Case on Acute pancreatits / PharmD / Case presentations / ppt
- 1. 1 CASE PRESENTATION ON ACUTE PANCREATITIS PRESENTED BY: P. Harshitha Reddy Doctor of Pharmacy
- 2. 2 Acute Pancreatitis Definition: Acute pancreatitis (AP) is an inflammatory disorder of the pancreas characterized by upper abdominal pain and pancreatic enzyme elevations. Clinical Manifestations (signs/symptoms): 1. Severe abdominal pain 2. Nausea and vomiting 3. Fever 4. Tachycardia 5. Abdominal tenderness 6. Bloating and distension 7. Jaundice 8. Decreased bowel sounds 9. Hypotension 10. Signs of dehydration
- 3. 3 Acute Pancreatitis Etiology: • Gallstones: Most common cause; blocks bile/pancreatic duct. • Chronic Alcohol Use: Damages pancreatic cells, leading to inflammation. • Medications: Some drugs (e.g., diuretics, corticosteroids). • Hypertriglyceridemia: High triglyceride levels (>1,000 mg/dL). • Hypercalcemia: High blood calcium levels, often due to hyperparathyroidism. • Trauma: Abdominal injuries or post-surgical complications. • Infections: Viral (e.g., mumps, hepatitis). • Pancreatic Duct Obstruction: Tumors, strictures. • Autoimmune Conditions: Body’s immune system attacks the pancreas. • Genetic Factors
- 4. 4 Acute Pancreatitis Complications: Local Complications: • Pancreatic Pseudocysts: Fluid-filled sacs that can develop in or around the pancreas, potentially leading to infection or rupture. • Necrotizing Pancreatitis: Death of pancreatic tissue, which can lead to infection and abscess formation. • Pancreatic Abscess: Collection of pus that requires drainage. • Hemorrhage: Internal bleeding due to damaged blood vessels in the pancreas. • Biliary Obstruction: Blockage of bile flow due to inflammation. • Gastrointestinal Bleeding • Hypocalcemia • Hyperglycaemia and Hypoglycaemia
- 5. 5 Acute Pancreatitis Diagnosis: The diagnosis of acute pancreatitis is made based on the presence of at least two of the following three criteria: • Clinical Presentation: – Acute onset of persistent, severe epigastric pain radiating to the back. – Nausea and vomiting often accompany the pain. • Laboratory Findings: – Elevated serum amylase and/or lipase levels (≥3 times the upper limit of normal). – Possible leukocytosis and elevated inflammatory markers (e.g., CRP). • Imaging Studies: – Findings suggestive of acute pancreatitis on contrast-enhanced CT, MRI, or ultrasound, such as pancreatic inflammation or edema.
- 6. 6 DEMOGRAPHIC DETAILS Patient’s Name : XXX Gender : Male Age : 67 Y/o Physician : Dr. Bathini Rajesh Patient ID : MH013895493 Date of Admission : 21/09/2024
- 7. 7 SUBJECTIVE EVIDENCE Chief Complaints: The 67 year old male patient have come to the hospital with chief complaints of lower abdomen pain since 2 days, decreased appetite and also c/o of vomitings, persistent HI cough. History of Present Illness: A 67 y/o male patient presented to the hospital with the chief complaints of lower abdomen pain since 2 days, decreased appetite and also chief complaints of vomitings, persistent cough and history of of present illness initially patient had similar complaints evaluated as acute pancreatitis, hyrpercalcemia, hyperthyoidism, s/o acute severe necrotic pancreatitis with severity index of 101, prostomegaly, but symptoms are not subsided. Here, he got admitted for furthur evaluation. Past Medical History: k/c/o moderate pancreatitis k/c hypercalcemia k/c hyperparathyroidism
- 8. 8 Past Medication History: S.No Drug Name (BRAND/ Generic) Dose FRQ Indication Category Mechanism of action 1 Cap. TAMDURA (Dutasteride + Tamsulosin) - OD To treat the enlarged prostate gland. α-Blockers It releases the muscle around bladder exit and allow easy passage of urine. 2 Tab. BETHERAN (Bethanechol chloride) 25 mg BID To treat the bladder problems such as inability to urinate. Parasympathoem-itic It acts on the parasympathetic receptors of gastric parietal cells. 3 Tab. CIPLOX (Ciproflaxin) 500 mg BID To treat urinary tract infections. Fluoroquinolone It inhibits the bacterial DNA gyrase and topoisomerase IV.
- 9. 9 Social History: Nil. Family History: Nil. Surgical History: Nil Personal History: Appetite – Decreased Bowel – normal Immunization History: Upto mark.
