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DISCUSSION # 1 Reply to Reesha 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
·
Differential Diagnosis
. Pancreatic Cancer
2. Cholelithiasis
3. Peptic Ulcer Disease
Patient and Family Teaching
· Eating small, frequent low-fat meals
· A low-fat diet with high protein and carbohydrates is recommended for patients with steatorrhea
· Fat intake should be less than 20g/day or less
· Oral supplementation of fat-soluble vitamins
· Replacement of fat-soluble vitamins and pancreatic enzymes
· Cut out all consumption of alcohol and all forms of tobacco
· Patients who continue to drink alcohol, have a death rate 3 times higher than those who do not drink alcohol
