pancreatitis and pancreatic cancer

2. DISORDERS OF
PANCREAS
PRESENTOR-
Ms. Anshu
M.Sc nursing
KGMU Institute of Nursing

3. INTRODUCTION-
A client with a pancreatic disorder may have
problems with both digestion and utilization of
glucose.
The relative inaccessibility of the pancreas to the
direct examination and the non specificity of
manifestation associate with pancreatic disorder
make the diagnosis of some conditions difficult.
In addition, more than 90% of the pancreas got
damaged before fat and protein digestion problems
become apparent.

4. Pancreas includes following
disorders:-
Acute pancreatitis
Chronic pancreatitis
Pancreatic cysts
Cancer of pancreas

5. ACUTE PANCREATITIS
Acute pancreatitis, an
inflammation of the pancreas
resulting in auto digestion of the
pancreas by its own enzymes.

7. EPIDEMIOLOGY
 The incidence of pancreatitis varies in
different countries and depends on the
causes(e.g., alcohol, gallstone, metabolic
factors, drugs).
 In united states and Asian countries acute
pancreatitis is related to alcohol
consumption.

9. ANATOMY OF PANCREAS
 In adults it is about 6
inches long but
 less than 2 inches
wide. The head of
the pancreas is on
the right side of the
abdomen
 (belly), behind
where the stomach
meets the
duodenum

10. PHYSIOLOGY OF PANCREAS
 Function of the
pancreas is to
release proteolytic
enzymes that assist
in the breaking down
food products so that
nutrients can be
absorbed.

12. Acute Pancreatitis
Etiology and Pathophysiology
Pancreatic ductPancreatic duct
become obstructedbecome obstructed
Hypersecretion of the exocrineHypersecretion of the exocrine
enzymes of pancreasenzymes of pancreas
These enzymes enter the bile duct,These enzymes enter the bile duct,
where they are activated and withwhere they are activated and with
bile back up into the pancreatic ductbile back up into the pancreatic duct
Pancreatitis

13. Acute Pancreatitis
Etiology and Pathophysiology
 Trypsinogen- (a proteolytic enzyme)
 Normally released into the small
intestine, where it is activated to trypsin
 In AP, activated to trypsin in the
pancreas causing autodigestion of
pancreas

14. Progression of Disease
 Autodigestion
Acute Inflammation of Pancreas
Necrosis of Pancreas
Digestion of vascular walls
Thrombus and Hemorrhage
Death

15. Precipitating Factors
 Trauma
 Use of alcohol *
 Biliary tract disease
 Viral or Bacterial disease
 Cholelithiasis *
 Peptic Ulcer Disease
*most common causes

16. Acute Pancreatitis
Clinical Manifestations
 Severe Abdominal painAbdominal pain is predominant
symptom
 Pain located in LUQ and mid-epigastrium
 Commonly radiates to the back
 Sudden onset
 Severe, deep, piercing, steady
 Aggravated by fatty meal or lying recumbent
position
 Not relieved by vomiting

17. Acute Pancreatitis
Clinical Manifestations
 Cyanosis, Dyspnea
 Bowel sounds decreased or absent
 Low-grade fever, Leukocytosis
 Hypotension, Tachycardia
 Jaundice
 Flushing
 Abnormal lung sounds - Crackles
 Discoloration of abdominal wall – Turner’s or
Cullen’s sign
 SIGNS OF SHOCK

21. Acute Pancreatitis
Diagnostic Studies
 History and physical examination
 Laboratory tests
 Serum amylase- hallmark test
 Serum lipase – also elevated
 Blood glucose
 Serum calcium
 Triglycerides

22. Acute Pancreatitis
Diagnostic Studies
 Abdominal/endoscopic ultrasound
 Endoscopic retrograde
cholangiopancreatography (ERCP)
 Chest x-ray
 CT of pancreas
 Magnetic resonance
cholangiopancreatography (MRCP)

24. Acute Pancreatitis
Can be a medical emergency
associated with a risk for life-
threatening complications

26. Acute Pancreatitis
Complications
 Two significant local complications
 Pseudocyst
 Abscess

27. Acute Pancreatitis
Complications
 Pseudocyst
 Cavity surrounding outside of pancreas
filled with necrotic products and liquid
secretions
 Abdominal pain
 Palpable epigastric mass
 Nausea, vomiting, and anorexia
 Elevated serum amylase

29. Acute Pancreatitis
Complications
 Pancreatic abscess
 A large fluid-containing cavity within pancreas
 Results from extensive necrosis
 Upper abdominal pain
 Abdominal mass
 High fever
 Leukocytosis

30. Acute Pancreatitis
Complications
 Main systemic complications are?

PulmonaryPulmonary

CardiovascularCardiovascular

Electrolyte imbalance – HypocalcemiaElectrolyte imbalance – Hypocalcemia

31. MEDICAL MANAGEMENT
Goals of Care
 Relief of pain
 Prevention or alleviation of shock
 Decrease respiratory failure
 ↓ of pancreatic secretions
 Maintain Fluid/electrolyte balance

32. MEDICAL MANAGEMENT
1. Pain management

IV morphine or Dilaudid

Antispasmodic agent
 Bentyl
 Pro-Banthine

Spasmolytics – Nitroglycerine

Antihistamine- pantaprazole or rantac

Positioning – sitting up and side lateral

33. Treatment
2. Prevention of Shock – hemodynamic
stability
* Administer Blood, Plasma expanders,
Albumin
* LR solution

34. What is the cause of
shock?

35. Treatment and Nursing Care
3. Suppress pancreatic enzymes
* NPO
* NG suction
* Antacids, H2 receptor antagonists, antispasmotics
4. Decrease respiratory distress
* Oxygen; check O2 saturation levels
* Semi-fowlers position, knees flexed, position
changes
* incentive spirometer
5. Antibiotics

