acute pancreatitis.ppt

OKK

1. Acute Pancreatitis

2. Inflammation of the Pancreas that may
result in autodigestionof the pancreas by
its own enzymes.
INCIDENCE
Common among middle aged men &
women
5000 cases/yr in US

3. Acute Pancreatitis
Function of the
pancreas is to
release proteolytic
enzymes that assist
in the breaking down
food products so that
nutrients can be
absorbed.

4. Etiology& Risk factors
Abdominal Trauma
Use of alcohol *
Biliary tract disease
(cholelithiasis)
Viral or Bacterial disease
Peptic Ulcer Disease
HYPERLIPIDEMIA
*most common causes

5. Pancreatic trauma/ischemia
Drugs (Azathioprine &estrogens)
Obesity
Duodenal obstruction
Viral infections
Carcinoma
Scorpion venom
Surgical procedures in stomach, duodenum/
biliary duct

6. Pathophysiology
 Due to the etiology
injury to the pancreatic cells/activate the pancreatic
enzymes
Enzymes may be triggered by reflux of bile from the
duodenum into the pancreatic duct /by pancreatic
obstruction.
Pancreatic ischemia

7. Acute Pancreatitis
Etiology and Pathophysiology
Pancreatic Ducts
become obstructed
Hypersecretion of the exocrine
enzymes of pancreas
These enzymes enter the bile duct,
where they are activated and with bile
back up into the pancreatic duct
Pancreatitis

8. Acute Pancreatitis
Etiology and Pathophysiology
Trypsinogen-(a proteolytic enzyme)
Normally released into the small
intestine, where it is activated to trypsin
In AP, activated to trypsin in the
pancreas causing autodigestion of
pancreas
Bleeding

9. Progression of Disease
Autodigestion
Acute Inflammation of Pancreas
Necrosis of Pancreas
Digestion of vascular walls
Thrombus and Hemorrhage
Death

10. Acute Pancreatitis
Clinical Manifestations
Severe Abdominal painis predominant symptom
Pain located in LUQ and mid-epigastrium
Commonly radiates to the back
Sudden onset
Severe, deep, piercing, steady
Aggravated by fatty meal or lying recumbent
position
Not relieved by vomiting
The pain may be accompanied by flushing ,
cyanosis ,& dyspnea

11. Acute Pancreatitis
Clinical Manifestations
Bowel sounds decreased or absent
Low-grade fever, Leukocytosis
Hypotension, Tachycardia
Jaundice
Nausea , vomiting, low grade fever
shock
Abnormal lung sounds -Crackles
Abdominal tenderness with muscle guarding
Paralytic ileus ----abdominal distension

12. Grey Turner’s sign: bluish discoloration of the
left flank
Cullen’s sign; bluish discoloration of the
periumbilical area .
Cerebral abnormalities; confusion, psychosis &
coma.

13. When the pancreas get damaged free fatty
acids are generated by the action of pancreatic
lipase . Insoluble calcium salts are present in
the pancreas ,& free fatty acids avidly chelate
the salts , resulting in ca deposition in the
reteroperitoneum .

14. Acute Pancreatitis
Diagnostic Studies
History and physical examination
Laboratory tests
Serum amylase-
Serum lipase –also elevated
Urinary amylase
Blood glucose
Serum calcium
Triglycerides
Liver enzymes

15. Acute Pancreatitis
Diagnostic Studies
Abdominal x ray
Abdominal/endoscopic ultrasound
Endoscopic retrograde
cholangiopancreatography (ERCP)
Chest x-ray
CT of pancreas
Magnetic resonance
cholangiopancreatography (MRCP)

16. Complications
Pseudocyst ; it is accumulation of fluid,
pancreatic enzymes , tissue debris &
inflammatory exudates surrounded by a wall
C/M; abdominal pain palpable epigastric mass ,
nausea, vomiting & anorexia.
It resolves within weeks
Pancreatic Abscess ; Pus collection in the
pancreas .
It results from extensive necrosis of the
pancreas

17. Pulmonary complications ; atelectasis, pleural
effusion
Pneumonia, & ARDS
Tetany
Pulmonary emboli
Disseminated intra vascular coagulation
Abdominal compartment syndrome

18. Acute Pancreatitis
Goals of Care
Relief of pain
Prevention or alleviation of shock
Decrease respiratory failure
↓of pancreatic secretions
Maintain Fluid/electrolyte balance

19. Treatment and Nursing Care
1. Pain management
IV morphine
Antispasmodic agent
Bentyl
Pro-Banthine
Spasmolytics –Nitroglycerine
Positioning –sitting up and leaning forward

20. Treatment
2. Prevention of Shock –hemodynamic
stability
* Administer Blood, Plasma expanders, Albumin
* RL solution/ Electrolyte solutions

21. Treatment and Nursing Care
3. Suppress pancreatic enzymes
* NPO
* NG suction
* Antacids, H2 receptor antagonists, antispasmotics
4. Decrease respiratory distress
* Oxygen; check O
2saturation levels
* Semi-fowlers position, knees flexed, position
changes
* C, A B; incentive spirometer
5. Antibiotics

22. Treatment and Nursing Care
6. Correction of electrolyte imbalance/
hypocalcemia
7. Maintain Hydration / Nutrition

23. Treatment and Nursing Care
Surgical therapy –if related to gallstones
ERCP
Endoscopic sphincterotomy
Laparoscopic cholecystectomy

24. Follow up care
Dietary teaching
High-carbohydrate, low-fat diet
Abstinence from alcohol,
Patient/family teaching
* Signs of infection, high blood
glucose, steatorrhea
Treatment -Home Care