Disorders of the Pancreas Flashcards
Where is the pancreas location
in epigastrum behind the stomach
What are the functions of the pancreas
Endocrine: hormones in the blood (insulin, glucagon)
Exocrine: hormones into ducts that go into the tissues (trypsin, lipase, amylase)
What are the 2 types of pancreatitis ?
Acute and chronic
What is acute pancreatitis caused by?
Gallstones**
Alcohol
What is acute pancreatitis
An acute inflammation of the pancreas which varies from mild edema to severe hemorrhagic necrosis.
Pathophysiology is auto digestion of the pancreas
With pancreatitis the patient can be acutely ill at risk for:
- hypovolemic shock (bleeding)
- fluid and electrolyte disturbances
- sepsis
Physiological map of pancreatitis
Etiological factors
alcohol use disorder
biliary tract disease
trauma
infection
drugs
postop GI sx
activation of pancreatic enzymes
OR
Injury to pancreatic cells
causes:
autodigestive of pancreatic enzymes
- trypsin - edema, necrosis, hemorrhage
- elastase - hemorrhage
- phospholipase - fat necrosis
- lipase - fat necrosis
- kallikrein - edema, shock, smooth muscle contraction etc.
Clinical manifestations of pancreatitis
Severe abdominal pain (predominant symptom), deep, piercing, top of the abdo radiating to the back, happens when laying down and after eating or drinking alcohol, not relieved by vomitting
Nausea and vomiting
Low grade fever
Leukocytosis (high WBC’s)
Abdomen can be rigid or board-like
Ecchymosis (bruising) in the flank (Grey Turner’s Sign) or around the umbilicus (Cullen’s Sign) in severe cases
Bowel sounds may be decreased
Crackles to lungs (can lead to ARDS – acute resp distress syndrome)
Both septic and hypovolemic shock are possible outcomes in severe cases
Stools are often bulky, pale, and foul smelling (fat content is 50 – 90% - normal is 20%), steatorrhea
Complications of pancreatitis
Severe pancreatitis – complete enzymatic autodigestion of the gland
- Tissue becomes necrotic
-Damage extends into retroperitoneal tissues
Local complications – pseudocyst develops
- Rupture/perforation – need to be drained
- Pancreatic abscess- a large collection of puss in the pancreas from pancreatic necrosis. Manifestations: abdo pain (palpable), nausea, vomiting, anorexia
- Must be drained promptly or can cause infection (abcess). Manifestations: fever
Systemic complications
- Primary ones are pulmonary (pleural effusion, atelectasis, and pneumonia) , cardiovascular (hypotension) and tetany caused by hypocalcemia
- Pulmonary complications are caused by: passage of exudate containing pancreatic enzymes from peritoneal cavity from trans diaphragmatic lymph channel. Causes lack of movement leading to atelectasis
Trypsin which is an enzyme in small intestine can activate prothrombin and plasminogen increasing the risk of? Pulmonary embolism
- Typsin breaks down proteins (from pancreas)
Diagnostic tests of pancreatitis
Serum amylase usually elevated early and remains so for 24 hours.
Serum lipase is also elevated and helps differentiate pancreatitis from other disorders
WBC – elevated
Calcium- decreased
Liver enzymes elevated, glucose increased, bilirubin increased.
HCT and hemoglobin levels – check for bleeding
Abdo ultrasound
Abdo CT with contrast (used to detect complications)
MRCP
Goals of care of acute pancreatitis
1) Pain relief (IV narcotic, demoral)
2) Other Meds (antiemetics, antispasmodics, antacids, nitro, PPIs)
3) Prevention/ alleviation of shock (tachycardia, fever, HTN)
4) Reduction of pancreatic secretions (NPO, NG tube, TPN)
5) Control of fluid and electrolyte imbalances (I and O)
6) Prevention/ treatment of infection (SEPSIS)
7) Assess Respiratory Functioning (O2, RR, O2 therapy, semi fowlers, ABGs)
8) Assess for hypocalcemia (tetany – muscle twitching, tremors, irritability)
9) Removal of the precipitating cause (if possible)
Care of acute pancreatitis - nutrition
Initially NPO
When food is allowed, the diet is usually high in carbs because they are the least stimulating
Abstain from alcohol
Prevention and promotion of acute pancreatitis
Avoid high fat foods, heavy meals, and alcohol
Referral to home care if going home
Referral to alcoholic support groups (ie. AA)
Chronic Pancreatitis
An inflammatory disorder characterized by progressive anatomic and functional destruction of the pancreas.
Pancreatic cells are replaced by fibrous tissue with repeated attacks of pancreatitis.
Two types of chronic pancreatitis
Obstructive: mechanical obstruction of pancreatic, common bile duct and the duodenum d/t biliary disease
Nonobstructive: associated with inflammation and sclerosis mainly in the head of the pancreas d/t alcoholism
Chronic pancreatitis manifestations
Like acute pancreatitis but recurring attacks are more severe, more frequent, and longer duration
Wt loss – experienced by 75% of pts (usually secondary to malabsorption); problems with digestion of fats and proteins; steatorrhea, diabetes mellitus, constipation, mild jaundice w dark urine
Pain LUQ or epigastric, but heavy, gnawing feeling; burning; cramp like. Not relieved with food or antacids.
