Acute Pancreatitis 1

Acute Pancreatitis

Elisabeth A. Fandrich

Montana Tech, Nursing Department

NURS 1566 Core Concepts of Adult Nursing

Noel Mathis RN, BSN, MSN

April 28, 2008

Acute Pancreatitis
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The pancreas is the only gland in the body which is both exocrine and endocrine. It plays

a very important role in the digestive process. Its exocrine functions are the production of

pancreatic enzymes and bicarbonate which are transported through the pancreatic duct to the

duodenum to break down proteins and fats and to neutralize hydrochloric acid. Its endocrine

functions are the production of the hormones insulin and glucagon which regulates how the body

utilizes glucose.

Acute pancreatitis is the new or short-term inflammation of the pancreas. Although it can

occur in anyone, it is rare in children, and more common in men than in women. The majority of

cases are the result of alcohol abuse and gallstones. Other causes include hyperlipidemia,

genetics, traumatic injury, certain medications and chemicals, surgery, infections such as mumps,

and abnormalities of the pancreas or intestine. In approximately 15% of the cases of acute

pancreatitis, the cause is unknown. The causative factors that most likely induced pancreatitis in

3502,D,J were excessive alcohol ingestion a few days prior to the attack, uncontrolled

(undiagnosed) hyperlipidemia and uncontrolled (undiagnosed) diabetes mellitus.

The most distinct symptom that is experienced by patients with pancreatitis is pain. The

pain can develop very suddenly, or come on gradually. It is usually very intense pain that is

located in the medial portion of the upper quadrants or in the upper left quadrant of the abdomen.

It may intensify after meals or when lying supine. The pain typically lasts several days. Other

symptoms that patients with pancreatitis experience are fever, chills, nausea and vomiting,

swelling and tenderness of the abdomen and tachycardia. In very severe cases of pancreatitis,

patients may have symptoms of dehydration, hypotension, orthostatic hypotension, fatigue and

lethargy, headache, confusion and irritability in addition to the more common symptoms described

above. Acute pancreatitis can lead to hypovolemic shock, so precautions should be taken to
 Acute Pancreatitis 3

prevent this (isotonic IV fluid replacement). 3502,D,J presented to the emergency department

complaining of severe abdominal pain. He reported that he had been vomiting earlier in the day.

Diagnosis of pancreatitis is made by ruling out other potential causes of these symptoms

through a complete assessment including history and physical. Laboratory testing of blood and

urine samples are needed to confirm a diagnosis of pancreatitis. Diagnostic imaging studies (CT

scan, X-ray, Ultrasound and ERCP) are also used for diagnostic purposes. Lab tests that are

commonly ordered are amylase, lipase, routine hematology, routine chemistry, lipid panel, arterial

blood gases, glucose, serum HCG (pregnancy test), INR/PT and urinalysis. If the lab tests are

inconclusive, or complications of pancreatitis need to be identified (gallstones), then diagnostic

imaging studies are indicated. Along with a complete assessment of 3502,D,J, lab results and a CT

scan confirmed the diagnosis of acute pancreatitis. Pertinent lab values for this patient were as

follows: amylase (normal: 25-115 u/L) 474, lipase (normal: 8-75 u/L) 804, hemoglobin A1c

(normal: 4.2-6.5%) 8.4, total cholesterol (normal: <200 mg/dL) 888, HDL (normal: 27-76

mg/dL) 10, triglyceride (normal: 35-160 mg/dL) 6,239, LDL (normal:<130 mg/dL) unable to

calculate because of high triglyceride level, serum glucose (normal: 65-100 mg/dL) 274, c-

reactive protein (normal: 0-1.0) 6.5, and WBC (normal: 3.5-10 K/uL) 12.11. A chest x-ray,

ultrasound and serial CT scans were performed and re-confirmed the diagnosis of severe acute

pancreatitis, but did not identify the presence of gallstones.

Treatment of acute pancreatitis primarily focuses on alleviation of symptoms and

prevention of further pancreatic damage. Hospitalization is usually required. The patient will be

placed on NPO status, nasogastric suction may be utilized to prevent ulcerative damage of the

gastrointestinal mucosa, oxygen supplementation for patients having respiratory difficulty, IV fluid

replacement (an isotonic solution will be used), analgesics (Demerol is the drug of choice),

antiemetics, antibiotics (if infection is suspected), total parenteral nutrition (if the patient will be
 Acute Pancreatitis 4

NPO for several days), and insulin. For long term management, lifestyle changes are indicated.

Cessation of alcohol consumption and a high carbohydrate, low fat diet consumed in smaller,

more frequent meals will help prevent subsequent occurrences of pancreatitis. If the pancreas is

unable to produce adequate insulin, diabetes management will be necessary. In cases of

pancreatitis involving gallstones, surgery (cholecystectomy) may be needed. 3502D,J’s treatment

included the use of antiemetic, analgesics, NPO status, nasogastric suction, total parenteral

nutrition, IV fluid replacement, antibiotics, insulin administration, antihypertensives, and the

insertion of a central line to facilitate administration of these medications (most of which are IV).

Most patients who have had acute pancreatitis are able to fully recover. 5-10% of patients

will have chronic conditions as a result of the pancreatitis such as kidney failure, brain damage,

diabetes mellitus and dypsnea. Upon discharge patients need to be educated about the importance

of abstaining from alcohol, as this is the only way to reduce the chances of reoccurring episodes.

3502,D,J and his family received patient teaching regarding medication regime and diabetes

management. In his case, at the time of discharge, his blood glucose levels were still very high,

indicating that insulin production was impaired. Areas addressed were blood glucose monitoring,

determination of insulin dosage, insulin administration, diet and exercise.

Prognosis for this patient is good, even though he suffered a severe case of acute

pancreatitis that required him to be hospitalized for 10 days. Some of the things that assist in

improving his prognosis are overall good physical condition, no tobacco use, infrequent alcohol

use (before his illness), openness to suggestions about lifestyle modification, strong support

network, financial capability to procure diabetic medications and supplies, and verbalization of

intent to manage his condition and prevent any recurrent episodes of pancreatitis.
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References

Balentine D.O, FACP, J. (2007). Pancreatitis. Retrieved April 21, 2008, from eMedicineHealth

Web site: http://www.emedicinehealth.com/pancreatitis/article_em.htm

Munoz MD, A (2000, July, 1). Diagnosis and management of acute pancreatitis. American

Family Physician, Retrieved March 21, 2008, from

http://www.aafp.org/afp/20000701/164.html