Also found in: Dictionary, Thesaurus, Encyclopedia.
pancreatitis(pang?kre-a-tit'is, pan?) [ pancreat- + -itis]
Alcohol abuse and obstruction of the pancreatic duct by gallstones are the most common causes of the disease; less often, pancreatitis results from exposure to drugs (e.g., thiazide diuretics or pentamidine), hypertriglyceridemia, hypercalcemia, abdominal trauma, or viral infections (e.g., mumps or coxsackievirus).
The patient receives nothing by mouth until pain, nausea, and vomiting have resolved and diagnostic markers (e.g., serum lipase level) show evidence of normalizing. Standard supportive measures include the administration of fluids and electrolytes, sometimes in massive quantities if dehydration or third-spacing of fluids in the abdomen occurs.
CAUTION!Refeeding patients before pancreatic inflammation has resolved may cause a relapse.
Several techniques are used to determine how well (or how poorly) patients with pancreatitis will progress during their illness and whether they may benefit from intensive care. The best of these is the Acute Physiology and Chronic Health Evaluation (APACHE II) system; it grades patients with pancreatitis on the basis of 14 measurable physiological parameters, including the patient's body temperature, heart rate, mean arterial pressure, respiratory rate, serum creatinine and sodium levels, arterial pH, white blood cell count, Glasgow coma scale, and age.
Other methods for determining the severity of illness in pancreatitis rely on abnormalities seen on computed tomography (CT) imaging or the measurement of other physiological criteria, including the serum calcium and glucose levels, fluid deficit, and liver function.
Intravenous fluids, antiemetics, and pain relievers are administered parenterally. A nasogastric tube may be inserted and placed on low, intermittent suctioning for patients with intractable nausea and vomiting or to reduce hydrochloric acid levels or relieve distention. Required nutritional support is best provided by jejunal enteral feedings that maintain gut integrity. These are as effective as parenteral feeding is and have the benefit of reducing the potential for infection and hypoglycemia. Total parenteral nutrition may be needed for patients with evidence of severe pancreatitis. Such patients may be critically ill and will require close monitoring of vital signs, oxygenation and ventilation, body temperature, cardiac and hemodynamic status, fluid and electrolytes, balance, body weight, serum calcium levels, renal function, level of consciousness, peripheral circulation, possible delirium, and possible multiorgan system failure. Severe pancreatitis often results in a prolonged and complicated hospitalization. Throughout the illness, range-of-motion exercises, correct positioning, prophylaxis against deep venous thrombosis, oral hygiene, and other physical support measures prevent debilitation and complications of prolonged illness. Both patient and family may need support, esp. in the presence of complications (pulmonary, cardiovascular, renal, immune, and coagulation abnormalities). After pancreatitis has resolved, alcoholic patients should be encouraged to seek help from Alcoholics Anonymous or other supportive programs. Follow-up with a gastroenterologist, primary care provider, or nutritionist may be helpful during convalescence and recovery. Patients should return for prompt reevaluation if they have nausea, vomiting, epigastric pain, fevers, or jaundice after discharge.
autoimmune-related pancreatitisAutoimmune pancreatitis.
The pain may be mild or severe, tending to radiate to the back. Jaundice, weakness, emaciation, malabsorption of proteins and fats, and diarrhea are present.