Pancreatitis

Question 1

Definition

Answer 1

ACUTE
- This is defined as the inflammation and swelling of the pancreas brought on by its ingestion by it’s own digestive enzymes.

CHRONIC
- This is when there is irreversible structural damage to the pancreas as a result of recurrent episodes of acute pancreatitis.

Question 2

Etiology

Answer 2

ACUTE
• Gallstones :- these are hardened undissolved deposits of cholesterol, salts or bilirubin… which occludes the pancreatic duct preventing the secretion of digestive enzymes into the duodenum. Subsequently, they activate because of the build up in pressure.

• Alcohol:- This damages cells of the pancreas (acinar cells) and pancreatic duct cells, which actually produces bicarbonate and fluid, as well as occlude the pancreatic duct.

CHRONIC
• Years of alcohol consumption:- recurrent inflammation damage

• Cystic fibrosis:- this is when there is an overproduction of mucus at the pancreatic duct which prevents the exit of digestive enzymes and so they activate. Over time, the pancreas stops producing digestive enzymes.

Question 3

Functions of Pancreas

Answer 3

Endocrine
° Insuline
° Glucagon

Exocrine 
° Amylase 
° Lipase 
° Trypsin 
° Nuclease (nucleic acid)

Question 4

Implications of care

Answer 4

Withhold oral intake
Administer prophylactic antibiotics
Use nasogastric suctioning
Correct any fluid or blood loss if necessary

Question 5

Clinical Manifestations (ACUTE)

Answer 5

• Sudden, very painful mid-epigastric pain of LUQ to back -> hurts worse lying flat
• Cyanosis
• Respiratory distress and hypoxia
• Fever, tachycardia, hypotension, nausea & vomiting, hyperglycemia, elevated amylase and lipase
• Cullen’s sign (severe pancreatitis): bluish discoloration @ the umbilicus r/o when free digestive enzymes damage surrounding tissues and so bleeding occurs which begins to collect at the belly button and flanks
• Grey-turner’s sign: bluish discoloration @ the flanks

Question 6

Clinical manifestations (CHRONIC)

Answer 6

• Chronic mid-epigastric pain
• Pain after drinking ETOH
• Swelling or masses “pseudocysts”
• Steatorrhea (Oily/greasy stool)
• Dark urine
• Jaundice
• Diabetes mellitus
• Weight loss

Question 7

Diagnostic measures

Answer 7

• Serum amylase
• WBC / FBC
• C - reactive protein
• Potassium
• Urinalysis
• Abdominal ultrasound
• Urine amylase
• Computerized tomography scan

Question 8

Pathophysiology

Answer 8

Sudden inflammation due to something obstructing the exit of digestive enzymes (amylase & lipase) through the pancreatic duct and subsequently resulting in their activation. Due to their activation, they begin to digest the pancreas resulting in pain and inflammation. Eventually tissues die, becoming fibrotic and develops cysts. Additionally, due to the pancreas location, these digestive enzymes may free flow and enter the lungs.

Question 9

Management

Answer 9

Goal: Rest pancreas, control pain, monitor for complications and administer drugs per MD

1. NPO initially to rest pancreas
2. Maintain IV hydration… may need TPN contents
3. Insert and maintain NG tube (removes stomach acid and gas)
4. Monitor blood glucose, stools
5. Administer medications

Question 10

Medications

Answer 10

Pancreatic enzymes 
Proton Pump Inhibitors (PPI) 
Analgesic (no morphine as causing spasms to sphincter of oddi)
H2 (histamine blockers) 
Antacids