NCP Pancreatitis

Pancreatitis is a painful inflammatory condition in which the pancreatic enzymes are prematurely activated resulting in autodigestion of the pancreas. The most common cause of pancreatitis are biliary tract disease and alcoholism, but can also result from such things as abnormal organ structure, blunt trauma, penetrating peptic ulcers, and drugs such as sulfonamides and glucocorticoids. Pancreatitis may be acute or chronic, with symptoms mild to severe.


Inpatient acute medical unit for initial incident or exacerbations with serious complications; otherwise condition is managed at the community level.


Alcoholism (acute); intoxication/overdose

Substance dependence/abuse rehabilitation

Diabetes mellitus/diabetic ketoacidosis


Psychosocial aspects of care

Renal failure: acute


Total nutritional support; parenteral/enteral feeding

Patient Assessment Database


May exhibit: Hypertension (acute pain); hypotension and tachycardia (hypovolemic shock or toxemia)

Edema, ascites

Skin pale, cold, mottled with diaphoresis (vasoconstriction/fluid shifts); jaundiced (inflammation/ obstruction of common duct); blue-green-brown discoloration around umbilicus (Cullen’s sign) from accumulation of blood (hemorrhagic pancreatitis)


May exhibit: Agitation, restlessness, distress, apprehension


May report: Diarrhea

May exhibit: Bowel sounds decreased/absent (reduced peristalsis/ileus)

Dark amber or brown, foamy urine (bile)

Frothy, foul-smelling, grayish, greasy, nonformed stool (steatorrhea)

Polyuria (developing DM)


May report: Food intolerance, anorexia; frequent/persistent vomiting, retching, dry heaves

Weight loss

May exhibit: Diffuse epigastric/abdominal tenderness to palpation, abdominal rigidity, distension

Hypoactive bowel sounds

Urine positive for glucose


May exhibit: Confusion, agitation

Coarse tremors of extremities (hypocalcemia)


May report: Unrelenting severe deep abdominal pain, usually located in the epigastrium and periumbilical regions but may radiate to the back; onset may be sudden and often associated with heavy drinking or a large meal

Radiation to chest and back, may increase in supine position

May exhibit: Abdominal guarding, may curl up on left side with both arms over abdomen and knees/hips flexed

Abdominal rigidity


May exhibit: Tachypnea, with/without dyspnea

Decreased depth of respiration with splinting/guarding actions

Bibasilar crackles (pleural effusion)


May exhibit: Fever


May exhibit: Current pregnancy (third trimester) with shifting of abdominal contents and compression of biliary tract


May report: Family history of pancreatitis

Diabetic ketoacidosis

History of cholelithiasis with partial or complete common bile duct obstruction; gastritis, duodenal ulcer, duodenitis; diverticulitis; Crohn’s disease; recent abdominal surgery (e.g., procedures on the pancreas, biliary tract, stomach, or duodenum); external abdominal trauma

Excessive alcohol intake (90% of cases)

Uses of medications, e.g., salicylates, pentamidine, antihypertensives, opiates, thiazides, steroids, some antibiotics, estrogens

Infectious diseases, e.g., mumps, hepatitis B, Coxsackie viral infection

Discharge plan

DRG projected mean length of inpatient stay: 5.7 days

May require assistance with dietary program, homemaker/maintenance tasks

Refer to section at end of plan for postdischarge considerations


CT scan: Shows an enlarged pancreas, pancreatic cysts and determines extent of edema and necrosis.

Ultrasound of abdomen: May be used to identify pancreatic inflammation, abscess, pseudocysts, carcinoma, or obstruction of biliary tract

Endoscopic retrograde cholangiopancreatography: Useful to diagnose fistulas, obstructive biliary disease, and pancreatic duct strictures/anomalies (procedure is contraindicated in acute phase).

CT–guided needle aspiration: Done to determine whether infection is present.

Abdominal x-rays: May demonstrate dilated loop of small bowel adjacent to pancreas or other intra-abdominal precipitator of pancreatitis, presence of free intraperitoneal air caused by perforation or abscess formation, pancreatic calcification.

Upper GI series: Frequently exhibits evidence of pancreatic enlargement/inflammation.

Serum amylase: Increased because of obstruction of normal outflow of pancreatic enzymes (normal level does not rule out disease). May be five or more times normal level in acute pancreatitis.

Serum lipase: usually elevates along with amylase, but stays elevated longer.

Serum bilirubin: Elevation is common (may be caused by alcoholic liver disease or compression of common bile duct).

Alkaline phosphatase: Usually elevated if pancreatitis is accompanied by biliary disease.

Serum albumin and protein: May be decreased (increased capillary permeability and transudation of fluid into extracellular space).

Serum calcium: Hypocalcemia may appear 2–3 days after onset of illness (usually indicates fat necrosis and may accompany pancreatic necrosis).

Potassium: Hypokalemia may occur because of gastric losses; hyperkalemia may develop secondary to tissue necrosis, acidosis, renal insufficiency.

Triglycerides: Levels may exceed 1700 mg/dL and may be causative agent in acute pancreatitis.

LDH/AST: May be elevated up to 15 times normal because of biliary and liver involvement.

CBC: WBC count of 10,000–25,000 is present in 80% of patients. Hb may be lowered because of bleeding. Hct is usually elevated (hemoconcentration associated with vomiting or from effusion of fluid into pancreas or retroperitoneal area).

Serum glucose: Transient elevations of more than 200 mg/dL are common, especially during initial/acute attacks.

Sustained hyperglycemia reflects widespread cell damage and pancreatic necrosis and is a poor prognostic sign.

Partial thromboplastin time (PTT): Prolonged if coagulopathy develops because of liver involvement and fat necrosis.

Urinalysis: Glucose, myoglobin, blood, and protein may be present.

Urine amylase: Can increase dramatically within 2–3 days after onset of attack.

Stool: Increased fat content (steatorrhea) indicative of insufficient digestion of fats and protein.


1. Control pain and promote comfort.
2. Prevent/threat fluid and electrolyte imbalance.
3. Reduce pancreatic stimulation while maintaining adequate nutrition.
4. Prevent complications.
5. Provide information about disease process/prognosis and treatment needs.


1. Pain relieved/controlled.
2. Hemodynamically stable.
3. Complications prevented/minimized.
4. Disease process/prognosis, potential complications, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.