A CASE PRESENTATION ON ACUTE

PANCREATITIS

UNDER THE PRECEPTOR OF: PRESENTED BY :

Dr. G. Kiran,M.Pharm, Ph.D K.NAGA ANUSHA
Professor VI/VI PHARM-D
Department of Pharmacology Y19PHD0311
AMRMCP. AMRMCP.

AM REDDY MEMORIAL COLLEGE OF PHARMACY, NARSARAOPET.

ANDHRA PRADESH-522601.
LALITHA SUPER SPECIALITY HOSPITAL 1
 INTRODUCTION
DEFINITION :
 It is a condition characterized by inflammation of the pancreas
 There are two main types
 ACUTE PANCREATITIS
 CHRONIC PANCREATITIS

EPIDEMIOLOGY :
 The global age-standardized incidence rate 34.8/100,000 during 1990-2019.
 The prevalence of CP was 45.52 per 100000 individuals, 55%male population and 35.78 % female population

ETIOLOGY :
THE MOST COMMON CAUSES OF PANCREATITIS INCLUDE :
 Alcohol abuse & smoking
 Lumps of solid material/gallstones found in gall bladder
 High levels of triglycerides in blood
 Certain genetic defects 2

 Congenital abnormalities in the pancreas

SIGNS & SYMPTOMS :
 Severe abdominal pain that may spread to back
 Nausea & vomiting
 Yellowing of the skin and eyes/jaundice,
 Rapid heart beat
 Fever
 Swelling of upper belly
 low blood pressure
PATHOPHYSIOLOGY :

[HTTPS://WWW.HOPKINSMEDICINE.ORG/HEALTH/CONDITIONS-AND-
DISEASES/PANCREATITIS]
COMPLICATIONS :
 Calcification of the pancreas
 Long-term (chronic) pain
 Diabetes
 Gallstones
 Kidney failure
 Buildup of fluid and tissue debris (pseudocysts)
 Pancreatic cancer
RISK FACTORS
 Excessive alcohol use
 Cigarette smoking
 Obesity
 Diabetes
 Family history of pancreatitis 4

 Obesity[ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6514487]
DIAGNOSIS :
 Physical examination
 Blood tests
 U/S scan of whole abdomen : Images can show gallstones in the gallbladder or inflammation of the pancreas.
 Endoscopic retrograde cholangio pancreatography {ERCP}:The doctor will then slide a thin, flexible tube
called a catheter through the endoscope and into the bile and pancreatic ducts. The doctor injects a special dye
through the catheter into the ducts. The doctor uses a type of x-ray imaging, called fluoroscopy, to examine the
ducts and look for narrowed areas or blockages.
 CT scan :The X-rays absorbed by the body's tissues will be detected by the scanner and transmitted to the
computer. The computer will transform the information into an image
 Magnetic resonance cholangio pancreatography {MRCP}:Magnetic resonance cholangiopancreatography
(MRCP) is a special type of magnetic resonance imaging (MRI) exam that produces detailed images of
the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas and pancreatic
5

duct.[https://www.radiologyinfo.org]
TREATMENT :
 Antibiotics
 Antacids
 Anti emetics
 Amino acids infusions
 Pancreatic supportive drugs
SURGICAL :
 Pancreatic debridement – Draining of fluid from pancreas
 Pancreatic resection – Removal of part of the pancreas[pancreatectomy]
 Drainage procedures
 Islet cell transplantation
 Distal pancreatectomy – Removes the tail of pancreas
LIFE STYLE MODIFICATIONS : Dietary changes – High in lean protein, low fat
 Maintain healthy weight
 Avoid alcohol consumption
 Quit smoking
 Manage underlying health conditions – Diabetes, auto immune disorders can increase risk of pancreatitis
 Eat smaller ,more frequent meals
 Take medications regularly 6

[ https ://www.nhs.uk/conditions/chronic-pancreatitis/treatment/]
SOAP NOTES

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 SUBJECTIVE EVIDENCE

A 45 Years Old Male Patient Came With C/O - Abdominal Pain Since 1 Week & Increased With Food Intake
Bloating after food intake
Nausea & vomiting's
Decreased appetite
Burning micturition
PAST MEDICAL HISTORY :
EPILEPSY – 10 YEARS – ON REGULAR MEDICATION
PAST MEDICATION HISTORY :
TAB. EPTOIN – 100MG- 1-0-1
SOCIAL HISTORY :
CHRONIC ALCOHOLIC – 10YEARS 8

