Biliary disorders part 2 : Pancreas Flashcards
what is the function of the panceas?
digesting food and managing your use of sugar for energy after digestion.
Pancreatitis
(inflammation of the pancreas) is a serious disorder
pancreatitis is commonly described as
autodigestion of the pancreas
forms of pancreatitis divides the disorder into categories based on duration
acute and chronic forms
Acute pancreatitis is considered
a medical emergency associated with a high risk of life-threatening complications and mortality,
The pancreatic acinar cells are
functional unit of the exocrine pancreas.
they secrete inactive digestive enzymes
when do the inactive digestive enzymes become active?
once they reach the duodenum and get in contact with stomach acids
If enzymes are not active, what happens to food in stomach?
food will not be digested!!!
what is the function of Epithelial cells in the pancreas?
they secrete secretin which is used to digest bicarb (bicarb is used to neutralize stomach acid and pH levels)
how many cases of Acute pancreatitis each year?
200k cases
what percentage of Acute Pancreatitis is caused by cholelithiasis or sustained alcohol abuse.
80%
two main types of acute pancreatitis (mild and severe) are classified as
interstitial edematous pancreatitis and necrotizing pancreatitis
Interstitial pancreatitis affects the majority of patients and It is characterized by
a lack of necrosis.
diffuse enlargement of the gland due to inflammatory edema.
The inflammation is confined to the pancreas itself.
what percentage of acinar cell function is lost at the diagnosis of acute pancreatitis?
90%
patients with Interstitial pancreatitis are at risk for?
Hypovolemic shock
Sepsis
Fluid and electrolyte imbalance
patients with Interstitial edematous pancreatitis are expected to return to normal function within?
6 months
Necrotizing Pancreatitis is characterized by
tissue necrosis
damage to blood vessels
bleeding and thrombosis
extends beyond the pancreas
patients with Necrotizing Pancreatitis are at risk for?
Organ failure
GI bleed
Shock
Fluid collection
what are risk factors for developing pancreatitis?
- blunt abdominal trauma
- alcohol abuse
- oral contraceptives
- tabacco
- use of diuretics
- corticosteroids
- hyperlipidemia
- hypercalcemia
clinical manifestation of pancreatitis
- severe abdominal pain
- cullen’s sign
- Gary-turner’s sign
- hypotension related to hypovolemia
- tachycardia, cyanosis, cold clammy skin
- respiratory distress & hypoxia
what type of pain associate with pancreatitis?
severe abdominal pain,
mostly post meals (24-48 hours),
not relieved by antacids.
abdominal rigidity is an indication of?
peritonitis
gary-turners sign is?
bruising on the sides of the patient when you TURN them. Indicating internal bleeding.
cullens sign is
C shaped bruising around the umbilicus
clammy skin means
wet skin due to sweating
The diagnosis of acute pancreatitis is based on the fulfillment of two out of the three following criteria:
- a history of upper abdominal pain,
- 3x increase in serum amylase or lipase levels
- findings on imaging (CT, MRI)
abscesses are seen via which imaging methods?
CT and MRI. Not X-rays
what other diagnostic lab work is used to assess pancreatitis?
- Hgb and Hct levels (decreased for bleeding)
- elevated WBC
- Hypocalcemia
- increased levels of pancreatic enzymes
What additional procedure might be used to visualize and treat?
ERCP
there are three degrees of pancreatitis severity:
- mild
- moderately severe
- severe acute
(1) mild pancreatitis
the absence of organ failure and no local or systemic complications
(2) moderately severe pancreatitis
the presence of short-term organ failure or local or systemic complications,
(3) severe acute pancreatitis
characterized by persistent organ failure
Medical management of acute pancreatitis starts with
- NPO to inhibit pancreas stimulation
- (NG) tube is used for nutrition
- pain relief using parenteral opioids such as morphine, fentanyl
- respiratory care
- Biliary drainage
respiratory care for Medical management of acute pancreatitis includes:
- monitoring arterial blood gases (ABG)
- using humidified oxygen
- intubation & mechanical ventilation
biliary drainage for Medical management of acute pancreatitis includes:
- Placement of biliary drains (for external drainage)
- stents (indwelling tubes) in the pancreatic duct
to reestablish drainage of the pancreas. This has resulted in decreased pain.
Surgery for pancreatitis is performed to
to establish pancreatic drainage;
or to resect or débride an infected, necrotic pancreas
what type of feeding given, and medication restriction must be followed post acute pancreatitis management includes:
- Oral feedings that are low in fat and protein are initiated gradually.
- Caffeine and alcohol are eliminated from the diet.
- discontinuing risk factor medications (corticosteroids, oral contraceptives)
- follow-up x-ray and ERCP
nursing bedside interventions for a hospitalized acute pancreatitis
- semi-fowler position (decrease pressure on diaphragm)
- frequent repositioning (prevent respiratory secretion pooling)
- monitor Pulse Ox (ABG)
- assess pain
- monitor Blood Glucose q4-6h
- assess drainage sites (infection)
- assess skin (hydration/turgor, jaundice)
a major cause of morbidity and mortality in patients with acute pancreatitis is
Pancreatic necrosis
Pancreatic necrosis requires
surgical, percutaneous or endoscopic débridement
