An inflammatory process affecting the Pancreas with varying degrees of pancreatic edema, fat necrosis, or hemorrhaging. Due to this, proteolytic and lipolytic pancreatic enzymes become activated in the Pancreas rather than the duodenum, which leads to tissue damage and autodigestion of the pancreas. This most occurs in the middle-aged, and may be caused by:
- Alcoholism and alcohol abuse
- Biliary Tract Disease/Obstruction
- Trauma, viral infection, PUD, abscesses
- Drug use (antihypertensives, steroids, thiazide diuretics, antimicrobials, immunosuppresives, oral contraceptives)
- Metabolic Disorders (hyperparathyroidism, hyperlipidemia)
- Idiopathic/Autoimmune
Assessment Findings
- Pain in the LUQ radiating to the back, flank, or substernal areas accompanied by DOB. Aggravated by eating.
- Nausea and Vomiting, decreased or absent bowel sounds
- Abdominal tenderness and guarding
- Grey Turner’s Spots (ecchymoses on flanks)
- Cullen’s Sign (ecchymoses of periumbilical area)
- Tachycardia
Diagnostic Examination
- Increased serum amylase (>300 somogyi units) and urinary amyllase
- Increased blood sugar and lipid levels
- Decreased serum calcium
- CT Scan: enlarged pancreas
Nursing Interventions
- Administer analgesics, antacids, and anticholinergics as ordered. Monitor for adverse effects.
- NPO, eliminate stimuli to prevent pancreatic excitation.
- NGT, assess for drainage
- Non-pharmacologic pain relief: positioning (knee-chest, fetal), relaxation techniques and a relaxing environment.
Discharge Planning and Education
- Dietary regimen once oral intake resumes:
- High CHO, High CHON (promote healing), and Low Fat (due to impaired fat metabolism)
- Eat small, frequent meals.
- Avoid caffeine and alcohol.
- Remain in a relaxed setting and mindset after meals.
- Reporting Complications or Recurrence
- Continued nausea and vomiting.
- Abdominal distention with increasing fullness.
- Persistent weight loss: instruct patient to regularly monitor weight.
- Severe epigastric or back pain
- Frothy/foul-smelling bowel movements.
- Irritability, confusion, persistent elevation of temperature for two days.
Medical Management
- NPO to promote GIT rest
- Peritoneal Lavage
- Dialysis for severe condition
Pharmacologic Management
- Analgesia (Morphine); Demerol is not used due to cerebrotoxicity.
- Smooth muscle relaxants (Papaverine, Nitroglycerin) also for pain.
- Anticholinergics: decreases pancreatic stimulation
- Atropine, Propantheline Bromide
- Antacids: decreases pancreatic stimulation
- H2 antagonists, vasodilators, calcium gluconate