Acute Pancreatitis PDF

2/14/24, 10:34 AM Realizeit for Student Acute Pancreatitis Medical Management Management of acute pancreatitis is directed toward relieving symptoms and preventing or treating complications. All oral intake is withheld to inhibit stimulation of the pancreas and its secretion of enzymes. Ongoing rese...

2/14/24, 10:34 AM Realizeit for Student Acute Pancreatitis Medical Management Management of acute pancreatitis is directed toward relieving symptoms and preventing or treating complications. All oral intake is withheld to inhibit stimulation of the pancreas and its secretion of enzymes. Ongoing research has shown positive outcomes with the use of enteral feedings. The current recommendation is that, whenever possible, the enteral route should be used to meet nutritional needs in patients with pancreatitis. This strategy also has been found to prevent infectious complications safely and cost-effectively (McClave, 2019; Mueller, 2017; Olson et al., 2019; Ramanathan & Aadam, 2019; Townsend et al., 2016). Enteral feedings should be started early in the course of acute pancreatitis (Goodchild et al., 2019; McClave, 2019; Mueller, 2017; Olson et al., 2019; Ramanathan & Aadam, 2019). Parenteral nutrition has a role in the nutritional support of patients with severe acute pancreatitis, particularly in those who are unable to tolerate enteral nutrition (Goodchild et al., 2019; Mueller, 2017; Olson et al., 2019). Nasogastric suction may be used to relieve nausea and vomiting and to decrease painful abdominal distention and paralytic ileus (Brunicardi, 2019). Research data do not support the routine use of nasogastric tubes to remove gastric secretions in an effort to limit pancreatic secretion. Though current literature discourages the use of acid-suppressive therapy, this practice is common for hospitalized patients. Histamine-2 (H2) antagonists such as cimetidine may be prescribed to decrease pancreatic activity by inhibiting secretion of gastric acid. Proton pump inhibitors such as pantoprazole may be used for patients who do not tolerate H2 antagonists or for whom this therapy is ineffective (Barbateskovic, Marker, Granholm, et al., 2019; Kavitt, Lipowska, Anyane-Yeboa, et al., 2019). Pain Management Adequate administration of analgesia is essential during the course of acute pancreatitis to provide sufficient pain relief and to minimize restlessness, which may stimulate pancreatic secretion further. Pain relief may require parenteral opioids such as morphine, fentanyl, or hydromorphone (Cameron & Cameron, 2020; Goodchild et al., 2019; Olson et al., 2019). The recommendation for pain management is the use of opioids, with assessment for their effectiveness, and altering therapy if pain is not controlled or is increased (Faghih et al., 2019; Goodchild et al., 2019; Olson et al., 2019). There is some evidence that implementing the World Health Organization (WHO) analgesia ladder provides a pragmatic approach to pain management in patients with pancreatitis (Z.orniak et al., 2019). This stepwise escalation from low potency to higher https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zVrT2hbWFsCuacrrvtQ3c5e2aqBPaKXEaVcMiuwkAz59F1Dmo… 1/15 2/14/24, 10:34 AM Realizeit for Student potency of nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with opioids may provide an effective method of pain management and lower the potential for opioid dependency (Z.orniak et al., 2019). NSAIDs must be avoided or used in caution in patients at risk for bleeding. GI paralysis and ileus are common problems in early acute pancreatitis that can be potentiated and aggravated with the use of highdose opioids (Z.orniak et al., 2019). More research is needed to identify the best option for pain management in the patient with acute pancreatitis (Faghih et al., 2019). Until evidence-based recommendations are developed, guidelines for acute pain management in the perioperative setting should be followed (Rothrock, 2019). Antiemetic agents may be prescribed to prevent vomiting. Intensive Care Correction of fluid and blood loss and low albumin levels is necessary to maintain fluid volume and prevent acute kidney injury. The patient is usually acutely ill and is monitored in the intensive care unit, where hemodynamic monitoring and arterial blood gas monitoring are initiated. Antibiotic agents may be prescribed if infection is present. Prophylactic antibiotics are not recommended for patients with acute pancreatitis (Faghih et al., 2019; Goodchild, 2019; Olson et al., 2019). Insulin may be required if hyperglycemia occurs. Intensive insulin therapy (continuous infusion) in the critically ill patient has undergone much study. The best practice recommendations, which have arisen from many investigations on this complex topic, include targeting a blood glucose level of 140 to 200 mg/dL if insulin therapy is required in critically ill medical and surgical patients. Additionally, clinicians are advised to avoid glucose targets