4 Nursing Diagnosis for Pancreatitis

Pancreatitis

Definition

Pancreatitis is a painful inflammatory condition in which pancreatic enzymes are activated prematurely resulting in autodigestion of the pancreas. (Doengoes, 2000;558)

Acute pancreatitis is inflammation of the pancreas that usually results from alcoholism and bile duct diseases such as cholelithiasis and cholecystitis. (Sandra M. Nettina, 2001)

Classification

Based on The Second International Symposium on the Classification of Pancreatitis (Marseilles, 1980), pancreatitis is divided into:

Acute pancreatitis (pancreatic function returns to normal again).
Chronic pancreatitis (remains of permanent damage).

Etiology/Causes

1. Alcohol

Alcohol increases the protein concentration in pancreatic juice and causes deposits which are the core for calcification which then causes higher intraductal pressure.

2. Gallstones

In one-third to two-thirds of patients, pancreatitis is accompanied by the presence of gallstones that are thought to have caused trauma during passage of the stone, or caused obstruction.

3. Drugs

A number of drugs have been implicated in the development of acute pancreatitis but none have been shown to cause this disease.

4. Infection

Viral infections have been associated with acute pancreatitis, particularly mumps and sackie infections, transient elevations of serum amylase are not uncommon.

5. Trauma

Accidental trauma is an important mechanical cause of pancreatitis (especially blunt abdominal trauma). Major trauma is also a significant cause of acute inflammation and pancreatitis following procedures on the stomach and bile ducts in a small percentage of cases. Usually the injury is not visible at the time of surgery and may result from blunt or sharp trauma.

Signs and Symptoms

1. Abdominal pain occurs due to irritation and edema of the inflamed pancreas causing stimulation of nerve endings. Increased pressure on the pancreatic capsule and obstruction of the pancreatic duct also contribute to pain.

2. The patient appears to be in severe pain, the muscular defenses are palpable in the abdomen. A stiff or plank-like stomach can occur and is a fatal sign. However, the abdomen may remain tender if peritonitis does not occur. Ecchymosis (bruising) in the waist area and around the umbilicus is a sign that indicates the presence of severe hemorrhagic pancreatitis.

3. Nausea and vomiting are common in acute pancreatitis. Vomiting usually comes from the stomach contents but can also contain bile. Symptoms of fever, jaundice, confusion and agitation may occur.

4. Hypotension that occurs is characteristic and reflects the state of hypovolemia and shock caused by the loss of large amounts of protein-rich fluid, because this fluid flows into the tissues and peritoneal cavity. Patients may experience tachycardia, cyanosis and cold, wet skin in addition to symptoms of hypotension. Acute renal failure is common in this situation.

5. Respiratory distress and hypoxia are common, and patients may present with diffuse pulmonary infiltration, dyspnoea, tachypnoea and abnormal blood gas results. Myocardial depression, hypocalcemia, hyperglycemia and disseminated intravascular coagulopathy can also occur in acute pancreatitis (Brunner & Suddart, 2001:1339)