Pancreatitis (Acute and Chronic): Nursing Study Guide

Pancreatitis is a high-yield GI topic on the NCLEX. This guide reviews the causes, presentation, diagnostics, and nursing priorities for both acute and chronic pancreatitis, including Ranson's criteria and key teaching points.

Causes (GET SMASHED mnemonic)

• G – Gallstones (most common cause of acute pancreatitis)
• E – Ethanol (most common cause of chronic pancreatitis)
• T – Trauma
• S – Steroids
• M – Mumps
• A – Autoimmune
• S – Scorpion stings
• H – Hyperlipidemia
• E – ERCP
• D – Drugs

Clinical Presentation

• Severe epigastric pain that radiates to the back and worsens after meals or when lying flat
• Pain improves by leaning forward (sitting up and bending forward)
• Grey Turner's sign – bruising on the flanks
• Cullen's sign – bruising around the umbilicus
• Both signs indicate severe necrotizing pancreatitis with retroperitoneal bleeding
• Chronic pancreatitis: steatorrhea (fatty, foul-smelling stools) and weight loss

Acute vs. Chronic Pancreatitis

Diagnostic Tests

• Lipase is more specific than amylase for pancreatitis
• CT scan is the gold standard for assessing severity and complications
• Ultrasound detects gallstones as a cause

Ranson's Criteria

Mortality interpretation:

• 0–2 criteria: Mild (<1% mortality)
• 3–4 criteria: Moderate (~15% mortality)
• 5–6 criteria: Severe (~40% mortality)
• 7+ criteria: Very severe (>90% mortality)

Management (First Actions)

• First priority: assess ABCs and establish two large-bore IV lines
• Aggressive IV fluid resuscitation with lactated Ringer's or normal saline
• Maintain NPO to rest the pancreas
• Insert an NG tube if vomiting or ileus is present
• Administer morphine for pain (safe in pancreatitis)
• Treat the underlying cause (ERCP for gallstones, stop alcohol)
• Chronic pancreatitis: pancreatic enzyme replacement with meals, low-fat diet, insulin for diabetes

Nursing Priorities

• Monitor for Grey Turner's sign (flanks) and Cullen's sign (umbilicus)
• Monitor for ARDS (dyspnea, hypoxia) and acute kidney injury (decreased urine output)
• Monitor calcium levels; hypocalcemia indicates severe disease
• After resolution, advance diet slowly from clear liquids to low-fat meals

Patient Teaching

• Avoid alcohol completely, especially in chronic pancreatitis
• Follow a low-fat diet with small, frequent meals
• Take pancreatic enzymes with every meal and snack
• Report steatorrhea, severe abdominal pain, fever, or vomiting

Common NCLEX Traps

• Lipase is more specific than amylase
• Grey Turner's and Cullen's signs indicate severe disease
• Morphine is safe in pancreatitis — the old fear of sphincter of Oddi spasm is outdated
• Aggressive IV fluids are the priority in acute pancreatitis
• Alcohol → chronic pancreatitis; gallstones → acute pancreatitis

Key takeaways

• Acute pancreatitis = sudden enzyme activation, often reversible; chronic = progressive and irreversible.
• Gallstones cause acute; alcohol causes chronic pancreatitis.
• Lipase is the most specific lab; CT is the gold standard for severity.
• First nursing priorities: ABCs, aggressive IV fluids, NPO, pain control with morphine.
• Grey Turner's and Cullen's signs = severe necrotizing pancreatitis with retroperitoneal bleeding.
• Chronic pancreatitis management centers on pancreatic enzyme replacement, low-fat diet, alcohol cessation, and treatment of diabetes.