What is Pancreatitis?

Pancreatitis refers to the inflammation of the pancreas, an organ in the stomach that produces digestive enzymes and hormones that regulate the body’s glucose processing. Pancreatitis could be either chronic or acute in nature. It can cause severe abdominal pain, vomiting, and nausea, among other symptoms and cause serious complications if not treated on time. When Pancreatitis is associated with haemorrhage and necrosis, the mortality rate may rise to 60%.

The range of Pancreatitis is from mild to a severe disorder that is not responsive to treatment. Thus: Pancreatitis is a severe pancreas disorder, and, in most cases, it is referred to as pancreas self-digest. In this case, the condition poses life-threatening complications, which can lead to a medical emergency.

Classification of Pancreatitis

The classification of Pancreatitis is based on the duration and causes of the inflammation. Thus, according to the classification system, Pancreatitis can be Acute or Chronic.

• Acute Pancreatitis is a sudden onset of inflammation that occurs when the pancreas is trying to recover from a short-term minor injury. Acute Pancreatitis patient recovers entirely in a few days when given supportive care such as hydration, rest and pain relief.
• Chronic Pancreatitis is a progressive, long-term condition that permanently damages body organs and their functions.

Pathophysiology of Pancreatitis

• Entrapment: Gallstone (solidified deposits of bile) form in the bile duct or gallbladder and enters the common bile duct that carries bile to the duodenum and gets lodged at the hepatopancreatic ampulla.
• Obstruction: Cholelithiasis deposited at the hepatopancreatic of the ampulla causes blockage of the central pancreatic duct and the common bile duct. Therefore, the blockage causes reflux of bile to the pancreas, causing inflammation and damage to the pancreas.
• Activation: The activation of the pancreas’s powerful enzymes occurs in the small intestine. However, when the pancreatic duct is obstructed, like gallstones or entrapment, the digestive enzymes become trapped in the pancreas. In this case, the enzymes start to digest the pancreas, causing damage and inflammation.
• Inactivity: The enzymes are inactive until the pancreatic secretions are deposited in the small intestine’s lumen.
• Enzyme activities: When the enzymes are activated in the pancreas, they may cause vasodilation, erosion, haemorrhage, necrosis and increased vascular permeability.
• Reflux: The activated digestive enzymes and bile in the pancreatic duct causes pain, tissue damage or inflammation, leading to Pancreatitis.

Pancreatitis Statistics and Epidemiology

Pancreatitis disease is common in all ages; however, the risk of mortality due to Pancreatitis increases with age. Older people are more vulnerable to pancreatitis complications such as organ failure and infections.

Around 185,000 Pancreatitis-related cases are recorded annually in the US, and about 150,000 are caused by alcohol abuse or cholelithiasis. The mortality rate due to Pancreatitis is about 2% to 10%, with a frequency of about 5000 new cases annually. The actual number of acute or Chronic cases is unknown. The instances of Pancreatitis differ from country to country, and alcohol is the most common cause in the United States,s while gallstones are common in England.

Causes of Pancreatitis

Pancreatitis usually originates from pancreas self-digesting. The causes include:

• Duodenitis
• Certain medications
• Excess alcoholism
• Viral and bacterial infection
• Gallstones
• Genetic disorders of the pancreas.

Clinical Manifestation of Pancreatitis

The followings Pancreatitis signs and symptoms:

• Pain abdominal
• Ecchymosis
• Tender and swollen abdomen
• Abdominal pain
• Oily stool
• Weight loss
• Nausea and vomiting
• Hypotension
• Dehydration
• Weakness and fatigue
• Fever
• Rapid pulse

Complications caused by Pancreatitis

The are various complications that arise as a result of Pancreatitis, like Pancreatic necrosis, which is the cause of mortality and morbidity among Pancreatitis patients. Another difficulty is fluid and electrolyte disturbances such as voting, fever, diaphoresis and nausea. In addition, multiple organ failure is most common in older people, such as kidney, lungs and heart. Lastly, chronic Pancreatitis increases the chances of developing Pancreatic cancer.  

Pancreatitis Diagnostic and Assessment Findings

Pancreatitis analysis is based on known risk factors, frequency of abdominal pain, diagnostic findings and physical examination.

• WBC count: The White Blood Cells are usually increased
• CBC: 80% of the patients have about 10,000 to 25,000 white blood cells.
• X-ray studies: The chest and Abdominal x-rays can help to differentiate between Pancreatitis from other diseases manifesting similar symptoms.
• Urinalysis: May contain blood, glucose, protein and myoglobin
• Ultrasound: Ultrasound helps in determining the size of the increased pancreas diameter.
• Serum glucose: Increases of transient above 200mg/dl are typical in acute attacks.
• Serum amylase and lipase levels:
• CT scan: Determines edema and necrosis and shows an enlarged pancreatic cyst and pancreas.
• Stool: The presence of fat content shows insufficient digestion of proteins and fats.
• Triglycerides: Triglycerides levels that are beyond 1700 mg/dl.
• Upper GI series: mainly shows the presence of inflammation.
• Potassium: Gastric loss may cause hypokalemia.
• Endoscopic retrograde cholangiopancreatography: Aids in diagnosing bile duct obstruction, fistulas, and pancreatic duct anomalies.
• Ultrasound of abdomen: Helps to identify necrosis, carcinoma, pancreatic inflation, obstruction of biliary tract and pseudocysts.
• LDH/AST: May increase 15 times due to the liver and biliary involvement.
• CT–guided needle aspiration: Helps determine the presence of Pancreatitis.
• Blood studies: The levels of hematocrit and haemoglobin help monitor a patient’s bleeding.
• Serum bilirubin: Elevation Serum bilirubin is commonly caused by alcoholic liver disease.
• Serum calcium: Hypokalemia manifests 2-3 days after the onset of Pancreatitis.

