Pancreatitis : Interprofessional Care

Interprofessional Care
- Objectives include
  - Relief of pain
  - Prevention or alleviation of shock
  - Decreased pancreatic secretions
  - Correction of fluid/electrolyte imbalance
  - Prevention/treatment of infections
  - Removal of precipitating cause
- Conservative Therapy
  - Supportive care
    - Aggressive hydration
    - Pain management
      - IV morphine, antispasmodic agent
    - Management of metabolic complications
      - Oxygen, glucose levels
    - Minimizing pancreatic stimulation
      - NPO status, NG suction, decreased acid secretion, enteral nutrition if needed
  - Conservative Therapy
    - Shock
      - Plasma or plasma volume expanders (dextran or albumin)
    - Fluid/electrolyte imbalance
      - Lactated Ringer’s solution
    - Ongoing hypotension
      - Vasoactive drugs: dopamine
    - Prevent infection
      - Enteral nutrition
      - Antibiotics
      - Endoscopically or CT-guided percutaneous aspiration
  - Surgical Therapy
    - For gallstones
      - ERCP
      - Cholecystectomy
    - Uncertain diagnosis
    - Not responding to conservative therapy
    - Drainage of necrotic fluid collections
  - Drug Therapy
    - IV morphine
    - Antispasmodics
    - Carbonic anhydrase inhibitors
    - Antacids
    - Proton pump inhibitors

Drug	Mechanism of Action
Acute Pancreatitis
Morphine	Relief of pain
Antispasmodics (e.g., dicyclomine [Bentyl])	Decreased vagal stimulation, motility, pancreatic outflow (decreased volume and concentration of bicarbonate and enzyme secretion) Contraindicated in paralytic ileus
Carbonic anhydrase inhibitor (acetazolamide)	Decreased volume and bicarbonate concentration of pancreatic secretion
Antacids	Neutralization of gastric hydrochloric (HCl) acid secretion Decreased production and secretion of pancreatic enzymes and bicarbonate
Proton pump inhibitors (e.g., omeprazole [Prilosec])	Decreased HCl acid secretion (HCl acid stimulates pancreatic activity)
Chronic Pancreatitis
Pancreatic enzyme products (pancrelipase [Pancrease, Zenpep, Creon, Viokace])	Replacement therapy for pancreatic enzymes
Insulin	Treatment for diabetes mellitus or hyperglycemia, if needed

- - Nutritional Therapy
    - NPO status initially
    - Enteral versus parenteral nutrition
    - Monitor triglycerides if IV lipids given
    - Small, frequent feedings when able
      - High-carbohydrate
    - No alcohol
    - Supplemental fat-soluble vitamins

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