The pancreas is a gland of the digestive system and endocrine systems. Pancreas endocrine and exocrine glands. The endocrine function of the pancreas secretes hormones and the exocrine function is a secret enzyme.

Pancreatitis Definition

Pancreatitis is acute and chronic inflammation of pancreas and is associated with injury to exocrine parenchyma. 80% of the exocrine gland of the pancreas is effective in pancreatitis. Pancreatitis is a disorder in which auto digestion of the pancreas.

Types of pancreatitis  

1. Acute pancreatitis
2. Chronic pancreatitis

Acute pancreatitis 

• Acute, sudden, severe inflammation of pancreas.
•  Common cause of acute pancreatitis is auto digestion of pancreas by its own enzymes.
• Acute pancreatitis is associated with abdominal pain.
• Acute pancreatitis is a reversible disorder.
• 80% of acute pancreatitis is mild.

Chronic pancreatitis

• Chronic pancreatitis is a chronic, ongoing, progressive and irreversible inflammation of pancreas.
• Chronic pancreatitis causes destruction of fibrous tissue.
• Chronic pancreatitis is more common in male patients, onset 40 years old.

Cause of Pancreatitis

• Excessive drinking of alcohol.
• Idiopathic.
• Cholelithiasis  ( gall bladder stone)
• Cholecystitis
• Pancreatic tumour
• Trauma to pancreas
• Peptic ulcer
• Hypercalcemia and hyperthyroidism
• Ischemic vascular disease
• Medication – Thiazide diuretics
• Steroids.
• Hyperlipidaemia.

Pathophysiology of Pancreatitis

Cause / risk factor

↓

Auto activation of the pancreatic enzyme (trypsin and lipase enzyme)

↓

Auto digestion of pancreas by activated enzymes

↓

Inflammation, injury, destruction, fibrosis

↓

Pancreatitis.

Acute pancreatitis symptoms

• • abdominal pain – mild epigastria pain
• Upper left quadrant pain
• Sudden severe pain.
  • Abdominal rigid and abdominal tenderness
  • Abdominal distension
  • Nausea and vomiting
  • Fever
  • Weight loss, weakness
  • Anxiety and palpitation
  • Hyperglycaemia
  • Elevated WBC
  • Tachycardia and dehydration
  • Cullen sign
  • Turner sign.

Chronic pancreatitis Symptoms

• Abdominal pain and tenderness.
• Steatorrhea (fatty stool)
• In digestion, flatus
• Weight loss, weakness, malnourished
• Diabetes mellitus
• Muscles wasting
• Jaundice.

 Most signs of pancreatitis

Cullen sign – Discoloration of the abdomen and periumbilical area.

Turner’s sign – Bluish discoloration of the flanks.

Diagnosis of pancreatitis

• History collection and physical examination.
• Serum amylase and serum lipase (elevated).
• Urinary amylase (elevated).
• Abdominal USG.
• Endoscopic retrograde cholangiopancreatography (ERCP).
• CT- scan and MRI.
• Blood glucose test (hyperglycemia).
• Serum calcium (hypocalcemia).
• LFT, AST, ALT.
• X-ray.

Treatment of Pancreatitis

• The Administrator prescribed IV therapy.
• Maintain NPO.
• Use NG Tube, when a client is vomiting or has paralytic ileus.

Drug use in Pancreatitis

– Analgesic (meperidine)

– Nitro-glycerine – relax smooth muscles.

– Antispasmodic – (Bus Copan)

– Carbonic anhydrase inhibitor (acetazolamide).

– Antibiotics – for inflammation

– Antiemetic – for vomiting.

– Antacids – for neutralization of gastric HCL.

– Proton pump inhibitors (pantocid)

– Calcium administer – for hypocalcemia.

– H2 blocker (ranitidine).

Surgical in Pancreatitis

• Subtotal pancreatectomy
• Cholecystectomy
• Endoscopic retrograde cholangio pancreatogram.
• Pancreato jejunostomy.
• Necrosectomy.

Complication in Pancreatitis

• Cirrhosis of the liver.
• Cholecystitis.
• Acute respiratory distress syndrome (ARDS).
• Diabetes mellitus.
• Haemorrhagic shock.
• Jaundice
• DIC.

Nursing management  

• Monitor vital signs and body weight.
• Nurses maintain fluid and electrolyte balance.
• Nurse examines diagnostic procedures.
• Provide IV fluid to maintain hydration status.
• Nurses provide parenteral nutrition in server cases.
• Provide comfort and rest to a patient.
• Administer meperidine analgesic for relief pain. (Morphine is contraindicated in pancreatitis).
• Instruct clients to avoid alcohol consumption.
• Instruct the client to avoid heavy meals.
• Insulin and hypoglycaemic agent administrator to treat DM.
• Assess pancreatic signs (Cullen and Turner sign).
• Provide low sugar food and vitamin A, D, E, K supplement.
• Educate about the importance of follow-up care.

Key Points

1. Sweat gland in the body – Pancreas.
2. Exocrine and endocrine glands in the body – Pancreas.
3. Pancreatitis loss which type function of pancreas – Enzymatic function.
4. Acute pancreatitis is associated with – Abdominal pain.
5. The most common cause of pancreatitis – Cholithiasis.
6. Abdominal pain site in pancreatitis – Left upper quadrant.
7. Pancreatitis common sign – Cullen sign or Turner sign.
8. Bluish discoloration of the flanks – Turner’s sign.
9. Administer analgesic in pancreatitis – Meperidine
10. Morphine is contraindicated in pancreatitis because – Spasm of sphincter of Oddi.