PANCREATITIS

                                                                       

Definition :

Pancreatitis is an inflammation of the parenchyma of pancreas, an organ that is important in digestion.

Pathophysiology:

Auto digestion of the pancreas by its own proteolytic enzymes particularly trypsin leads to vasodilation, increase permeability, necrosis , erosion & hemorhhage leads to acute pancreatitis

Alcohol abuse & other etiologoical causes leads to inflammation & destruction of secreting cells  of pancrease causing maldigestion & malabsorption of protein & fat & these cells are then replaced by fibrous tissue causing obstructiuon of pancreatic & common bile duct leading to chronic panctreatitis.

Etiology & Risk factors :

Excessive alcohol consumption

Biliary tract diseases :

• Cholelithiasis
• Acute & Chronic Cholecystitis

Bacterial & Viral infection

Peptic ulcer
Ischemic Vascular Disease

Obstruction :

• Cholidolithiasis
• Sphincter of Oddi stenosis
• Tumors

Trauma :

• Blunt Abdominal trauma
• Abdominal Operation
• ERCP procedure

Metaboloc :

• Acute hypercalcemia
• Hypertrigylceridemia

Vascular :

• Shock
• Vasculitis

Toxins :

• Alcohol
• Snake & scorpion venom

Drugs:

• Valproic acid,Azathioprine, Metronidazole, Tetracycline, ACE inhibitors

Types :

Acute Pancreatitis : Auto-digestion of pancreas by its own enzymes & development of fibrosis causing inflammation & edema to the pancreas. It may be self limiting or fatal.

Chronic Pancreatitis : Recurrent exacerbation leading to fibrosis after acute inflammation & persistent pancreatic tissue damage leading to decrease in pancreatic exocrine & endocrine function

Sign & symptoms :

• Epigastric pain
• Boring abdominal pain radiating to back or lest shoulder
• Gnawing continous abdominal pain after intake of meal
• Nausea & Vomiting (gastric origin but also bile stained)
• Ascities
• Weight loss
• Blood glucose level fluctuation
• Fatigue
• Jaundice
• Fever
• Mental confusion
• Tachycardia, cyanosis, cold, clammy skin & hypotension
• Steatorrhea
• Hypoglycemia, Hypocalcemia
• DIC
• DM

Medical & Nursing Management :

• NPO status
• IV Fluids for hydration
• Vitamin Supplementation
• Analgesics for pain management- IV/IM/Transdermal patch
• H2 Receptor blockers : Rantidine & Cimetidine
• Insulin therapy in case of DM or Hyperglycemia
• Antipyretics & Antiemetics
• Assess bilateral equality of lungs due to the presence of Ascites
• Place patient in Knee chest position to relieve pain
• Administer bland, low-fat, high protein, high calorie, small frequent meals after NG tube removal
• Suction the NG tube after episodes of vomiting
• Administer pancreatic enzymes
• Monitor blood glucose levels

Distinctive Facts :

• Ix: Elevated serum amylase, lipase, cholesterol, bilirubin, WBC, ERCP (Endoscopic Retrograde Cholangio Pancreatography )
• Positive Turner's sign ( Bluish gray discoloration of flank areas) & Cullen's Sign ( Bluish gray discoloration of periumbilical area of abdomen)
• Surgical Rx : Whipple procedure ( distal pancreatography), Autotransplantation of islets cells, Pancreaticojejunostomy, Drainage & Abrassion of pancreatic pseudocyst
• Complications include Pleural effusion, GI hemorrhage,Shock, Pancreatic fistula, Necrosis & Abscess of Pancreas

Prognosis :

In the chronic form, episodes of pancreatitis tends to become more severe over time and the overall 10-year and 20-year survival rates are estimated to be about 70% and 45%, respectively.

Acute Pancreatitis may be life threatening if not treated