Medical Management of Pancreatitis

Pancreatitis management practices are aimed at treating, preventing or relieving symptoms. For instance, pain management is essential in providing adequate relief and reducing restlessness, which leads to additional pancreatic secretion stimulation. Intensive care focused on correcting blood, low albumin level, and fluid loss is critical in maintaining the fluid level and preventing kidney failure. In addition, breathing treatment is required to prevent the high risk of diaphragm elevation, atelectasis, effusion and pulmonary infiltrates. Lastly, biliary drainage helps to restore pancreas drainage.

Surgical Management of Pancreatitis

Various surgical approaches can be used in the surgical management of Pancreatitis. The first approach is Roux-en-Y Pancreaticojejunostomy performed in the presence of pancreatic duct dilation with calculi and septa with a 60% to 90% success rate. The second approach is Distal Pancreaticojejunostomy, recommended for uncommon proximal pancreatic ductal stenosis that does not involve the ampulla. The third approach is Pancreatic surgery which may involve postoperative drains and an open surgical incision for repacking and irrigation after every two to three days to remove dead tissue. The last approach is pancreaticoduodenal (right-sided) resection (ablative) significant for alterations in the pancreatic heads.

Nursing Management of Pancreatitis

The patient admitted to a healthcare facility with a pancreatitis diagnosis is promptly sick and requires special nursing attention.

Nursing Assessment of Pancreatitis

Nursing assessment of Pancreatitis patients may include:

• Evaluation of Electrolyte loss and source of fluid.
• Assessment of abdomen for fluid build-up.
• Evaluation of electrolyte and fluid balance.
• Examination of Respiratory status.
• Evaluation of heightened metabolic requirement and current nutritional status.

Pancreatitis Diagnosis

The nursing diagnosis of Pancreatitis based on the assessment includes:

• Nutrition imbalance.
• Acute pain-associated swelling.
• Swelling of the pancreas.
• Peritoneal discomfort.
• Respiratory problems.
• Minimized pancreatic secretions.
• Heightened dietary needs.

Pancreatitis Planning and Goals

The plans and goals that are generated for the pancreatitis patient aim at the following:

• Enhance the nutritional status of the patient.
• Improving respiratory performance.
• Alleviate the patient’s pain and discomfort.
• Balance electrolytes and fluid status.

Nursing intervention for Pancreatitis patients

Practical and expert nursing care is vital for Pancreatitis patients.

• Improving respiratory pattern: The nurse must ensure the patient is in a semi-recumbent position and frequently changing posture.
• Protecting skin integrity: The nurse is responsible for dressing the wound as directed and taking necessary measures to ensure intact skin is protected from drainage.
• Enhancing nutritional status: The patient is provided with a low-fat diet, high carbohydrates, and low protein during acute attacks.
• Relieving pain and discomfort: Parenteral opioids like fentanyl, hydromorphone or morphine via bolus are recommended for pain management for pancreatitis patients.

Evaluation of successful Plan

Evaluation of a successful pancreatitis patient care plan should include the following:

• Enhanced dietary intake.
• Enhanced breathing status.
• Enhanced electrolytes and fluid status.
• Relieved pain and discomfort
• Home care and discharge instruction.

More time is needed for the pancreatitis patient to regain strength and return to normal activities.

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• Home care: The nurse should assess the psychological and physical status of the patient and adhere to the therapeutic regimen.
• Teaching: The pancreatitis patient needs to be taught repeatedly because they might have challenges recalling several instructions and explanations provided.
• Identification of complications: Written and verbal guidelines about signs and symptoms of Pancreatitis that the patient should report to the doctor are vital.
• Prevention: The necessary information on the implications of the beginning of Pancreatitis and the importance of avoiding alcohol, heavy meal and high-fat food.

Documentation

The nursing documentation about pancreatitis patients includes the following:

• Prior medication.
• Use of respiratory supports
• Laboratory values.
• Caloric intake
• Patient’s description of the acceptable level of pain and response to pain.
• Breath sound, use of accessory muscle and respiratory patterns.
• Patient’s religious and cultural restrictions and preferences.
• Long-term needs
• Progress or attainment towards the desired outcome.
• Modification to the care plan
• Care Plan
• Response to teaching, intervention and actions performed.
• Teaching plan