PANCREATITIS

Mr.Mihir.M.Patel,Nursing Tutor,
Government College of
Nursing,Siddhpur
Definition
Pancreatitis is the acute inflammation of the

pancreatic cells. The degree of inflammation

varies from mild edema to severe hemorrhagic

necrosis.
Etiology/Risk Factors
Biliary Tree Disorders
Alcoholism
Trauma to Pancreas
Malnutrition
Viral Infection
Intake of Certain drugs
Metabolic diseases
Other Causes (Duodenal ulcer, cysts, abscess, cystic
fibrosis)
Endoscopic Retrograde Cholangio Pancreatography
Alcohol related pancreatitis
Classification
1.Acute Pancreatitis
It is the acute inflammation of pancreas ranging from
mild, self limiting disorders to a severe rapidly fatal
disease that does not respond to treatment. The
degree of inflammation varies from mild edema to
severe hemorrhagic necrosis.
2.Chronic Pancreatitis
It is a continuous prolonged, inflammatory and
fibrosing process of the pancreas.
Clinical Manifestation
Severe Abdominal Pain
Severe, steady and excruciating pain located in the
epigastric or umbilical region may radiate to the back
also.
Vomiting
It is worsened by ingestion of food and fluid. It is
accompanied by nausea. The emesis is usually of
gastric origin and is bile stained.
Cont..
Low grade fever Leukocytosis (102F)
Abdominal tenderness with muscle guarding is present
Abdominal Distention
Hypotension and Hypovolemia with shock may be
present due to loss of large amount of protein rich fluid
into tissue and peritoneal cavity.
Respiratory Distress, hypoxia crackle on auscultation
Cynosis, Ecchymosis, Cullens Sign (Bluish discoloration
of periumbilical area)
Others: Jaundice, cold clammy skin, mental confusion.
Diagnostic Evaluation
History Collection
Physical Examination
Blood Investigation
Urine Analysis
Stool Specimen
Paracentesis Fluid Analysis
Chest X-ray
Abdominal USG
Endoscopic Ultrasound
Magnetic resonance cholangio pancreatography
Secretin Stimulation Test
Management
Objectives of Management are;
Relief of Pain

Prevention of Alleviation of shock

Reduction of pancreatic secretion

Prevention or treatment of infection

Removing of precipitating cause

Emergency Management
Administer Crystalloids, colloids or combination of
both.
Monitor BP hrly to monitor fluid loss and bleeding
Monitor heart rate, ECG, and cardiovascular status
hourly
Measure the hemodynamic parameter such as
PAWP, CVP, CO for any decrease.
Measure urine out put hrly
Monitor for physical indicators of hypovolemia
including cool extremities, delayed capillary refill
and absence of distal pulse.
Medical Management
Pain Management: Morphine Sulfate Others
spasmolytic to relax smooth muscle.
Estimate fluid loss
Respiratory System;
Administer O2 as prescribed
Intubation and mechanical ventilation as needed
Provide position on unaffected side
Provide Head Elevated Position
Cont.
Suppressing pancreatic Action;
Patient is kept NBM
NG suctioning to reduce vomiting and secretion
Peritoneal lavage or Dialysis
Pharmacological Therapy
Antibiotics: To Prevent Infection

Nitroglycerine/ Morphine : Relaxation of smooth

muscle and relief of pain.

Anti-Spasmodic: Decrease vagal stimulation,

motility and pancreatic out flow.

Antacid reduces the HCL Concentration

Surgical Management
Diagnostic Laprotomy
It Assist in diagnosis
ERCP with endoscopic sphincterotomy followed by
laparoscopic cholecystectomy.

Endoscopic retrograde cholangio pancreatography

(ERCP)
Nursing Management
Acute Care
Monitor vital sign, hemodynamic status, hypotension,
fever, fluid and electrolyte balance.
NG suctioning to relieve abdominal distention.
Oral fluid are withdrawn and parenteral fluids are
administered.
Pain Relief
Administer IV morphine sulfate
Comfortable position
Cont.
Improving Breathing Pattern
Provide semi fowlers position
Pulmonary assessment
Encourage the deep breathing and coughing exercises.
Improving Nutrition
Enteral / parenteral feeding
Small frequent meal
Diet should be bland, low in fat, high in carbohydrates.
Avoid Alcohol Intake
Cont
Monitoring Complication
Monitor vital signs, weight, fluid and electrolyte
levels and abdominal girth.
IV fluids are administered with infusion of blood
and blood product.
Intake and output chart should be maintained
Continuous hemodynamic monitoring
Monitor for early signs of neurologic,
cardiovascular, renal and respiratory dysfunction
Complication
Pseudo cyst

Pancreatic Abscess

Shock

Pleural Effusion

Tetany
Thank You