36. Treatment and Nursing Care
 6. Correction of electrolyte imbalance/
hypocalcemia
 7. Maintain Hydration / Nutrition

37. SURGICAL MANAGEMENT
 Surgical therapy – if
related to gallstones
 ERCP
 Endoscopic
sphincterotomy
 Laparoscopic
cholecystectomy
 Debridement of
necrotic tissues

38. CHRONIC PANCREATITIS
 DEFINITION-
Chronic pancreatitis is a
progressive, inflammatory,
destructive disease of the
pancreas most often caused by
alcoholism.

39. PATHOPHYSIOLOGY

40. CLINICAL MANIFESTATONS
 abdominal pain:
 may be continuous, intermittent or absent

LUQ of the back

Diffuse throughout upper abdomen

May be referred to the anterior chest or
flank
 Weight loss
 Pancreatic calcification
 Diabetes mellitus
 steatorrhea

42. MEDICAL MANAGEMENT
GOALS-
 Relieve pain
 Treat endocrine insufficiency
 Treat exocrine insufficiency

43. SURGICAL MANAGEMENT
GOALS-
o Alleviate pain
o Correction of bilary tract disease
o Relieve ductal obstruction

44. NURSING MANAGEMENT
Assessment
 Assess for the pain, GI problems.
 Assess respiratory status of patient.
 Assess for the emotional and psychological
status.

45. Nursing diagnosis-
 Acute pain related to inflammation, edema,
distension of pancrease, and peritoneal
irritation.
 Ineffective breathing pattern related to
severe pain, pulmonary infiltrates, pleural
effusion, atelectasis, elevated diaphragm

46.  Imbalanced nutrition, less than bodies
requirements, related to reduced food
intake and increased metabolic demands.
 Impaired skin integrity related to poor
nutritional status, bed rest, and surgical
wound.

47. Expected outcomes
 The major goal of the patient include the
relief of pain and discomfort, improved
respiratory function, improved nutritional
status, maintenance of skin integrity and
absence of complication

48. 1. Relieving pain and discomfort
 Give comfortable position
 Withhold oral feeds to decrease the
formation and secretion of pancreatic
enzymes
 Do NG suctioning to relieve abdominal
distension.
 Give analgesics as told by physician.

49. 2. Impaired breathing pattern
 Give proper position
 Frequently change the position
 Deep breathing and coughing
 Maintain spO2
 O2 therapy

50.  NPO status initially to reduce pancreatic
secretion
 As pancreatitis resolves, small, frequent
feedings
 High-carb, low-fat, high-protein diet
 Bland diet
 No alcohol or caffeine (stimulants)
 Supplemental fat-soluble vitamins
 Supplemental commercial liquid
preparations- TPN
3. Nutrition improvement

51. PANCREATIC CANCER

52.  DEFINITION-
 Pancreatic cancer begins when cells in the
pancreas start to grow uncontrollably.

53. EPIDEMIOLOGY

54. Modifiable Risk factors
 Tobacco use
 Overweight and obesity-Carrying extra
weight around the waistline
 Workplace exposure to certain chemicals-
chemicals used in the dry cleaning and
metal working industries.

55. Non modifiable Risk factors
 Age- more than 45 yrs
 Gender- male>female
 Race- african american>whites
 Family history
 Diabetes
 Chronic pancreatitis

58. Diagnostic testing
 Medical history and physical exam
• Ultrasound
• CT scan
– Show pancreatic mass, dilatation of the
biliary system or pancreatic duct, distal
spread to the liver, regional lymph nodes
or peritoneum
– CA 19-9

59. • ERCP
– Stricture or obstruction, obtain brushings
of a stricture for cytology or for placing
stents
• Endoscopic Ultrasound
– Small lesions (<2-3cm), local staging
• MRCP
– Defines anatomy of the pancreatic duct
and biliary tree

60. TREATMENT
Surgery
 · Ablation or embolization treatments
 · Radiation therapy
 · Chemotherapy and other drugs

66. • Symptomatic management
• Advanced Pancreatic Cancer
• With metastatic or locally advanced
inoperable disease and are the
majority with newly diagnosed disease
– Endoscopic biliary or duodenal stenting
– Intestinal bypass surgery
– Deoxycytidine analogue Gemcitabine

67.  Operable Disease
 Complete surgical resection (Stage I or II)
with distant metastases excluded by
prior CT is potentially curative
 Lymph node-negative disease, smaller
tumors (<3cm) negative resection
margins and well-differentiated tumors
 Surgery preceded by laparoscopy

To exclude peritoneal metastases

68.  Follow up care
 Dietary teaching

High-carbohydrate, low-fat diet

Abstinence from alcohol and
caffeine
 Patient/family teaching
* Signs of infection, high blood
glucose, steatorrhea
Discharge teaching -
Home Care

71. EVALUATION
Q1. What is collen’s sign?
A) discolouration of nail bed
B) discolouration of lips
C) discolouration of abdominal wall
D) discolouration of periphery
Ans.- c)

72. Q2. Location of pain in pancreatitis?
A. RUQ and epigastric
B. LUQ and epigastric
C. RLQ and hypogastric
D. LLQ and hypogastric
Ans.- b)