Pancreatitis Flashcards
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Pancreas Anatomy
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Divided into the head, body and tail
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Endocrine functions
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Islet of Langerhans
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Exocrine functions
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Acinar cells
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Pancreatitis: Defined as
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an autodigestion of the pancreas. This occurs due to a premature activation of pancreatic enzymes. Can lead to inflammation, necrosis, and hemorrhage Acute mortality is 10-20% Chronic mortality is 50%
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Acute Pancreatitis: Etiology
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alcoholism biliary tract disease infection (viral) trauma drugs postop GI surgery (ERCP)
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Acute Pancreatitis: Manifestations
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•Abrupt onset of continuous severe epigastric and LUQ pain (relieved by sitting up and leaning forward, radiates to back) •N/V •Abd distention and rigidity •Decreased bowel sounds or absent •Hypotension (fluid shift) •Fever, cold clammy skin (shock) •Jaundice •Bruising in flanks or around umbilicus
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Acute Pancreatitis: Complications
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Hypovolemia (fluid shift, renal failure) Chronic Pancreatitis Hypocalcemia (?) Pancreatic Infection (cyst) Type I Diabetes pulmonary effusion, atelectisis
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Acute Pancreatitis: Ranson's Criteria
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•Ranson Score of 0-2, minimal mortality •Ranson Score of 3-5, 10%-20% mortality •Ranson Score of >5 has more than 50% mortality and is associated with more systemic complications (renal, acute respiratory distress)
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Acute Pancreatitis: Diagnostics
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•Serum Amylase and Lipase •Ultrasound (tissue) •ERCP (bile duct, in pancreas) •CBC (WBC, H&H)
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Edemitus Pancreatitis
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mild inflamation, edema
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Necrotizing Pancreatitis
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cell death, tissue damage, systemic complications
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Turner's sign
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bruising on flank risk for hemorrhage and shock
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Cullen's Sign
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bruising around the umbilicusrisk for hemorrhage and shock
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Acute Pancreatitis: Goals
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•Pain Relief (PCA) •Prevention or alleviation of shock (ARF) •Reduce pancreatic secretions (NPO) •Control of fluid/electrolyte imbalances (Hydration) •Prevention or tx of infections
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Chronic Pancreatitis
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•Defined as progressive destruction of the pancreas (calcifies and becomes necrotic) Alcohol causes 80% •Mortality can be as high as 50%
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Chronic Pancreatitis: Manifestations
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•Abdominal pain •Nausea/Vomiting •Fever •Bloating/Flatulence •Steatorrhea (oily stools) enzymes in pancreas not breaking down fats •Jaundice with dark urine (dehydration)
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Chronic Pancreatitis: Etiology
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•Obstruction (gall stones) •Genetics •Trauma (or ERCP) •Toxic Metabolic Process (alcohol, immunosuppresives) •Increased Triglycerides (toxic to acinar cells) •Infectious Agents (bacterial, viral)
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Chronic Pancreatitis: Chronic Complications
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•Malabsorption, Malnutrition (TPN, Lipids) •Pancreatic Pseudocyst (necrotic agent) •Diabetes Mellitus •Risk for Pancreatic Cancer •Risk for Narcotic Addiction (PCA, assess pain, anxiety, coping)
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Chronic Pancreatitis: Diagnostics
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•Serum Amylase (2-3 times normal) (CHO) •Serum Lipase (elevated 7-14 days)(lipids) •Serum Glucose •Serum Bilirubin and ALT (compressed bile duct) •CBC, BUN, Cr (WBC, renal) •Ultrasound, ERCP, Aspiration (Dx cancer, malignancy)
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Chronic Pancreatitis: Collaborative Care
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•Bland diet: low fat, high carbs, no alcohol •Pancreatic Enzyme replacement (with meals) •Control Diabetes
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Chronic Pancreatitis: Nursing Interventions
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•Rest (pancreas and bowel) •Pain Relief •Replace (fluid and electrolytes) •Nutritional Support (slowly intro food back)
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Chronic Pancreatitis: Nursing Diagnoses
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•Acute Pain •Imbalanced Nutrition: Less than body requirements •Anxiety •Ineffective Coping •Risk for infection •Noncompliance
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Chronic Pancreatitis: Patient Teaching
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•Related to Etiology •Alcohol Abuse •Diet (Low fat, high carb, no alcohol) •Surgical Education
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autodigestive effects of enzymes
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Trypsin: edema, necrosis, hemorrhage Elastase: hemorrhage Phospholipase A: Fat necrosis Lipase: fat necrosis Kallkrein: edema, vascular permeability, smooth muscle contraction, shock
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WBC
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>16,000
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Glucose
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>200
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LDH
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>350
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AST
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>250
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age
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>55yrs
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Reevaluate 24-48hrs
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Hct drop 10% bleed BUN increase >8 renal failure Ca2+ <8 not absorbing
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PCA
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•Pain Relief
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ARF, volume expanders (albumin), plasma
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•Prevention or alleviation of shock
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NPO with suction
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•Reduce pancreatic secretions
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Hydration
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•Control of fluid/electrolyte imbalances
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Chronic Pancreatitis: Interventions
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•Antibiotics •Imipenem (broad spec, don't give with dextrose) •Treatment of triglycerides •Lipid Lowering drugs (statins) •Surgery remove gall stones, cholecystectomy, drainage proceedures, resection •Preparation other: folic acid, coping,
