PANCREAS

DISORDERS OF THE PANCREAS

Overview of Pancreatic Disorders

  • Acute and Chronic Pancreatitis

  • Cancer of the Pancreas

  • Course: Nursing course (NUR 3 Fall 2025)

Anatomy and Function of the Pancreas

  • Divisions of the Pancreas:

    • Divided into four regions; positioned between the stomach and spine, with part located in the curve of the duodenum.

    • Dimensions: Approximately 4-6 inches long, ½ inch wide, and less than 1 inch thick.

  • Functional Overview:

    • Exocrine Function:

    • Secretes digestive enzymes for breaking down fats, proteins, and carbohydrates.

    • Dominantly exocrine (about 95% of pancreatic function) focused on digestive enzyme production and transport.

    • Endocrine Function:

    • Produces hormones like insulin (lowers blood glucose) and glucagon (raises blood glucose).

Exocrine Function Detailed

  • Digestive Enzymes:

    • Lipase:

    • Breaks down dietary fats (triglycerides) into fatty acids and glycerol for absorption.

    • Insufficient lipase leads to impaired fat absorption, resulting in fatty stools and diarrhea.

    • Amylase:

    • Digest complex carbohydrates (starches) into simpler sugars for energy use.

    • Deficiency in amylase can lead to diarrhea from undigested carbohydrates.

    • Protease:

    • A group of enzymes that break down proteins into amino acids.

    • Secreted in inactive forms to prevent self-digestion, activated in the small intestine.

    • Bicarbonate:

    • Secreted to neutralize stomach acid, enhancing enzymatic effectiveness.

Normal Lab Values for Pancreatic Enzymes

  • Amylase: 30-110 IU/L

  • Lipase: 0-160 IU/L

  • Urinary Amylase Levels: 2.6 to 21.2 IU/L

    • Normal values may differ across laboratories.

  • Protease: Not measured directly via serum levels.

Endocrine Function Detailed

  • Hormonal Functions:

    • Insulin:

    • Produced by beta cells; facilitates glucose uptake by muscle, fat, and liver cells for energy/storage.

    • Glucagon:

    • Produced by alpha cells; initiates the release of stored glucose from the liver back into the bloodstream when levels drop.

    • Somatostatin:

    • Secreted by delta cells; regulates release of insulin and glucagon.

Pancreatitis Overview

  • Definition:

    • Inflammation of the pancreas; can be acute or chronic.

  • Acute Pancreatitis:

    • Medical emergency with high risk of life-threatening complications.

    • Symptoms often develop swiftly.

  • Chronic Pancreatitis:

    • Often goes undetected early on; usually by the time symptoms arise, much of the pancreatic function has deteriorated.

    • Can present with episodes similar to acute pancreatitis.

Severity of Pancreatitis

  • Mild Pancreatitis (Interstitial Edematous Pancreatitis):

    • Inflammation resolves usually within a week, little to no permanent damage.

  • Severe Pancreatitis (Necrotizing Pancreatitis):

    • Characterized by widespread inflammation potentially causing tissue death (necrosis).

Causes of Pancreatitis

  • Gallstones:

    • Hard deposits obstructing ducts; cause enzyme backup and damage.

  • Alcohol Use:

    • Heavy, prolonged consumption linked to both forms of pancreatitis.

  • High Triglycerides (>1,000 mg/dL).

  • Cystic Fibrosis:

    • Causes thick mucus obstructing pancreatic ducts.

  • Autoimmune Diseases:

    • Associated with conditions like lupus and inflammatory bowel disease (IBD).

  • Medications:

    • Some diuretics, hormones, and antibiotics may contribute.

  • Trauma or Surgery:

    • Including accidents and procedures like ERCP,

  • Smoking:

    • Independent risk factor for pancreatitis.

  • Infections:

    • Viral and bacterial, including mumps and hepatitis.

  • Hypercalcemia:

    • Excess calcium leading to premature enzyme activation.

  • Pancreatic Cancer:

    • Tumors causing duct obstruction.

  • Obesity:

    • Increased risk (BMI ≥ 30).

  • Idiopathic Cases:

    • No identified cause, particularly in chronic cases.

Pancreatitis and Obesity

  • Chronic Inflammatory State:

    • Visceral fat exacerbates inflammatory responses in pancreas during acute attacks.

