Concordia College

College of Nursing

Case
Study
On
Acute
Pancreatitis
Prepared by:
De Castro, Richelle Sandriel C.
BSN III-D

Submitted to:
Mrs. Cedie Loo RN, MSN
 I. INTRODUCTION

Acute pancreatitis is an acute inflammatory process with variable involvement of adjacent and
remote organs. Although pancreatic function and structure eventually return to normal, the risk of
recurrent attacks is nearly 50% unless the precipitating cause is removed. Initial manifestations and
exacerbations of chronic pancreatitis may be indistinguishable from attacks of acute pancreatitis. And
they should be treated as such. The inflammation begins in the perilobular and peripancreatic fatty
tissue, manifested by edema and spotty fat necrosis. The disease may progress to the peripheral acinar
cells, pancreatic ducts, blood vessels, and bordering organs. In severe cases; patchy areas of the
pancreatic parenchyma become necrotic.

II. OBJECTIVES

General:

After this case study, I will be able to know what Acute Pancreatitis is, causes of Acute Pancreatitis,
how it is acquired and prevented, its treatments and prevention its occurrence.

Specific:

After the completion of this study, I will be able to:

 Define what is Acute Pancreatitis
 Trace the pathophysiology of Acute Pancreatitis
 Enumerate the different sign and symptoms of Acute Pancreatitis
 Identify and understand different types of medical treatment necessary for the treatment of
Acute Pancreatitis

III. PATIENT’S PROFILE

Name: E.S
Address: San Juan City
Age: 65 years old
Sex: Female
Nationality: Filipino
Religion: Roman Catholic
Date & Time of Admission: April 16, 2010 (09:34 pm)
Mode of Arrival: wheelchair
Chief Complaint: Severe Abdominal Pain
Source of Information: Patient, Chart, SO
Final Diagnosis: Acute Pancreatitis, Acalculous Cholecystitis, Multiple Hepatic Cysts
 IV. NURSING HISTORY

PAST MEDICAL HISTORY

According to the patient’s SO, she had completed his childhood immunization. He had no allergy
to foods or medications. She has hypertension and takes Amiodipine and Metropolol to manage her
illness. On June 2006, the patient was admitted at a government hospital due to Polycystitis.

HISTORY OF PRESENT ILLNESS

According to the patient’s SO, 3 days prior to admission the patient experienced sudden onset of
abdominal pain, diffuse. No meds taken or consultation made. 2 days PTA the patient still have the same
abdominal pain, this time was more severe and they monitored it. The patient is negative to bladder
change. Few hours PTA, the patient could not any more tolerate the pain; she was brought to OLLH
hence admitted.

FAMILY HEALTH HISTORY

According to the patient’s SO, both his maternal and paternal have a history Hypertension and
Kidney Problem: Polycystic Kidney.

PERSONAL / SOCIAL HISTORY

The patient is the 4th among 6 siblings. She is living with 7 other family members. His spouse is
unemployed and so was she. They are only financially supported with their children who are working.

V. Laboratory Works
NURSING
TEST PURPOSE NORMAL VALUES ABNORMAL RESULTS
CONSIDERATIONS
1. Serum Levels of The patient need not 26 to 102 units/L A marked increase (more
amylase amylase in a fast before test but (SI, o.4 to 1.74) than three times the
blood sample must abstain alcohol. upper limit of normal) in
Most commonly If severe abdominal the level strongly
used test to pain occur, obtain suggests acute
diagnosis of sample before pancreatitis.
acute therapeutic After the onset of acute
pancreatitis. intervention. pancreatitis, levels of
To evaluate Handle sample gently amylase in the blood rise
possible to prevent hemolysis. within six to 12 hours,
pancreatic injury peak within 12 to 48
caused by hours and remain
abdominal elevated for three to five
trauma. days in uncomplicated
attacks.
2. Serum lipase Determines levels Instruct patient to less than 160 Increased levels suggest
of lipase in a blood fast overnight units/L acute pancreatitis or
sample before test. (SI,<2.72 µkat/L) pancreatic duct
Elevated serum Handle sample obstruction. After an
lipase levels help gently to prevent acute attack, levels
to confirm the hemolysis. remain elevated for up to
pancreatic origin 14 days.
of elevated serum Increased levels may
amylase levels. occur in other pancreatic
injuries such as
perforated peptic ulcer
with chemical
pancreatitis caused by
gastric juices.

