Acute Pancreatitis
Acute Pancreatitis
- inflammation of the pancreas, ranging from mild edema to extensive hemorrhage, resulting from various insults to the pancreas.
- defined by a discrete episode of abdominal pain and serum enzymes elevations
- function and structure usually return to normal after an acute attack
Pathophysiology and Etiology
- excessive alcohol consumption
- biliary tract disease such as cholelithiasis, acute and chronic cholecystitis
- mortality is high because of shock, anoxia, hypotension or multiple organ dysfunction
- autodigestion of all or part of the pancreas is involved
Clinical Manifestations
- abdominal pain, usually constant, midepigastric or periumbilical, radiating to the back or flank
- nausea and vomiting
- fever
- involuntary abdominal guarding, epigastric tenderness
- dry mucous membranes, hypotension, cold clammy skin, cyanosis or tenderness, tachycardia and mild to moderate dehydration
- shock with respiratory distress and acute renal failure
- purplish discoloration of the flanks (Turner’s sign) or of the periumbilical area (Cullen’s sign)
Diagnostic Evaluation
- serum amylase, lipase, glucose, bilirubin, alkaline phosphatase, lactate dehydrogenase, AST, ALT, potassium and cholesterol may be elevated
- Serum albumin, calcium, sodium, magnesium and potassium may be low due to dehydration
- Abdominal x-ray to detect an ileus or isolated loop of small bowel overlying pancreas
- CT scan is the most definitive study
- Chest x-ray for detection of pulmonary complications
Management
- Restoration of circulating blood volume with IV crystalloid or colloid solutions
- Maintenance of adequate oxygenation
- Pain control to alleviate pain and anxiety, which increases pancreatic secretions
- Rest of the GI tract
- Maintenance of alkaline gastric pH with H2-recepto antagonists and antacids to suppress acid drive of pancreatic secretions
- Nutrition provided through parenteral feedings
- Pharmacotherapy: electrolytes, insulin, sodium bicarbonate and antibiotics
- Surgical interventions for complications
Complications
- Pancreatic ascites, abscess or pseudocyst
- Pulmonary infiltrates, pleural effusion, acute respiratory distress syndrome
- Hemorrhage with hypovolemic shock
- Acute renal failure
- Sepsis and multi-oran dysfunction syndrome
Nursing Management
- Assist patient to comfortable position.
- Administer medications as ordered.
- Maintain patency of NGT.
- Maintain NOP status.
- Observe and measure abdominal girth.
- Administer oxygen supplementation.
- Instruct patient in coughing and deep breathing exercises.
- If due to alcoholism, emphasize the need for alcohol elimination.
Photo credits: www.pennmedicine.org
Daisy Jane Antipuesto RN MN
Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.
