E2-Pancreas Patho Flashcards
What is acute pancreatitis?
Inflammation of pancreas
What is the cause of acute pancreatitis?
Obstruction of the outflow of pancreatic enzymes usually r/t pancreatic and bile duct obstruction (usually gallstone)
Also: Alcohol, drugs, viral infection
The backup of of enzymes leads to..
auto digestion of pancreatic cells
Autodigestion of pancreatic cells causes
PANCREATITIS
-Vascular damage
-Coagulopathy
-Necrosis
-Fat necrosis within pancreas
What are the pancreatic enzymes and causes
- Trypsin: edema, necrosis, hemorrhage
- Elastase: Hemorrhage
- Phospholipase A: fat necrosis
- Kallikrein: Edema, vascular permeability, smooth muscle contraction, shock
- Lipase: Fat necrosis
What is vascular permeability?
enlarged abdomen from fluid leaking into the space causing ascites
leads to shock
Acute pancreatitis manifesations
-Epigastric pain: severe
-Sudden onset
-Radiates to back
-Guarding
-Tenderness
-N/V
-abdominal distention
-Hypoactive bowels
-Hypotension
-Tachycardia
-Jaundice
What do labs look like in acute pancreatitis?
Increased Amylase, Lipase, and WBC
Glucose can be increased or decreased
Unique manifestations of acute pancreatitis that could occur?
-Cyanosis or green/yellow/brown discoloration of abdomen
-Ecchymoses: severe, hemorrhagic pancreatitis (leaky vessels)
1. Flanks (Grey Turners sign)
2. Periumbilical (Cullen’s sign)
Acute pancreatitis complications?
- Pseudocyst
- Abscess
- Pulmonary complications (from pain or pleural effusion)
- Hypotension –> shock
- Tetany from hypocalcemia
What is pseudocyst?
Fluid-filled cavity that surrounds the outside of the pancreas (CT scan)
Pseudocyst results in
scarring and inflammation of areas near pancreas
Clinical manifestations of pseudocyst?
-similar to pancreatitis + palpable epigastric mass
What is the biggest concern of pseudocyst?
May perforate –> peritonitis
What is a pancreatic abscess?
A large fluid filled cavity inside the pancreas
Pancreatic abscess is a result of
extensive necrosis in the pancreas
Clinical manifestations of pancreatic abscess?
Similar to pancreatitis + abdominal mass, high fever, & leukocytosis
Biggest concern of pancreatic abscess?
May become infected or perforate (peritonitis)
What is chronic pancreatitis?
Progressive, fibrotic disease of the pancreas
What is the most common cause of chronic pancreatitis?
Alcohol abuse
Explain why alcohol causes chronic pancreatitis?
Toxic metabolites release inflammatory cytokines and cause destruction of acinar cells & islet of langerhans
What do acinar cells do?
processes alcohol
What do islet of langerhans do?
glucose/insulin management
What is pancreatic cysts?
walled off areas of pancreatic juice, necrotic debris, or blood
Clinical manifestations of chronic pancreatitis?
-Attacks of acute pancreatitis w/ progressive signs of dysfunction after attack subsides
-Abdominal pain & weight loss
-Lead to diabetes
-Issues w/ nutritional absorption esp. fats
Drug therapy for pancreatitis
- Opioids
- Dicyclomine
- Antacids
- H2-receptor antagonists
- Pancrelipase
- Insulin
MOA of dicyclomine
Antispasmodic (anticholinergic effects)
-Decrease secretions & relax smooth muscle to decrease secretion of pancreatic enzymes
MOA of antacids & H2-receptor antagonist
Decrease HCl secretion in the stomach which decreases secretion of pancreatic anzymes
Classification of pancrelipase
Pancreatic enzyme replacement
Indication of pancrelipase
Reduced secretion of pancreatic enzymes
Adverse effects of pancrelipase
rare
Nursing implications of pancrelipase
Take with every meal and snack
(bc don’t have digestion enzymes)
