This NCLEX study guide is made for nursing students to better understand the function of the pancreas, the definition of pancreatitis, its two types, what causes it, how it is diagnosed, the signs and symptoms, and the nursing interventions.
What Is the Definition of Pancreatitis?
Pancreatitis is the inflammation of the pancreas. There are two types of pancreatitis: acute and chronic. Acute pancreatitis can improve and may not cause any problems in the future. While chronic pancreatitis can result in life-threatening complications or may lead to multiple organ failure.
What Is the Function of the Pancreas?
The pancreas is an organ as big as the hand and is found in the abdominal area. It is responsible for producing enzymes for breaking down fats, sugar, and starches. The pancreas contains enzymes called acinar and the hormones Islet of Langerhans. Both of these performs endocrine and exocrine functions.
- Endocrine (Islets of Langerhans): These cells produce glucagon, insulin, somatostatin, and polypeptide. All of these are important in metabolizing nutrients in the body and maintains safe blood sugar levels.
- Exocrine (Acinar Cells): The acinar cells secrete three enzymes: amylase, protease, and lipase. The amylase breaks down carbohydrates into glucose. While the protease breaks down proteins into amino acids, and the lipase breaks down the fasts.
What happens when the pancreas gets inflamed?
When the pancreas loses function, this may lead to many problems. If the pancreas is inflamed, it cannot deliver and produce the hormones and enzymes properly. As the pancreas is inflamed, it swells, and that’s when digestive enzymes leak. Patients with Pancreatitis can experience:
- Weight loss problems caused by malabsorption
- Digestion issues (diarrhea, abdominal pain, wet stools)
- Abnormal blood glucose levels
- Internal bleeding, shock, hemorrhage
- Organ failure
What Are the Two Types of Pancreatitis?
There are two types of pancreatitis: acute and chronic. As a nurse, you should know how to differentiate the two, so you’ll know the proper nursing interventions required. Here’s what you should know:
- Acute Pancreatitis: It is the sudden inflammation of the pancreas. It can be mild or life-threatening but can usually subside with the right interventions. The main causes of acute pancreatitis are gallstones and alcohol abuse. The digestive enzymes may spread to the nearby organs and cause organ and vessel damage (e.g., respiratory distress).
- Chronic Pancreatitis: It is the chronic inflammation of the pancreas that recurs for years leading to irreversible damage. This leads to the loss of function of exocrine and endocrine cells and other severe complications like diabetes, kidney failure, breathing problems, kidney failure, diabetes, malnutrition, and pancreatic cancer.
What Causes Pancreatitis?
Pancreatitis occurs when the digestive enzymes are activated while still inside the pancreas (which normally should be activated in the intestinal tract). These digestive enzymes may cause the cells to get irritated, which leads to the inflammation of the pancreas. Here are some causes of pancreatitis:
- Excessive alcohol consumption
- Excessive cigarette smoking
- Medications (e.g. corticosteroids)
- Abdominal surgery Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Cystic Fibrosis
- Family History of Pancreatitis
- High levels of calcium in the blood (hypercalcemia)
- High levels of triglycerides in the blood
- Excessive smoking
- Injury to the abdomen
- Pancreatic cancer
- Autoimmune diseases
How Is Pancreatitis Diagnosed?
The two most expected procedures for pancreatitis are blood tests to check the digestive enzyme levels lipase and amylase. In the case of Pancreatitis, lipase or amylase may be three times more than normal levels.
- Amylase normal level: 23-85 units U/L
- Lipase normal level: 0-160 U/L
Other tests expected to be ordered by the doctor to confirm the diagnosis of pancreatitis is:
- Electrolyte test: Especially calcium levels
- CT Scan or Ultrasound: To check the image of the pancreas if it’s inflamed
- ERCP (Endoscopic Retrograde Cholangio-Pancreatography): To assess the pancreas, bile ducts, and gall bladder with the use of a small scope.
What Are the Signs and Symptoms of Pancreatitis?
Here are the signs and symptoms the nurse should watch out for acute pancreatitis and chronic Pancreatitis:
- Sudden and painful abdominal pain (the location of the pain is mid-epigastric or left upper quadrant and may radiate at the back as well)
- Worsened pain when lying flat
- The patient reports pain after consuming fatty, oily, or greasy meals and alcoholic beverages
- Increased heart rate
- Decreased BP
- Nausea and vomiting
- Important to remember: Cullen’s Sign and Grey Turner’s Sign (both bluish discoloration)
- Cullen’s Sign: Check the belly button for bluish discoloration or bruising
- Grey-Turner’s Signs: Check the hip area or the flanks for bluish discoloration 
- Persistent abdominal pain
- Worse pain after eating a greasy meal or drinking alcohol
- Formation of mass or swelling in the abdomen
- Steatorrhea: Diarrhea with oily stools
- Weight loss: There are no enzymes that can metabolize food
- Jaundice: Yellowing of skin and eyes due to bile build-up
- Dark-colored urine: Due to excessive bile production in the body
- Diabetes Mellitus: The pancreas cannot secrete insulin because the Islet of Langerhans are damaged
What Are the Nursing Interventions for Pancreatitis?
The goal of intervention for patients with pancreatitis is to let the pancreas rest. This means to prevent the pancreas from being stimulated and prevent the production of digestive enzymes. Nursing interventions will also include controlling the pain, monitoring for complications, and proper diet. To easily remember the nursing interventions for pancreatitis, remember the acronym PANCREATITIS:
- P – Pancreatic enzymes administration as per doctor’s order: to help with the digestion of carbohydrates, fats, and protein because the body is unable to sufficiently produce pancreatic enzymes
- A – Administer pain medications as ordered by the doctor
- N – NPO status and maintain IV hydrations
- C – Check for stools if it is greasy or oily.
- R – Recommednding pain relief: To lean or sit forward
- E – Education on a diet: To avoid fatty foods and alcohol. Small frequent, low fat, bland and high protein meals are recommended.
- A – Assess blood sugar levels, urine color, intake, and output
- T – To avoid sugary foods and refined carbohydrates. Fruits, vegetables, and grains are okay.
- I – Insertion of NGT as per doctor’s order (to remove any stomach contents like bile or has)
- T – To avoid mixing creamy foods with pancreatic enzyme medications.
- I – Insulin administration, especially for patients with diabetes.
- S – Supine positioning should be avoided as this may cause further pain.