6 Pancreatitis
Learn how acute and chronic pancreatitis are recognized and managed, including diagnostic criteria, supportive care, complications, and nursing priorities.
Types and causes
Pancreatitis is inflammation of the pancreas. begins suddenly and may resolve. involves persistent or recurrent inflammation and can lead to permanent structural damage and loss of digestive and endocrine function.
Gallstones and alcohol are common causes of . Other causes include very high triglycerides, medications, and other biliary or metabolic problems. Repeated acute attacks and ongoing alcohol or tobacco use can contribute to chronic disease.
Recognizing
Typical causes persistent upper abdominal or epigastric pain, often radiating to the back, with nausea and vomiting. Diagnosis generally requires two of three findings: characteristic pain, serum or amylase at least times the upper limit of normal, or characteristic imaging findings. is generally preferred. A combination of characteristic pain and a qualifying enzyme elevation can meet the diagnostic criteria without imaging; an enzyme level alone does not determine disease severity.
For example, characteristic epigastric pain radiating to the back with a level times the upper limit of normal meets two diagnostic criteria. A normal amylase does not by itself exclude pancreatitis when other criteria are met.
Assess vital signs, hydration and perfusion, pain, mental status, respiratory status, urine output, and abdominal findings. Laboratory evaluation commonly includes pancreatic enzymes, blood count, electrolytes, renal function, glucose, and liver tests. Check triglycerides and calcium when appropriate.
Use ultrasound to assess for gallstones. Early CT is not routinely needed to grade severity; it is generally reserved for diagnostic uncertainty or failure to improve after – hours.
care
Treatment is primarily supportive. Provide prescribed analgesia and moderately aggressive IV crystalloid hydration, often with lactated Ringer’s, while reassessing the patient’s response and monitoring for fluid overload. Use particular care in patients with cardiac or renal disease.
Do not routinely keep a patient without oral intake. In mild disease, start oral food as soon as tolerated; feeding does not need to wait for pancreatic enzyme levels to normalize. If oral intake is not possible in moderately severe or severe disease, enteral tube feeding is preferred. Parenteral nutrition is generally reserved for situations in which enteral feeding is not possible, tolerated, or sufficient.
Identify and treat the cause. Biliary pancreatitis may require gallbladder removal to prevent recurrence. Urgent is indicated when pancreatitis is complicated by cholangitis. Do not give antibiotics prophylactically for sterile inflammation or necrosis; use them when infection is present or suspected.
Complications and deterioration
Complications include pancreatic necrosis or infected necrosis, , bleeding, systemic inflammatory response, shock, respiratory or renal failure, electrolyte abnormalities including hypocalcemia, and hyperglycemia.
Trend the patient’s condition rather than relying on a single result. Worsening vital signs, oxygenation, urine output, mental status, or perfusion requires prompt reassessment and escalation. These changes may signal deterioration, impaired perfusion, or organ dysfunction. Monitor for signs of hypovolemia, fluid overload, infection, and organ dysfunction.
Living with
causes lasting pancreatic injury. Persistent or recurrent abdominal pain may occur, although some patients have little pain. Loss of exocrine function can cause maldigestion, weight loss, and greasy stools (). Loss of endocrine function can cause diabetes.
Monitor nutritional status, weight, stool pattern, pain, and glucose, and coordinate dietitian and specialist care. Management may include prescribed with meals and snacks, diabetes treatment, nutrition support, correction of deficiencies, and specialist procedures for duct obstruction or other complications.
Teach patients to avoid alcohol and stop smoking, and offer referral or support to help achieve these changes. Support follow-up for nutrition, pain, and blood-glucose management.
Nursing priorities
Assess pain and response to prescribed analgesia, and provide positioning and nausea care as appropriate. Use aspiration precautions when the patient is vomiting or mental status is impaired.
Administer prescribed fluids and reassess the response. Monitor for crackles, edema, or increasing oxygen needs as signs that fluid status may be worsening. Offer oral intake when tolerated rather than defaulting to prolonged fasting, and support prescribed when needed.
Reinforce alcohol and smoking cessation, explain the purpose and timing of prescribed pancreatic enzymes, and encourage follow-up for nutrition, pain, and blood-glucose management.