3. To aid in the Instruct patient to Pancreas Alterations in the size,

Ultrasonography diagnosis of fast for 8 to 12 demonstrates a contour and
(Pancreas) pancreatitis, hours before the coarse, uniform parenchymal texture of
pseudocysts, and test to reduce echo pattern the pancreas suggest
pancreatic bowel gas. (reflecting tissue possible pancreatic
carcinoma. Instruct to abstaindensity) and is disease.
for initial from smoking usually more An enlarged pancreas
evaluation when before the test to echogenic than with decreased
biliary causes are eliminate the risk the adjacent liver. echogenicity and distinct
suspected. of swallowing air borders suggests
The sensitivity of while inhaling, pancreatitis.
this study in which interferes An ill-defined mass with
detecting with test results. scattered internal
pancreatitis is 62 echoes, or a mass in the
to 95 percent. head of the pancreas
(obstructing the common
bile duct) and a large
noncontracting
gallbladder suggest
pancreatic carcinoma.
4. Particularly useful Provide a fat-free Gallbladder is Mobile, echogenic areas,
Ultrasonography for identifying meal in the sonolucent and usually linked to an
(Gallbladder & gallstones in the evening before pear-shaped; its acoustic shadow, suggest
Biliary system) gallbladder or in the test. outer walls gallstones within
the ducts that Tell patient that normally apper gallbladder lumen or the
drain the he must fast for 8 sharp and smooth. biliary system.
gallbladder as the to 12 hours The common bile May not be visible when
cause of acute before the duct has a linear the gallbladder is
pancreatitis procedure. apperance but is shrunken or filled with
However, this test During the scan, sometimes gallstones.
cannot identify the instruct to exhale obscured by A fine layer of echoes
more serious deeply and hold overlying bowel that slowly gravitates to
abnormalities his breath, when gas. the dependent portion
associated with requested. of the gallbladder as the
moderate and patient changes position,
severe pancreatitis suggests biliary sludge
within the gallbladder
lumen.

5. Abdominal X- Reveal a normal The bowel gas pattern The size, shape, or location of the
ray appearance of the (stomach, small and bladder or kidneys may be
digestive tract or large bowel) and soft abnormal. Kidney stones may be
abnormalities tissue densities (liver, seen in the kidney, ureters,
(paralysis of spleen, kidneys, and bladder, or urethra.
regions of the bladder) are normal Abnormal growths, such as large
small intestine and in size, shape, and tumors, or ascites may be seen
spasm of part of location. In some cases, gallstones can be
the colon). seen on an abdominal X-ray.
The walls of the intestines may
look abnormal or thick
A collection of air inside the belly
cavity but outside the intestines
(caused by a hole in the stomach
or intestines) may be seen.
6. Chest X-ray To evaluate any The diaphragm looks Elevation of diaphragm, collection
abnormalities on normal in shape and of fluid in the chest cavity collapse
the chest. location of the base of the lungs and
No abnormal inflammation of the lungs.
collection of fluid or
air is seen, and no
foreign objects are
seen.
The lungs look normal
in size and shape, and
the lung tissue looks
normal. No growths
or other masses can
be seen within the
lungs.

7. For diagnosing Instruct patient to The pancreatic Changes in the pancreatic size
Computed acute fast after parenchyma and shape suggests carcinoma
tomography pancreatitis administration of displays a and pseudocysts.
scan for determining oral contrast uniform density, Acute pancreatitis, either
(pancreas) the extent of medium. especially when edematous (interstitial) or
pancreatitis. Check patient’s an I.V. contrast necrotizing (hemorrhagic),
enlargement or history for recent medium is used. produces diffuse enlargement of
abnormal barium studies The gland the pancreas.
contours of the and for thickens from tail In acute edematous pancreatitis,
pancreas, hypersensitivity to and has a parenchyma density is uniformly
inflammation of iodine, seafood, or smooth surface. decreased.
the tissues contrast media. In acute necrotizing pancreatitis,
surrounding the Describe possible the density is non-uniform
pancreas, adverse reactions because of the presence of
collection of fluid to the medium necrosis and hemorrhage.
around the (nausea, flushinf, In acute pancreatitis,
pancreas, dizziness, inflammation typically spreads
and collection of sweating) and tell into the peripancreatic fat.
gas in the to report these Pseudocysts, may be unilocal,
pancreas or in symptoms. multi-local, appear as sharply
the tissues circumscribed, low-density areas
behind the that may contain debris.
pancreas.

VI. PATHOPHYSIOOGY
VII. ANATOMY AND PHYSIOLOGY
Pancreas

 Pancreas is an organ located behind the stomach and next to the liver and the gall bladder. Pancreatic
juices contain Enzymes, which help digest or break down food proteins. Normally the juices leave the
pancreas via a duct like channel and join the common bile duct, which carries the secretions from the
gallbladder, and pour the mixture into the duodenal portion of the stomach.

