Acute and Chronic Pancreatitis

  Acute Pancreatitis • Acute condition of diffuse pancreatic inflammation & autodigestion, presents with abdominal pain, and is usually associated with raised pancreatic enzyme levels in the blood & urine. • Reversible inflammation of the pancreas • Ranges from mild to severe Differentia Diagnosis: • Perforated bowel • Acute cholecystitis • Acute intestinal obstruction • Signs & Symptoms of Acute • Upper Abdominal pain, sudden onset, sharp, severe, continuous, radiates to the back, reduced by leaning forward. Generalized abdominal pain, radiates to the shoulder tips. Patient lies very still. • Nausea, non-projectile vomiting, retching • Anorexia • Fever, weakness • Distressed, moving continuously, or sitting still • Pale, diaphoretic. Confusion • Low grade fever • Tachycardia, Tachypnea • Shallow breathing • Hypotension • Mild icterus • Abdominal distension (Ileus, Ascites) • Grey Turner's sign, Cullen's sign, Fox's sign • Rebound tenderness, Rigidity • Shifting dullness, reduced bowel sounds • Treatment Modalities • Aggressive supportive care • Decrease inflammation • Limit superinfection • Identify and treat complications (of pancreatitis & its treatment) • Treat cause if possible • Give analgesics (IM pethidine). • Give antiemetics. • Keep the patient NPO (until pain free/2-3 days). • NGT insertion to relieve vomiting   Patient and/or Family Teaching and Information ▪ Explain what pancreatitis is and its causes ▪ What are the signs and symptoms ▪ Explain how acute pancreatitis is treated ▪ Lifestyle modifications ● Chronic pancreatitis is a progressive inflammatory disorder that leads to irreversible destruction of exocrine and endocrine pancreatic parenchyma caused by atrophy and/ or replacement with fibrotic tissue. ● Alcohol consumption, nicotine habits, nutrition, hereditary, well characterized mutations, ductal obstruction and autoimmune factors can contribute to the diagnosis of CP (Brock, et, al., 2013). ● Functional consequences include: ○ severe abdominal pain ○ diabetes mellitus ○ malabsorption Chronic pancreatitis ● Chronic pancreatitis is a progressive inflammatory disorder that leads to irreversible destruction of exocrine and endocrine pancreatic parenchyma caused by atrophy and/ or replacement with fibrotic tissue. ● Alcohol consumption, nicotine habits, nutrition, hereditary, well characterized mutations, ductal obstruction and autoimmune factors can contribute to the diagnosis of CP (Brock, et, al., 2013). ● Functional consequences include: ○ severe abdominal pain ○ diabetes mellitus ○ malabsorption ● The pancreas is an accessory organ that functions in the endocrine and exocrine systems ● Responsible for hydrolysis of proteins, carbohydrates, and fats ● The pancreas has a main pancreatic duct running through the length of it, an accessory duct, and many various cell types. ○ The ducts can become blocked, or they can be genetically deformed ● During constant inflammation, scarring and fibrosis of the ducts lead to permanent damage to many structures, impairing its secretory functions. Treatment Methodologies ● Goal of treatment is to decrease abdomen pain and malabsorption ● Enzyme replacement treatment and dietary modification ● Non-opioid regimens should be utilized (TCA, NSAIDs, pregabalin) ● New studies show some benefit of using medium-chain triglycerides (Benjamin & Lappin, 2022). ● During breakthrough uncontrollable pain hospitalization may be necessary ● Decompression surgery can be considered in those with intractable pain who have failed medical therapy