Acute pancreatitis.- Sudden onset of constant, severe epigastric pain, often a large meal or alcohol intake. The pain frequently radiates to the back or left shoulder and is somewhat relieved by a sitting position. The chief causes of acute pancreatitis in adults are gallstones, other gallbladder (biliary) disease, and alcohol use. Viral infection (mumps, coxsackie B, mycoplasma pneumonia, and campylobacter), hereditary conditions, traumatic injury, pancreatic or common bile duct surgical procedures and certain medications (especially estrogens, corticosteroids, thiazide diuretics, and azathioprine) are other causes. Pancreatitis without any apparent cause- this is known as idiopathic pancreatitis.

Generally the patient needs hospitalization with administration of intravenous fluids to help restore blood volume. Medication for pain and nausea are provided to ease these symptoms and food is withheld until these symptoms have subsided considerably. Antibiotics are often prescribed in cases of severe acute pancreatitis or if infection occurs. Surgery is sometimes needed when complications such as infection, cysts or bleeding occur. 

Chronic pancreatitis. Chronic pancreatitis is an ongoing inflammation of the pancreas, an organ located behind the stomach.  This progressive disorder associated with the destruction of the pancreas may be confused with acute pancreatitis due to the similarities of the symptoms. Upper abdominal pain and back pain with nausea and vomiting are the main symptoms of chronic pancreatitis. As the disease becomes more chronic, patients may develop malnutrition, weight loss and insulin-dependent diabetes.   The treatment for chronic pancreatitis depends on the symptoms.  However, most therapies centers focus on pain management ( Demerol and morphine sulfate)and nutritional support. Oral pancreatic enzyme supplements are utilized to aid in the digestion of food.(Creon, Bioglan, Panazyme Donnazyme, Entozyme) (Pancrease, ultrase, viokase, Zymase, Pancreacarb)

Hereditary Pancreatitis. Hereditary Pancreatitis is a rare inherited condition characterized by recurrent episodes of acute pancreatitis attacks. In about half of these cases the problem progresses to chronic pancreatitis, which is severe scarring of the pancreas. Laboratory tests performed during an attack usually detect high blood levels of amylase and lipase, which are enzymes released from the pancreas. The first attack typically occurs within the first two decades of life, but can begin at any age. Patients with hereditary pancreatitis may have chronic abdominal pain, diarrhea, nausea, vomiting, malnutrition, or diabetes. The treatment for hereditary pancreatitis depends on the symptoms.  However, the primary treatment focuses on pain control and pancreatic enzyme replacement. Surgery may be indicated to improve symptoms. Removal of the entire pancreas can be performed to eliminate the source of the problem, however in most cases this results in permanent insulin-dependent diabetes.

Cholecystitis.

Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. Cholecystitis is usually caused by a gallstone in the cystic duct, the duct that connects the gallbladder to the hepatic duct.

A typical attack of cholecystitis usually lasts two to three days. The following are the most common symptoms of gallstones. However, each individual may experience symptoms differently. Symptoms may include:

• intense and sudden pain in the upper right part of the abdomen
• recurrent painful attacks for several hours after meals
• pain (often worse with deep breaths and extends to lower part of right shoulder blade), nausea, vomiting, rigid abdominal muscles on right side, slight fever, chills
• jaundice – yellowing of the skin and eyes, itching (rare), loose, light-colored bowel movements, abdominal bloating .

Treatment for acute cholecystitis usually involves a hospital stay, to reduce stimulation to the gallbladder. Antibiotics are usually administered to reduce the inflammation and/or fight the infection. Sometimes, the gallbladder is surgically removed.

Medical and surgical management.

When the gallbladder is acutely inflamed, the client takes nothing by mouth. Instead, a nasogastric tube is inserted. And antibiotics and parental fluids are prescribed until the inflammation subsides. Treatment of mild or chronic cholecystitis involves a low-fat diet. To relieve pain and discomfort, analgesic, anticholinergics, and even nitroglycerin are prescribed.Fat soluble vitamins may be ordered to compensate for their reduced absorption. A bile-binding resin, such as cholestyramine (questran), is prescribed to relieve pruritus. Client who are a surgical risk receive oral bile acids, either chenodeoxycholic acid (ursodiol, Actigall or UDCA, in attempt to dissolve the gallstones.

Lithotripsy.- is a non surgical procedure to break some types of gallstones. See pag 898 on timby.  LAPAROSCOPIC CHOLECYSTECTOMY, is a surgical procedure for gallbladder removal. This procedure requires general anesthesia.

Nursing Management.

During an attack of biliary colic, the nurse ensures that the client rests, monitors the ability to digest a bland liquid diet, and prescribed antispasmodic or analgesics. If gastric descompression  is required the nurse will insert a nasogastric tube and connects it to suction.