- 10. 10 OBJECTIVE EVIDENCE Vitals: On examination: Pulse : 86 bpm Blood pressure : 110/70 mm Hg SpO2 : 99 %
- 11. 11 Abnormal biochemical tests: S.NO NAME OF THE TEST OBSERVED VALUE NORMAL VALUE 1 WBC 11,200 cells/cu mm (↑) 4400-1100 cells/cu mm 2 RBC 3.32 million/ cu mm (↓) 4.5-6.5 million/cu mm 3 Hb 9.4 g/dl (↓) 14-18 g/dl 4 PCV 28.8 % (↓) 42-54% 5 RDW 14.8 % (↑) 11-14 % 6 Neutrophils 84 % (↑) 40-75 % 7 Lymphocytes 6.0 % (↓) 20-45 % 8 BNP 6673.00 pg/ml (↑) <100.00pg/ml
- 12. 12 Abnormal biochemical tests: S.NO NAME OF THE TEST OBSERVED VALUE NORMAL VALUE 9 Serum Calcium 10.3 mg/ml (↑) 8.6-10.2 mg/ml 10 Serum Potassium 5.5 mmol/L (↑) 3.5-5.1 mmol/L 11 Serum Lipase 455 IU/ml (↑) 0-60 IU/ml 12 Serum Amylase 719 IU/L (↑) 28-100 IU/L 13 Serum Sodium 130 mmol/L (↑) 3.5-5.2 mmol/L
- 13. 13 Diagnostic Procedures Real Time Ultrasonography of the Abdomen: •Necrotic pancreatitis •Aneurym near the hilum of liver •Bilateral mild pleural effusion •Right moderate hydroureteronephrosis •Bilateral simple renal cortical cysts •Simple hepatic cyst •Gall bladder sludge
- 14. 14 Diagnostic Procedures MRI of Pelvis: •Diffuse bladder wall trabeculation with small diverticulae. •Prostatomegaly Plain MRI study of Lumbar spine: •Right perineural cyst •Bladder
- 15. 15 Assessment Based on subjective and objective evidences this case was diagnosed as “ACUTE PANCREATITIS”.
- 16. 16 Pathophysiology Acute Injury Initial Insult •Zymogen activation •Ischemia •Duct obstruction Release of vasoactive substances Vascular damage Ischemia Generation of Cytokines e.g., TNF-α, IL-1, PAF, IL-6, IL-8 Tissue damage and cell death Release of active enzymes Inflammation
- 17. 17 Planning (Drug Card) S.NO Dosage form Drug Name BRAND (Generic) Dose ROA Freq 1 Inj PAN (Pantoprozol) 40 mg IV BID 2 Inj EMESET (Odanestrone ) 4 mg IV BID 3 Inj TRAMADOL (Tramadol) 1 Amp IV BID 4 Tab BACLOFEN (Lioresal, Gablofen) 10 mg PO BID 5 Cap TAMDURA (Tamsulosin + Dustasteride) 1 Cap PO BID 6 Tab BETHERAN (Bethanechol chloride) 25 mg PO BID 7 Tab CIPLOX (Ciprofloxacin) 500 mg PO BID
- 18. 18 PLANNING (Drug Card) S. No Drug Name BRAND (Generic) Dose Indication Category Mechanism of action Monitoring parameters 1 Inj PAN (Pantoprazol) 40 mg To treat acid related disorders like GERD, duodenal and gstric ulcers. Proton pump inhibitors (PPI) It inhibits the proton pump in the parietal cells of stomach. Serum Mg 2 Inj EMESET (Odansterone ) 4 mg To prevent and treat nausea, vomiting. Antiemetics It blocks serotonin receptors located in the brain. Serum K and Mg levels, bowel activity 3 Inj TRAMADOL (Tramadol) 1 Amp It is a pain relief medication. Opioid analgesic It binds to opioid receptors in CNS and inhibits the reuptake. Respiratory depression, sedation 4 Tab BACLOFEN (Lioresal, Gablofen) 10 mg To treat muscle spasticity such as multiple sclerosis. Muscle relaxant It activates GABA-B receptors in CNS and inhibits excitation. Spasticity, posture, sedation
- 19. 19 PLANNING (Drug Card) S. No Drug Name BRAND (Generic) Dose Indication Category Mechanism of action Monitoring parameters 5. Cap TAMDURA (Tamsulosin and Dustasteride) 1 cap To treat benign prostatic hyperplasia and it relieves symptoms like incomplete bladder etc… Alpha-blocker It blocks α-1 adrenergic receptors in the smooth muscles of prostateand leads to relaxation. pH levels 6. Tab CIPLOX (Ciprofloxacin) 500 mg To treat variety of bacterial infections like UTI, gastrointestinal infections and intra-abdominal infections. Fluoro- quinolone antibiotic It inhibits bacterial gyrase and topoisomerase IV. Thus prevents the bacterial replication. Renal function (creatinine levels)
- 20. 20 Pharmacist Interventions S. No Drugs Involved Type of Interaction Interaction Effect 1 Ciprofloxacin & Tramadol Major Tramadol rarely develops seizures, and combining with Ciprofloxacin can increase that risk. 2 Ondansetron & Tramadol Major Combining these drugs increase the risk of serotonin syndrome and an irregular heart rhythm. 3 Baclofen & Tramadol Major Using narcotic pain or cough medications together with other medications that also cause CNS depression.
- 21. 21 Patient Counseling About Oral Drugs/Spacers/Powders/Special Drugs: S no Drug name Dose ROA When the drug should be administered Avoid substances 1. Tab CIPLOX (Ciprofloxacin) 500 mg PO It is better to take at a fixed time. Avoid this with caffeine and chocolate. 2. Tab BACLOFEN (Lioresal, Gablofen) 10 mg PO It should be taken with food. --
- 22. 22 Patient Counseling Goals to be normalise: • Control inflammation and pain • Restore fluid balance • Provide pancreatic rest
- 23. 23 LIFE STYLE MODIAFICATIONS DIET • Low fat diet • High protein • Fiber rich foods • Stay hydrated EXERCISES • Exercise regularly i.e. gentle exercises like yoga etc.. • Meditation for stress mabnagement. DO’s • Get enough sleep for 7-8 hrs • Maintain healthy weight • Eat small and frequent meals • Choose low fat and high protein foods • Include fiber foods • Stay hydrated • Monitor pancreatic enzyme levels DONT’s • Avoid fatty, greasy or spicy foods • Limit or avoid caffeine • Avoid high sugar foods • Avoid processed foods • Avoid alcohol and smoking • Don’t ignore the symptoms