43 - Pancreatitis Flashcards
acute pancreatitis
spillage of pancreatic enzymes into surrounding pancreatic tissue
>causes autodigestion + severe pain
degree of inflammation varies fr mild edema to severe hemorrhagic necrosis
pancreatitis etiology
-ETOH
-biliary tract disease/gallstones
-treauma
-infectn
-drug/smoke
-post op GI
-unknown??
patho causes
-activation of pancreatic enzyme in the pancreas instead of the intestines
-injury to pancreatic cells
autodigestive effects of pancreatic enzymes
TRYPSIN
activation of trypsinogen to trypsin in the pancreas:
-edema
-necrosis
-hemorrhage
-when it leaks to abdomen, can cause green/yellow/brown discoloration
autodigestive effects of pancreatic enzymes
ELASTASE
hemorrhage
autodigestive effects of pancreatic enzymes
PHOSPHOLIPASE A + LIPASE
fat necrosis
autodigestive effects of pancreatic enzymes
KALIKREIN
-edema
-vasc permeability
-smooth muscle contraction
-shock
types of MILD pancreatitis
edematous or interstitial
SEVERE pancreatitis
-NECROTIC
-more permanent
-organ failure
-sepsis
most common manifestations
ab pain due to distention of pancreas, peritoneal irritation, + obstruction of biliary tract
**upper left quad or mid-epigastric
**radiate to back
**sudden onset
-eating worsens
-not resolved by vomiting
manifestations
-n/v
-low grade fever
-leukocytosis
hypotension
-tachycardia (severe sign)
-jaundice
-ab guarding
-decr/absent bowel sounds
—-paralytic ileus
-crackles in l ungs
-grey turner’s spot
-cullens sign
-hypo-Ca (chvostek or Trousseau)
hemorrhaging can lead to..
shock or toxemia
2 complicationis
pseudocysts + abscess
pancreatic pseudocysts
accum of fluid, enzymes, tissue debris, + inflmmtn exudates surrounded by a wall next to pancreas
pancreatic pseudocysts
manifestations
-ab pain
-palpable epigastric mass
-n/v
-anorexia
-HIGH amylase
pancreatic pseudocysts prognosis
-may be self limiting
-may perforate + cause peritonitis or rupture into stomach
pancreatic abscess
infected pesudocysts
everything is elevated except… from..
calcium
from fat necrosis
elevated diagnostics
-serum/urinary amylase
-lipase
-glucose
-triglycerides
primary diagnostic tests
serum amylase +lipase
-usually high early + stays high for 24-72 hrs
-lipase is more important
best imaging test
CT scan
Endoscopic retrograde cholangiopancreatography - ERCP
- check for obstruction in bile ducts
if paralytic ileus or constipation is present, then avoid which meds/.
anticholinergics like ATROPINE
-use spasmolytics likr nitro or papaverine instead
reduce/suppress pancreatic enzymes to decrease stimulation by…
RESTING
-NPO
-NG tube
-enteral support
-no ETOH/smoking
-low fat, high carb
-limit stress
