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


  1. Restoration of circulating blood volume with IV crystalloid or colloid solutions
  2. Maintenance of adequate oxygenation
  3. Pain control to alleviate pain and anxiety, which increases pancreatic secretions
  4. Rest of the GI tract
  5. Maintenance of alkaline gastric pH with H2-recepto antagonists and antacids to suppress acid drive of pancreatic secretions
  6. Nutrition provided through parenteral feedings
  7. Pharmacotherapy: electrolytes, insulin, sodium bicarbonate and antibiotics
  8. Surgical interventions for 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

  1. Assist patient to comfortable position.
  2. Administer medications as ordered.
  3. Maintain patency of NGT.
  4. Maintain NOP status.
  5. Observe and measure abdominal girth.
  6. Administer oxygen supplementation.
  7. Instruct patient in coughing and deep breathing exercises.
  8. If due to alcoholism, emphasize the need for alcohol elimination.

Photo credits:

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.

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