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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