VIII. DISCHARGE PLANNING
 MEDICATIONS:
- Metoclopromide (Plasil)
- Omeprazole ( Omepron) 40mg
- Metronidazole 500mg
- Amikacin ( Konmalin) 500mg
- Calcibloc 5mg
 ECONOMIC STATUS:
E.S. a housewife, supported financially by her children who are working, can afford for to pay for her
medications, and other necessities by using the money sent to her.
 TREATMENT:
The client should be encouraged to learn and use of relaxation techniques including guided imagery
and music therapy are used to shift the focus of the brain away from the pain, decrease muscle tension,
and reduce stress. Tension and stress can also be reduced through biofeedback. Being massaged or
applying backrub is very relaxing and helps reduce stress.
 HEALTH TEACHINGS:
- Encourage to take a well - balanced diet.
- Encourage a healthy lifestyle.
- Educate patient in pain management.
  OPD VISITS:
Teach patient that if acute abdominal pain or biliary tract disease (as evidenced by jaundice, clay-
colored stools, and darkened urine) occurs, she should notify it to the physician. She may report to the
physician after 7 to 10 days to know the indictor of disease or response progression.
 DIET:
The client should be instructed to avoid alcohol, spicy foods, any caffeine- containing foods, heavy
meals, high fatty foods. Small, frequent feeding of bland diet.
 SPIRITUAL CARE:
Encourage client to pray in accordance with their beliefs. Ask for help to God for complete recovery.
DAILY DIARY

29 April 2010 (Thursday)

I woke up at 4:30am and did my everyday routine. Took a bath, dressed up and ate. Then
went to school to fetch Cess then headed to Our Lady of Lourdes Hospital in Mandaluyong. We
stayed in the waiting are only to find out that Mrs. Loo was our C.I. I got ecstatic and excited at
the same time because I admit that she’s one of my favorite C.I’s (no joke to ma’am ah).  Then
Mrs. Loo took the endorsement form and jot down important things that we need to know with
our oatients then she assigned it to us one by one. I got a patient in room 415A. Me and April
were assigned there. It’s my first time to handle a patient that has NGT tube, Jackson Pratt, and
T-tube. I was so excited to drain all of those.  We did the taking of Vital Signs then we
recorded it. Then off to morning care. I sponged bathed my patient with the help of my duty
mate, Lyka. Then we also did perineal care. After that we went to the station to plot the vital
signs. Then we were assigned to have the first break. After which, we went to our room and told
us to do a Nursing Care Plan of our patient. Mrs. Loo then told us the requirements. We did the
NCP then have it checked. Glad I got 8/10.  Then by 12nn, we did the VS again, recorded it
then plot it. Then before we left, I drained the NGT, JP and T-Tube of my patient. I was so glad of
that day’s duty. 

REFLECTION
This is the second time that I am handled by Mrs. Loo. And yet again, she never failed us to give
insights and new learnings about the things in the ward. This is our first time to have a duty in
St. Anthony Unit in Our Lady of Lourdes Hospital. Yet, the things to do are the same with the
ones in the St. Vincent Unit. This time, the patients are less and our ratio is 1:1. I have a patient
with NGT, T-Tube and JP. I’m tasked to drain those at the end of our shift. I felt really excited
because it is my first time to handle a patient with those tubings. I’m glad that our c.i, Mrs. Loo
was very patient to teach me the things I need to do with my patient. I felt great that day
because we’re not that kind of busy and at the same time we had a lot of time to talk about
things under the sun. 

De Castro, Richelle Sandriel C.

BSN III-D
Journal

Scorpion venom may help treat pancreatitis

Researchers at North Carolina State University and East Carolina University have gained insight into
scorpion venom’s effects on the ability of certain cells to release critical components - a finding that may
prove useful in understanding diseases like pancreatitis or in targeted drug delivery.

A common result of scorpion stings, pancreatitis is an inflammation of the pancreas.

ECU microbiologist Dr. Paul Fletcher believed that scorpion venom might be used as a way to discover
how pancreatitis occurs - to see which cellular processes are affected at the onset of the disease.

Fletcher pinpointed a protein production system found in the pancreas that seemed to be targeted by
the venom of the Brazilian scorpion Tityus serrulatus and then contacted NC State physicist Dr. Keith
Weninger, who had studied that particular protein system.

"This particular protein system has special emphasis at two places in the body - the pancreas and the
nervous system," Weninger says. "In the pancreas, it is involved in the release of proteins through the
membrane of a cell."

The pancreas specializes in releasing two kinds of proteins using separate cells: digestive enzymes that
go into the small intestine and insulin and its relatives that go into the bloodstream, yet this same
release mechanism is important in all of our cells for many processes.

Cells move components in and out through a process called vesicle fusion. The vesicle is a tiny, bubble-
like chamber inside the cell that contains the substance to be moved, stored and released - in this case,
proteins like enzymes or hormones. The vesicle is moved through the cell and attaches to the exterior
membrane, where the vesicle acts like an airlock in a spaceship, allowing the cell membrane to open and
release the proteins without disturbing the rest of the cell’s contents. The proteins that aid in this
process are known as Vesicle Associated Membrane Proteins, or VAMPs.

Weninger provided Fletcher with two different VAMP proteins found in the pancreas, VAMP2 and
VAMP8. They were engineered to remove the membrane attachments so they could be more easily used
for experiments outside cells and tissues. Fletcher’s team demonstrated that the scorpion venom
attacked the VAMP proteins, cutting them in one place and eliminating the vesicle’s ability to transport
its protein cargo out of the cell.i
i
http://timesofindia.indiatimes.com/life/health-fitness/health/Scorpion-venom-may-help-treat-
pancreatitis/articleshow/5742047.cms