PANCREATITIS
o What is it?
▪ Inflammation of the pancreas
• Enzymes that usually go down duct to the stomach to digest food
turns on early and starts digesting the organ/vessels in the organ
instead
• Exocrine function: release digestive enzymes; endocrine: produce
insulin
o Causes
▪ Gall bladder disease
▪ Alcoholism
▪ Smoking
o Risk factors
▪ Middle aged
▪ Men
o S/S
▪ Severe belly pain that may spread to your back or chest (it may feel
worse after you eat)
▪ Nausea
▪ Vomiting
▪ Rapid heart rate
▪ Fever
, ▪ Swelling and feeling sore or tender in your upper belly
▪ Fluid buildup in your belly
▪ Lowered blood pressure
▪ Yellowing of the skin and eyes (jaundice)
o Diagnostics
▪ Serum amylase elevated (0-130)
▪ Serum Lipase elevated (0-160)-most specific
▪ Urinary Amylase (24 hr) elevated
▪ Random blood glucose elevated (Pancreas can’t make the insulin
needed)
▪ Serum Ca (critically low) (9-11) –fatty acids combine with calcium during
fat necrosis
• Monitor calcium
o Diet
▪ Bland, low fat, high carb, high protein
▪ Pancreatic enzyme replacement
▪ Elimination of alcohol
▪ No caffeine
▪ TPN while NPO
• Monitor glucose q6h
o Treatment
▪ Strict NPO to reduce pancreatic secretion
▪ NGT to decrease stimulation of enzymes
▪ H2 blockers/ PPIs/ antacids
▪ Aggressive hydration with LR or volume expanders (Dextran, albumin)
▪ Dopamine to increase BP if fluids aren’t working
▪ Morphine Sulfate + antispasmodic for pain
o Nursing Care
, ▪ Monitor for signs of hypocalcemia
• Chvostek or Trousseau signs: Assess for Chvostek by flicking cheek–
positive Chvostek (cheek tremors)
• Signs of hypocalcemia incl. weakness, dysphagia, tingling around
the mouth
▪ Assess for fever—high infection risk
▪ IV fluids
▪ Assess resp fxn (risk for ARDS)
o Complications
▪ Pulmonary: pleural effusion, atelectasis, pneumonia which are all caused
by enzyme induced inflammation from the passage through
transdiaphragmatic lymph channels. Pt can develop ARDS
▪ CV: Hypotension & shock due to hemorrhages into pancreas or activated
enzymes forming kinins which cause vasodilation, increased capillary
permeability, & decreased vascular tone
▪ Neuro: Tetany due to hypocalcemia-tetany is vasoconstriction of smooth
muscle
• Monitor breathing/airways
TRAU MA, TRI AGE, EMERGENC Y CARE
o Triage Classification system
▪ Emergent
• ESI 1 & 2; Life, limb, eye threatened
• Unstable vitals
o What is it?
▪ Inflammation of the pancreas
• Enzymes that usually go down duct to the stomach to digest food
turns on early and starts digesting the organ/vessels in the organ
instead
• Exocrine function: release digestive enzymes; endocrine: produce
insulin
o Causes
▪ Gall bladder disease
▪ Alcoholism
▪ Smoking
o Risk factors
▪ Middle aged
▪ Men
o S/S
▪ Severe belly pain that may spread to your back or chest (it may feel
worse after you eat)
▪ Nausea
▪ Vomiting
▪ Rapid heart rate
▪ Fever
, ▪ Swelling and feeling sore or tender in your upper belly
▪ Fluid buildup in your belly
▪ Lowered blood pressure
▪ Yellowing of the skin and eyes (jaundice)
o Diagnostics
▪ Serum amylase elevated (0-130)
▪ Serum Lipase elevated (0-160)-most specific
▪ Urinary Amylase (24 hr) elevated
▪ Random blood glucose elevated (Pancreas can’t make the insulin
needed)
▪ Serum Ca (critically low) (9-11) –fatty acids combine with calcium during
fat necrosis
• Monitor calcium
o Diet
▪ Bland, low fat, high carb, high protein
▪ Pancreatic enzyme replacement
▪ Elimination of alcohol
▪ No caffeine
▪ TPN while NPO
• Monitor glucose q6h
o Treatment
▪ Strict NPO to reduce pancreatic secretion
▪ NGT to decrease stimulation of enzymes
▪ H2 blockers/ PPIs/ antacids
▪ Aggressive hydration with LR or volume expanders (Dextran, albumin)
▪ Dopamine to increase BP if fluids aren’t working
▪ Morphine Sulfate + antispasmodic for pain
o Nursing Care
, ▪ Monitor for signs of hypocalcemia
• Chvostek or Trousseau signs: Assess for Chvostek by flicking cheek–
positive Chvostek (cheek tremors)
• Signs of hypocalcemia incl. weakness, dysphagia, tingling around
the mouth
▪ Assess for fever—high infection risk
▪ IV fluids
▪ Assess resp fxn (risk for ARDS)
o Complications
▪ Pulmonary: pleural effusion, atelectasis, pneumonia which are all caused
by enzyme induced inflammation from the passage through
transdiaphragmatic lymph channels. Pt can develop ARDS
▪ CV: Hypotension & shock due to hemorrhages into pancreas or activated
enzymes forming kinins which cause vasodilation, increased capillary
permeability, & decreased vascular tone
▪ Neuro: Tetany due to hypocalcemia-tetany is vasoconstriction of smooth
muscle
• Monitor breathing/airways
TRAU MA, TRI AGE, EMERGENC Y CARE
o Triage Classification system
▪ Emergent
• ESI 1 & 2; Life, limb, eye threatened
• Unstable vitals
