs of bleeding or
shock. Maintain urine output at 30 to 50 ml/hr.
Initiate pulmonary hygiene.
Establish effective pain management.
Monitor dressing and drainage tubes.
Maintain nutritional support with enteral and
parenteral support. Monitor BS and insulin.
Administer pancreatic enzyme replacement.
Assess for signs of dumping syndrome ( rapid shift
of fluid from vascular into the intestinal lumen
with a resultant decrease in blood volume).

MANIFESTASI KLINIS

Menghilang atau mengurangnya bising usus

Ada massa di epigastrium

PANCREATITIS
RANSONS CRITERIA

Admission criteria

Criteria during initial 48

hours

Age: 55 yrs. Or older

Hct: decrease or more than

10%

WBC: 16,000/mm3 or
higher

BUN:increase greater than 5

mg/dl.

LDH: 350 IU/L or higher

Glucose > 200 mg/dl.

CA: falls to less than 8

mg/dl.
PaO2 < 60 mm Hg

AST: 250 U/L or higher

Fluid sequestration; greater

than 6 liter.

PANCREATITIS
NURSING
Alleviate pain & anxiety. Anxiety increases
INTERVENTIONS
pancreatic
secretions. Demerol-then morphine.
Reduce

pancreatic stimulus- NPO, NGT to remove

gastric secretions. Drugs to reduce pancreatic
secretions-anticholinergics-suppress vagal
stimulation, NaHco-reverse metabolic
acidosis.Regular insulin to treat hyperglycemia.
Prevent or treat infection-with abx.
Aggressive respiratory care- monitor ABG.
Reduce body metabolism- bedrest, cool quiet
environment.
Provide client and family instruction-avoid
alcohol, coffee,heavy meals and spicy food.

PANCREATITIS
MAJOR
Cardiovascularhypotension/shock from
COMPLICATIONS

hypovolemia.
Hematologic-Anemia from blood loss, DIC,
leukocytosis from gen.inflammation or
secondary infections.
Respiratory-atelectasis, pneumonia, pleural
effusion, ARDS
GI- bleeding
Renal- oliguria, acute tubular necrosis
Metabolic-hyperglycemia, hypocalcemia.