Acute Pancreatitis Parts 1 & 2

Question 1

Acute Pancreatitis

Answer 1

Acute inflammatory process of pancreas
Varies from mild edema to severe necrosis
Most common in middle-aged persons and African Americans

Question 2

Etiology

Answer 2

Gallbladder disease (women)
Chronic alcohol intake (men)
Smoking
Hypertriglyceridemia

Question 3

Microlithiasis

Answer 3

Biliary sludge
Mixture of cholesterol crystals and calcium salts
Found in 20%-40% of pts
Formation is seen in patients with bile stasis

Question 4

Less common causes

Answer 4

Drugs
Metabolic disorders
Vascular diseases
Surgery and endoscopic procedures
Idiopathic causes
Trauma (postsurgical, abdominal)
Viral infections
Penetrating duodenal ulcer
Cysts
Abscesses
Cystic fibrosis
Kaposi sarcoma

Question 5

Pathophysiology

Answer 5

Autodigestion of pancreas
Lipolysis (hypocalcemia)
Proteolysis (gangrene)
Necrosis of blood vessels
Inflammation

Question 6

Lipolysis

Answer 6

Breakdown of fats and other lipids by hydrolysis to release fatty acids

Question 7

Proteolysis

Answer 7

Breakdown of proteins or peptides into amino acids by by the action of the enzyme

Question 8

Predominant abdominal pain

Answer 8

Clinical manifestations
LUQ or midepigastrium
Radiates to back
Sudden onset
Deep, piercing, continuous or steady
Aggravated by eating
Starts when recumbent
Not relieved w/ vomiting

Question 9

Clinical Manifestations

Answer 9

Flushing
Cyanosis
Dyspnea
Nausea/Vomiting
Low-grade fever
Leukocytosis
Hypotension, Tachycardia
Jaundice
Abdominal tenderness w/ guarding
Decreased/absent bowel sounds
Crackles
Abdominal skin discoloration (Grey Turner's or Cullen's sign)
Shock

Question 10

Grey Turner’s Sign

Answer 10

Back or flank discoloration (bluish)

Question 11

Cullen’s Sign

Answer 11

Periumbilical discoloration (bluish)

Question 12

Pseudocyst

Answer 12

*Complicaiton
Fluid, enzyme, debris, exudates surrounded by wall
Abdominal pain, palpable mass, N/V, anorexia
Detected w/ imaging
Resolves spontaneously or may perforate and cause peritonitis
Surgical or endoscopic drainage

Question 13

Peritonitis

Answer 13

Inflammation of the peritoneum

Question 14

Pancreatic Abscess

Answer 14

*Complication
Collection of pus
Results from extensive necrosis
May perforate
Upper abdominal pain, mass, high fever, leukocytosis
Surgical drainage

Question 15

Systemic Complications

Answer 15

Pleural effusion
Atelectasis
Pneumonia
ARDS
Hypotension
Hypocalcemia: tetany

Question 16

Lab Tests

Answer 16

Serum amylase level
Serum lipase level
Liver enzyme levels
Triglyceride levels
Glucose level
Bilirubin level
Serum calcium level

Question 17

Diagnostic Studies

Answer 17

Abdominal ultrasonography
X-ray
Contrast-enhanced CT scan
ERCP
ADDITIONAL STUDIES:
Endoscopic Ultrasonography
MRCP
Angiography

Question 18

Objectives of Collaborative Care

Answer 18

Relief of pain
Prevention of shock
Decrease pancreatic secretions
Correction of fluid/electrolyte imbalance
Prevention/treatment of infection
Removal of precipitating cause

Question 19

Supportive Care (Collaborative Care)

Answer 19

Aggressive hydration
Pain management
Management of metabolic complications
Minimizing pancreatic stimulation

Question 20

Conservative Therapy

Collaborative Care

Answer 20

Shock
Fluid/Electrolyte imbalance
Prevention infection

Question 21

Surgical Therapy

Answer 21

For gallstones
-ERCP
-Cholecystectomy
Uncertain diagnosis
Not responding to conservative therapy
Drainage of necrotic fluid collections

Question 22

Drug Therapy

Answer 22

IV Morphine
Antispasmodics
Carbonic anhydrase inhibitors
Antacids
Proton pump inhibitors

Question 23

Nutritional Therapy

Answer 23

NPO status initially
Enteral vs parenteral nutrition
Monitor triglycerides if IV lipids given
Small, frequent feedings when able (high-carbs)
No alcohol
Supplemental fat-soluble vitamins

Question 24

Objective Data

Answer 24

Low-grade fever, anxiety, restlessness
Flushing, diaphoresis
Discoloration of abdomen/flank
Cyanosis
Jaundice
Decreased skin turgor
Dry mucous membranes
Tachypnea
Basilar crackles
Tachycardia
Hypotension
Abdominal distention/tenderness
Diminished bowel sounds

Question 25

Abnormal lab findings

Answer 25

Increase serum amylase/lipase levels
Leukocytosis
Hyperglycemia
Hypocalcemia
Abnormal findings on ultrasonography/CT scans
Abnormal findings on ERCP

Question 26

Planning

Answer 26

Relief of pain
Normal fluid/electrolyte balance
Minimal to no complications
No recurrent attacks

Question 27

Health Promotion

Answer 27

Assessment and early treatment of predisposing/etiologic factors
Early diagnosis/treatment of biliary tract disease
Elimination of alcohol intake

Question 28

Acute Interventions

Answer 28

Monitoring VS
Assess respiratory function
Monitor IV fluids
Pain assessment/management
Frequent oral/nasal care
Proper administration of antacids
Observe for signs of infection
TCDB, semi-Fowler's position
Wound care
Observe for paralytic ileus, renal failure, mental changes
Monitor serum glucose
Post-op wound care

Question 29

Monitor fluid and electrolyte balance

Answer 29

Chloride, sodium, potassium
Hypocalcemia
-Tetany
-Calcium gluconate to treat
Hypomagnesemia

Question 30

Chvostek’s Sign

Answer 30

Contraction of facial muscles in response to light tap over facial nerve in front of ear

Question 31

Trousseau’s Sign

Answer 31

Carpal spasm induced by inflating BP cuff above systolic pressure for a few minutes

Question 32

Ambulatory and Home Care

Answer 32

Physical therapy
Assessment of narcotic addiction
Counseling regarding abstinence from alcohol and smoking