Acute Pancreatitis Parts 1 & 2 Flashcards
Acute Pancreatitis
Acute inflammatory process of pancreas
Varies from mild edema to severe necrosis
Most common in middle-aged persons and African Americans
Etiology
Gallbladder disease (women)
Chronic alcohol intake (men)
Smoking
Hypertriglyceridemia
Microlithiasis
Biliary sludge
Mixture of cholesterol crystals and calcium salts
Found in 20%-40% of pts
Formation is seen in patients with bile stasis
Less common causes
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
Pathophysiology
Autodigestion of pancreas Lipolysis (hypocalcemia) Proteolysis (gangrene) Necrosis of blood vessels Inflammation
Lipolysis
Breakdown of fats and other lipids by hydrolysis to release fatty acids
Proteolysis
Breakdown of proteins or peptides into amino acids by by the action of the enzyme
Predominant abdominal pain
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
Clinical Manifestations
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
Grey Turner’s Sign
Back or flank discoloration (bluish)
Cullen’s Sign
Periumbilical discoloration (bluish)
Pseudocyst
*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
Peritonitis
Inflammation of the peritoneum
Pancreatic Abscess
*Complication Collection of pus Results from extensive necrosis May perforate Upper abdominal pain, mass, high fever, leukocytosis Surgical drainage
Systemic Complications
Pleural effusion Atelectasis Pneumonia ARDS Hypotension Hypocalcemia: tetany
Lab Tests
Serum amylase level Serum lipase level Liver enzyme levels Triglyceride levels Glucose level Bilirubin level Serum calcium level
Diagnostic Studies
Abdominal ultrasonography X-ray Contrast-enhanced CT scan ERCP ADDITIONAL STUDIES: Endoscopic Ultrasonography MRCP Angiography
Objectives of Collaborative Care
Relief of pain Prevention of shock Decrease pancreatic secretions Correction of fluid/electrolyte imbalance Prevention/treatment of infection Removal of precipitating cause
Supportive Care (Collaborative Care)
Aggressive hydration
Pain management
Management of metabolic complications
Minimizing pancreatic stimulation
Conservative Therapy
Collaborative Care
Shock
Fluid/Electrolyte imbalance
Prevention infection
Surgical Therapy
For gallstones -ERCP -Cholecystectomy Uncertain diagnosis Not responding to conservative therapy Drainage of necrotic fluid collections
Drug Therapy
IV Morphine Antispasmodics Carbonic anhydrase inhibitors Antacids Proton pump inhibitors
Nutritional Therapy
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
Objective Data
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
Abnormal lab findings
Increase serum amylase/lipase levels Leukocytosis Hyperglycemia Hypocalcemia Abnormal findings on ultrasonography/CT scans Abnormal findings on ERCP
Planning
Relief of pain
Normal fluid/electrolyte balance
Minimal to no complications
No recurrent attacks
Health Promotion
Assessment and early treatment of predisposing/etiologic factors
Early diagnosis/treatment of biliary tract disease
Elimination of alcohol intake
Acute Interventions
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
Monitor fluid and electrolyte balance
Chloride, sodium, potassium Hypocalcemia -Tetany -Calcium gluconate to treat Hypomagnesemia
Chvostek’s Sign
Contraction of facial muscles in response to light tap over facial nerve in front of ear
Trousseau’s Sign
Carpal spasm induced by inflating BP cuff above systolic pressure for a few minutes
Ambulatory and Home Care
Physical therapy
Assessment of narcotic addiction
Counseling regarding abstinence from alcohol and smoking