  • Risk of Complications:

    • Increases risk for systemic complications, including acute kidney injury (AKI) and respiratory failure due to obesity.

Acute Pancreatitis Clinical Features

  • Presentation:

    • Severe abdominal pain, often leading to medical care sought.

    • Pain commonly radiates to the back; worsens after heavy meals or alcohol intake; independent of antacid relief.

    • Symptoms may include nausea, vomiting, fever, and abdominal distension.

  • Specific Signs:

    • Rigid abdomen may indicate peritonitis, ecchymosis in flank or umbilicus indicates severe pancreatitis.

Biomarkers for Acute Pancreatitis Diagnosis

  • Diagnostic Criteria:

    • History of upper abdominal pain.

    • Elevated serum amylase or lipase (≥3 times normal).

    • Imaging findings consistent with pancreatitis (CT, MRI, or ultrasound).

Management of Acute Pancreatitis

  • Pain Management:

    • Parenteral opioids to treat severe pain, combining with NSAIDs for effective relief.

    • Antiemetics for nausea.

  • Fluid and Electrolyte Management:

    • Common disturbances; monitor fluid intake/output and daily weights.

  • Monitoring for Complications:

    • Early alertness for complications such as AKI, MODS, and hypotension.

Post-Operative Management of Acute Pancreatitis

  • Diet:

    • Gradual introductions of low-fat and high-protein feeds; caffeine and alcohol eliminated.

    • Regular follow-up with imaging studies to assess pancreatitis resolution or complications.

    • Manage hydration and electrolyte status postoperatively.

  • Surgical Interventions:

    • Biliary drain placement and surgical debridement may be necessary; manage drainage and maintain nutritional support.

Chronic Pancreatitis Overview

  • Pathology:

    • Progressive pancreatic tissue destruction replaced by fibrous tissue; leads to duct blockage and loss of secretory function.

  • Risk Factors:

    • Alcohol use, malnutrition, smoking, resulting in pancreatic damage.

Chronic Pancreatitis Clinical Features

  • Symptoms:

    • Recurring severe abdominal pain, significant weight loss from appetite issues and poor digestion. Weight loss over 80% common.

    • May also cause steatorrhea due to fat malabsorption.

Chronic Pancreatitis Diagnostic Findings

  • Initial Tests:

    • CT scan showing duct anomalies or calcifications, glucose tolerance test indicating diabetes risk, and ERCP for further evaluation.

Management of Chronic Pancreatitis

  • Medical Management:

    • Targets cause-specific treatment of acute attacks and managing pain; involves pancreatic enzyme replacement, dietary modifications, and possible surgery if needed.

  • Surgical Management:

    • Rare but includes Cholecystectomy for gallbladder-related issues and Roux-en-Y for drainage improvement.

Cancer of the Pancreas Overview

  • Etiology:

    • Environmental toxins, dietary factors, smoking, diabetes, chronic pancreatitis, etc. Risk of metastasis from other tumors also present.

Symptoms of Pancreatic Cancer

  • Presentation:

    • Pain, jaundice, and significant weight loss are common in over 80% of cases. Pain may worsen at night and when reclining.

Diagnostic Procedures for Pancreatic Cancer

  • Tests:

    • Spiral CT, MRI, ERCP, possibly PTC or angiography for assessing for obstructions and tumor removal possibilities.

Management of Pancreatic Cancer

  • Supportive Care:

    • Emphasis on pain management, nutritional support, skin care, and psychosocial support, especially during critical recovery phases post-surgery.

Nursing Interventions and Management Summary

  • Key Points:

    • Monitor vital signs, nutritional status, and any changes in abdominal pain or jaundice.

    • Provide education on avoidance of alcohol, dietary modifications, and chronic disease management.

Questions for Review

  1. Most indicative lab finding in acute pancreatitis?

    • A. Elevated serum amylase and lipase

  2. Appropriate intervention for upper abdominal pain in acute pancreatitis?

    • B. Provide analgesics and position leaning forward

  3. Symptom indicating chronic rather than acute pancreatitis?

    • B. Recurrent or persistent abdominal pain

  4. Risk factors for pancreatic cancer include?

    • A. Chronic pancreatitis, B. Cigarette smoking, C. Obesity, E. Advanced age and family history