MARITAL STATUS : MARRIED

 OBJECTIVE EVIDENCE

VITALS D1 D2 D3 D4 D5

BLOOD PRESSURE ( mmHg) 120/70 120/80 110/70 110/80 130/80

PULSE RATE (bpm) 90 80 76 100 80

RESPIRATORY RATE (cpm) 20 22 22 18 21

SPO2 ( %) 97 99 98 97 99

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 LAB INVESTIGATIONS

PARAMETERS REFERENCE RANGE DAY-1

HAEMOGLOBIN 11.5-16.5 g/dl 10.2
RED BLOOD CELLS 3.8-6.0 millions/cumm 3.4
WHITE BLOOD CELLS 4000-11000 cells / mm 10500
NEUTROPHILS 40-70 % 73
PACKED CELL VALUE 42-52 % 32.9
MEAN CORPUSCULAR VOLUME (MCV) 80-94 FL 95.9
MEAN CORPUSCULAR HAEMOGLOBIN (MCH) 28-32 Pg 29.7
MEAN CORPUSCULAR HAEMOGLOBIN 30-36 g/dl 31.0
CONCENTRATION(MCHC)
ERYTHROCYTE SEDIMENTATION RATE(ESR) 1-20 mm/hr 20
PLATELET COUNT 1.5-4.5 lakhs /cumm 3.70
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 PARAMETERS REFERENCE RANGE DAY-1
TOTAL BILIRUBIN 0.1 – 1.0 mg/dl 5.2

DIRECT BILIRUBIN 0-0.6 mg/dl 7.8

INDIRECT BILIRUBIN 0-0.4 mg/dl 1.1

SERUM GLUTAMIC OXALOACETIC UP to 35 IU/L 205

TRANSAMINASE(SGOT)
SERUM GLUTAMIC PYRUVIC TRANSAMINASE UP to 45 IU/L 155
(SGPT)
ALKALINE PHOSPHATE 30-120 IU/L 280

C- REACTIVE PROTEIN 0.3-1.0 mg/dl 10.5

SERUM AMYLASE 30-110 U/L 211

SERUM LIPASE 10-140 U/L 146

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 OTHER INVESTIGATIONS

U/S SCAN OF WHOLE ABDOMEN :

Acute pancreatitis with intra pancreatitic cystic collection
Both kidneys altered echo texture
Minimal free fluid in pelvis
Pseudo pancreatic cyst
ECHO REPORT : EF- 60 %
No MR/AR
Normal LV diastolic dysfunction
CT SCAN OF ABDOMEN :
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Pancreatic & hepatic sub capsular pseudocysts
Minimal ascites
 ASSESMENT

From the both subjective evidence and objective evidence assess that the patient was diagnosed with

ACUTE PANCREATITIS

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 PLAN
TRADE NAME GENERIC NAME DOSE ROA FREQ D1 D2 D3 D4 D5
INJ.MICROTAZ PIPERACILLIN+TAZOBA 4.5g IV 1-1-1     
CTUM
INJ. PAN PANTOPRAZOLE 40mg IV 1-.0-1     

INJ.TRAMADOL TRAMADOL HCL 1cc IV 1-1-1     

INJ.DIPEPTIVEN L-ALANYL-L- 50ml IV 1-0-0     

GLUTAMINE IV SOL
INJ. EPTOIN PHENYTOIN 100mg IV 1-1-1     

CAP. MECOMOST MULTI VITAMINS 1 cap IV 1-0-0    - -

TAB.FAROBACT FAROPENUM SODIUM 3000mg PO 1-0-1     

INJ.GENSTATIN ULINASTATIN 20mg IV 0-1-0     

TAB.CREON MINI MICRO SPHERE 1tab PO 1-0-1     

CAPSULE
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INJ.EMESET ONDANSETRON 4mg PO 1-0-1     
 DRUG INTERACTIONS

Phenytoin < > Tramadol

Phenytoin decreases the blood levels of tramadol & in addition, stopping the use of phenytoin
may increase the risk of seizures & respiratory problems.
DISCHARGE SUMMARY

A 45 years male patient came with chief complaints of Abdominal pain since 1 week & increased with food
intake
Bloating after food intake
Nausea & vomiting's
Decreased appetite
Burning micturition
Case was seen by a general surgeon & advised investigations was done and diagnosed as acute pancreatitis. Patient
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was treated with antibiotics, antacids, anti emetics nsaids, pancreatic supportives, anti convulsants, pancreatic
 DISCHARGE MEDICATIONS

TRADE NAME GENERIC NAME DOSE ROA FREQ

TAB.MECOMOST MULTI VITAMIN 1TAB PO 1-0-0

TAB. FAROBACT FAROPENEM 300mg PO 1-0-1

TAB.PAN DSR PANTOPRAZOLE+ 40/30mg PO 1-0-1

DOMPERIDONE

TAB. EPTOIN PHENYTOIN 100mg PO 1-0-1

TAB. CREON MINI MICRO SPHERE 1 CAP PO 1-0-1

CAPSULES

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PATIENT COUNSELLING
ABOUT DISEASE :It is a condition characterized by inflammation of pancreas
ABOUT MEDICATIONS :[ REFERENCE : CLINIREX]

• INJ. GENSTATIN : It is used in treatment of severe sepsis and inflammation of pancreas. It works by blocking the chemicals

which involved in inflammation of pancreas.

• TAB. CREON : It is an pancreatic enzyme supplements, works by replacing3 pancreatic enzymes normally made by

healthy pancreas.
• LIFE STYLE MODIFICATIONS :

 Dietary changes – high in lean protein, low fat

 Avoid alcohol consumption

 Quit smoking

 Manage underlying health conditions – diabetes, auto immune disorders can increase risk of pancreatitis
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 Eat smaller ,more frequent meals
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