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Amanda Sabulski

on 3 December 2014

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Transcript of Pancreatitis

The inflammation of the pancreas, which is the long, flat gland in the upper abdomen that aids in digestion and regulating hormones
There are two main types of pancreatitis
Acute (Mild - Severe)
What is
Patients can experience jaundice, abdominal distention, pain and tenderness, as well as nausea, vomiting, tachycardia, myocardial insufficiency, fever, hypoxemia, leukocytosis, hypovolemia, hypotension, shock and tetany
Signs and Symptoms of

May include:
Chronic or intermittent abdominal pain
Weight loss
Steathorrhea (oily stools)
Signs and Symptoms of

Obstructive biliary tract disease, such as
(gall stones)
Peptic ulcers
Genetic factors, such as cystic fibrosis
Certain drugs
Risk Factors
Normal digestion
: bile concentrated in the gallbladder + pancreatic juice containing inactivated pancreatic enzymes and bicarbonate enter the duodenum via the hepatopancreatic ampulla
: enzymes are prematurely activated, which causes inflammation and damage to the gland
of Pancreatitis
Acute Pancreatitis
Hypersecretion of pancreatic enzymes coupled with a decreased production of proteases allows protein to precipitate in the pancreas and obstruct the ducts
Over time, the inflammatory process damages the pancreatic tissue in a positive feedback loop, causing irreversible structural or functional damage
Ducts become dilated, strictured, and irregular
Leads to further scarring, fibrosis, calcification, duct obstruction, and cysts
Chronic Pancreatitis
It is believed that alcohol causes the pancreatic juice to be rich in proteins, increasing the likelihood of damage precipitated by pancreatic stones
How does pancreatitis relate to alcoholism?
Obstruction or pressure on the pancreatic ducts causes bile reflux or increased ductal pressure from the accumulation of pancreatic secretions
Both mechanisms can cause premature activation of pancreatic enzymes
Increased levels of prematurely activated pancreatic enzymes such as phospholipase A2, tryptase, and elastase causes autodigestion of pancreatic tissue and activates the inflammatory process (localized)
Inflammatory process becomes generalized and continues to damage pancreatic tissue, leading to vascular damage, necrosis, and edema within the pancreas

fluid and debris collect in cyst-like pockets in the pancreas
Internal bleeding
Breathing problems
Kidney failure
Weight loss
Pancreatic adenocarcinoma

Case Study:
Jeanne is a 45 year old overweight alcoholic with a history of gallstones. She does not exercise and loves to go to her favorite bar and eat fried onion rings with a side of 6 jelloshots. One day, she comes into the bar as usual and the bartender notices Jeanne’s eyes are yellow, her stomach is more distended than usual, she’s out of breath, slightly confused, and running a fever. After talking with her friend, Jeanne starts to feel nauseated and drops to the floor from severe abdominal pain and hypoxia. She is rushed to the ER and later meets with her doctor. Her vitals and labs come back as follows:

Diagnosis and Treatment for Jeanne
Jeanne is diagnosed with acute pancreatitis with gallstones. Treatment included bowel rest, electrolyte replacement, IV fluids, and analgesics to manage her pain.

After being released from the hospital, Jeanne realizes she needs to make some life changes to decrease her risk for chronic pancreatitis. She joins an AA group, starts to exercise, and eats healthier foods.
NCLEX Question #1:
What is the most common cause of both acute and chronic pancreatitis?

a. Obesity
b. Peptic ulcers
d. Chronic alcohol abuse
Question #2:
A patient who came into the hospital with acute pancreatitis is now being discharged. His pancreas is not completely healed but he would like to go out to eat with his family to Garden Breeze. Which option on the menu should he most likely choose?

a. Red wine with spaghetti & meatballs
b. An apple martini with Caesar salad
c.  A diet Coke with a cheeseburger and onion rings
d. Tea with a strawberry salad
Analgesics for pain management
Fluid & electrolyte replacement
Ceasing alcohol consumption
No smoking
No fatty foods
Avoiding medications that could further damage the pancreas
Eating whole grains and avoiding simple carbohydrates
Staying hydrated
US has one of the highest incidence rates
Yearly incidence of AP: 32-44 new cases per 100,000 population
Has increased over the last decade - over 274,000 people were hospitalized in 2012 for the treatment of
acute pancreatitis
Over 100,000 people a year see their doctor for treatment of
chronic pancreatitis
There are roughly 50,000 hospitalizations for the chronic condition
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Huether, S. E. & McCance, K. L. (2012). Understanding pathophysiology (5th ed.). St.
Louis, MO: Elsevier Mosby
Mayerle, J., Hoffmeister, A., Werner, J., Witt, H., Lerch, M. M., & Mössner, J. (2013).
Chronic pancreatitis--definition, etiology, investigation and
treatment. Deutsches Aerzteblatt International, 110(22), 387-393. doi:10.3238/arztebl.2013.0387
Nair, R. J., Lawler, L., Miller, M.R. "Chronic pancreatitis." American family physician
76.11 (2007): 1679-1688.
Pancreatitis. (2012). U.S. Department of Health and Human Services, National
Institute of Diabetes and Digestive and Kidney Diseases. Retrieved from
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of acute pancreatitis: impact of social deprivation, alcohol
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Communities. Retrieved November 11, 2014 from
Pulse: 120 bpm
Blood pressure: 85/60
Respirations: shallow and rapid, 22 breaths per min
Temperature: 100 degrees F
Oxygen saturation: 88%

Elevated white blood cell count
HDL: 30 mg/dL
LDL: 130 mg/dL
Total cholesterol: 250 mg/dL
Amylase: 455 U/L
Lipase: 406 U/L

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