Presentation on pancreatitis

A QUICK REVIEW OF PANCREATITIS

1. Medical case presentation on PANCREATITIS SUBMITTED TO : SUBMITTED BY : MRS. NIDHI JOSEPH MA’AM (TUTOR) MS. SHRUTI SHARMA ( Bsc.HONORS NURSING 2 ND YEAR)

2. Pancreas is a retroperitoneal gland 12-20cm long and 2.5cm thick, lies to posterior to greater curvature of stomach .The pancreas consists of a head, a body and a tail is usually connected to duodenum by two duct. The head is the expanded portion of the organ near duodenum ,superior to and to the left of the head are the control body and tapering tail. ANATOMY OF PANCREAS

3. Pancreatic juices secreted by the exocrine into small ducts, that form two larger duct i.e , pancreatic duct and accessory duct where turn into small intestine .Pancreatic duct is larger of the two duct .Pancreatic duct join to the common bile duct from liver and gall bladder and enters duodenum as dilated common duct called hepatopancreatic ampulla.

4. The pancreas is both an endocrine and an exocrine gland . ENDOCRINE PANCREAS EXOCRINE PANCREAS Physiology of pancreas

5. Pancreatitis is a serious disorder. It is a condition characterized by inflammation of the pancreas .The pancreas is a pale grey gland behind the stomach and is situated in epigastric and left hypochondriac region of the abdominal cavity .Although the mechanism causing pancreatic inflammation are unknown, pancreatitis is commonly described as auto digestion of the pancreas. It is believed that the pancreatic duct becomes temporarily obstructed ,accompanied by hypersecretion of the exocrine enzymes of the pancreas .These enzymes enter the bile duct ,where they are activated and together with bile ,back up into the pancreatic duct, causing pancreatitis. PANCRAETITIS

6. IT CAN BE OF TWO TYPES: ACUTE PANCREATITIS Protolytic enzymes produced by pancreas are secreted in inactive form ,which are not activated until they reach the intestine ;this protect the pancreas from digestion by its own enzymes .If there pancreatic enzymes are activate while still in pancreas ,pancreatitis results .It is of two types: ACUTE PANCREATITIS CHRONIC PANCREATITIS

7. It occurs after acute pancreatitis .It is an inflammatory condition or disorder characterized by progressive anatomic and functional dysfunction of pancreas. The inflammation of pancreas does not heal in this condition and leads to permanent damage . CHRONIC PANCREATITIS

8. Family history of pancreatitis Cholelithiasis Pancreatic cancer Pancreatic duct obstruction Abdominal trauma Hyperlipidemia Hypercalcemia Infection Alcoholism Cigarette smoking Obesity ETIOLOGY OF PANCREATITIS

9. PATHOPHYSIOLOGY Gall stones Alcoho-lism

10. Severe hemmorhagic shock

11. CLINICAL MANIFESTATIONS Abdominal pain Vomiting Fever Discoloration of abdominal wall Sign of shock Abdominal distention Hypotension Hypovolemia Constipation Jaundice

12. Steatorrhea : T he excretion of abnormal quantities of fat with the faeces owing to reduced absorption of fat by the intestine. Dyspnea Weakness Abdominal bloating Food malabsorption Foul fatty stool Fatigue Epigastric or umbilical pain radiate to back as well as flank and lower abdomen Swollen or tenderness Nausea

13. History taking Physical examination Lab tests COMPLETE BLOOD COUNT SERUM BILIRUBIN SERUM AMYLASE AND LIPASE SERUM CALCIUM KIDNEY FUNCTION TEST LIVER FUNCTION TEST GLUCOSE TOLERANCE TEST LDH (Lactic acid dehydrogenase) DIAGNOSTIC EVALUATION

14. Imaging tests X-RAY CT SCAN ULTRASONOGRAPHY MRI (MAGNETIC RESONANCE IMAGING) Other important procedures ERCP (Endoscopic retrograde colangiopancreatography ) MRCP (Magnetic resonance colangiopancreatography )

15. Analgesics Antibiotics Maintain volume status, electrolyte balance and nutritional status Vitals signs should be checked properly Maintain pancreatic rest Treat complications: like pancreatic abscess, infection and necrosis Give oral rehydration solution to keep hydrated and to maintain electrolyte balance MEDICAL MANAGEMENT

16. Laparotomy Pancreaticojejunostomy Subtotal pancreatectomy Frey’s procedure Cholecystectomy SURGICAL MANAGEMENT

17. A laparotomy is a surgical procedure involving small incisions through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy . laparotomy

18. The Puestow procedure is a surgical technique used in the treatment of chronic pancreatitis. It involves a side-to-side anastomosis of the pancreatic duct and the jejunum. Pancreaticojejunostomy

19. Subtotal pancreatectomy  is the  surgical removal  of all or part of the  pancreas . Subtotal pancreatectomy

20. Frey’s procedure

21. Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. Cholecystectomy

22. Relieve pain and discomfort : The current recommendation for pain management in this population is parenteral opioids including morphine or fentanyl via patient-controlled analgesia or bolus. Improve breathing pattern: The   nurse  maintains the patient in a semi-Fowler’s position and encourages frequent position changes. Improve nutritional status: The patient receives a diet high in carbohydrates and low in fats and proteins between acute attacks. Maintain  skin integrity   : The nurse carries out wound care as prescribed and takes precautions to protect intact skin from contact with drainage. NURSING MANAGEMENT

23. Pancreatitis can cause serious complications, including: Pseudocyst . Acute  pancreatitis  can cause fluid and debris to collect in cystlike pockets in your pancreas. ... Infection. ... Kidney failure. ... Breathing problems. ... Diabetes. ... Malnutrition. ... Pancreatic cancer COMPLICATIONS

24. Dietary changes Maintain healthy weight Stop alcohol intake Smoking cessation HEALTH EDUCATION