Acute and Chronic Pancreatitis Study Notes

Acute Pancreatitis Overview

• Introduction to Acute Pancreatitis
  • Acute pancreatitis is a condition characterized by inflammation of the pancreas.
  • It can lead to severe, life-threatening complications.

Complications of Acute Pancreatitis

• Severe Complications

  • Jaundice:

  • Occurs due to swelling of the head of the pancreas, slowing bile flow through the common bile duct.

  • Compression of the bile duct may occur due to a stone or pancreatic pseudocyst.

  • Resultant bile flow obstruction leads to severe jaundice.

  • Intermittent Hyperglycemia:

  • Caused by glucagon release and decreased insulin due to damage to pancreatic islet cells.

  • Total destruction of the pancreas can lead to Type 1 diabetes mellitus requiring lifelong insulin.

  • Pleural Effusion:

  • Particularly on the left lung due to anatomical placement of the pancreas and fluid migration.

  • Acute Respiratory Distress Syndrome (ARDS):

  • Severe form of pulmonary edema; pulmonary failure accounts for many deaths within the first week of acute pancreatitis.

  • Multi-Organ Failure:

  • Can arise from severe forms of pancreatitis.

  • Coagulation Defects:

  • Can result in death due to complications.

Causes of Acute Pancreatitis

• Primary Causes:

  • Alcohol abuse:
  • Binge drinking, especially during holidays, is a common trigger.
  • Gallstones:
  • Blockage of the common bile duct, causing bile backup into the pancreas.

• Other Causes:

  • Trauma to the abdomen.
  • Surgical procedures such as Endoscopic Retrograde Cholangiopancreatography (ERCP), where complications may arise leading to swelling and obstruction.

• Incidence:

  • Increasing in the U.S. and globally due to rising rates of alcohol consumption and gallstones.

Risk Factors and Demographics

• Risk Considerations:

  • Alcohol consumption is primarily a male risk factor.
  • Women may be more at risk due to gallstones or during childbirth.

• Mortality Rate:

  • Death occurs in a small % of patients; early treatment can reduce mortality.
  • Increased mortality rate among hospitalized older adults and those with acute pancreatitis.

Pathophysiology of Acute Pancreatitis

• Premature Activation of Enzymes:
  • Causes self-digestion of pancreatic tissue.
  • Additional factors include alcohol abuse, gallstones, abdominal trauma, viral infections, drugs, and tumors.

Clinical Presentation

• Patient Symptoms:

  • Severe continuous abdominal pain, often described as "boring" pain.
  • Pain exacerbates in supine position, relieved by fetal position or sitting upright.
  • Associated symptoms: abdominal tenderness, nausea, vomiting, jaundice, and signs indicating bleeding (e.g., Cullen's sign around the umbilicus, Turner's sign on the flank).

• Assessment Tools:

  • Vital signs monitoring is crucial, with attention to tachycardia and hypotension as indicators of hemorrhage or fluid shifts.
  • Auscultate lung fields for abnormal sounds and perform a psychosocial assessment related to alcohol use.

Laboratory Assessments

• Key Lab Tests:
  • Amylase and Lipase:
  • Amylase levels rise within 12-24 hours and remain elevated for 2-3 days.
  • Lipase levels rise later (up to 5-7 days) and indicate pancreatic issues more reliably when amylase levels normalize.
  • Other Labs:
  • Serum bilirubin, alkaline phosphatase (for bile duct obstruction), white blood cell count, erythrocyte sedimentation rate (ESR, indicates inflammation), glucose (usually elevated), and calcium (typically decreases).

Treatment Approaches

• Pain Management:

  • Use opioids for severe pain, transitioning to non-opioids as necessary.

• Fluid Management:

  • Intravenous hydration and electrolyte replacement are critical.
  • Isotonic fluids such as normal saline (NS) and lactated Ringer's (LR) are preferred.

• Nutritional Support:

  • Patients often remain NPO initially; as recovery progresses, reintroduce clear fluids and bland, low-fat meals.
  • Enteral feeding is preferred over total parenteral nutrition (TPN) to avoid blood sugar spikes.

• Medication Use:

  • H2 receptor antagonists or proton pump inhibitors may be employed for managing gastric protection.
  • Pancreatic enzyme replacement therapy (PERT) is crucial for patients with malabsorption.

Monitoring and Discharge Planning

• Patient Monitoring:

  • Monitor for complications such as hypovolemic shock, paralytic ileus, respiratory distress, and multiple organ failure.

• Education:

  • Initiate education upon admission, emphasizing dietary management, signs of complications, and when to seek further care after discharge.

• Self-Management:

  • Discuss abstinence from alcohol, adherence to dietary recommendations, and understanding signs of diabetes or organ failure.

Chronic Pancreatitis

• Definition:

  • Chronic pancreatitis is characterized by progressive, permanent damage to the pancreas compared to the self-limiting nature of acute pancreatitis.

• Causes:

  • Often due to chronic alcohol use, protein malnutrition, and hereditary factors.

• Symptoms and Treatment Similarities:

  • Pain management, nutritional support, and possible PERT, albeit usually on a long-term basis with chronic pancreatitis cases.

• Nursing Interventions:

  • Diagnostic studies, case management, and collaborative care are essential for managing chronic conditions effectively, alongside patient education.