Hepatic System: Pancreatitis Flashcards
What are the two most common GI disorders?
• Liver and pancreas disorders
What is pancreatitis?
• Inflammation of the pancreas
What is the patho of pancreatitis?
• Pancreatic digestive enzymes are activated prematurely (before reaching the duodenum), resulting in autodigestion and fibrosis of the pancreas
What are the risk factors for pancreatitis?
- Alcohol abuse
- Bile tract disease/gall stones
- GI surgery
- Trauma
- Medication toxicity
What are the s/s of pancreatitis?
- Tachypneic Dyspnea, basilar crackles
- Tachycardia/Hypotension
- Severe LUQ or epigastric pain, radiating to back or left shoulder
- N/V – non-stop
- Ascites
- Jaundice
- Tetany
What are the two integumentary assessment signs indicating pancreatitis?
• Cullen’s and Turner’s
Describe Cullen’s Sign.
• Blue/grey discoloration around the umbilicus
Describe Turner’s Sign.
• Ecchymosis on flanks
What labs indicate pancreatitis?
- ↑ amylase, lipase, WBCs, bilirubin, glucose, PT
- ↓ potassium, calcium, magnesium, Hgb/Hct, platelets
- ABG = hypoxemia (metabolic acidosis)
What dx imaging is used for pancreatitis?
- Ultrasound
- CT/MRI
What is the immediate tx for suspected pancreatitis?
- NPO, then slowly progress to bland/low fat diet
- IV fluids/electrolytes (100mL NS)
- Get type and xmatch (bleeding expected)
What is the medication tx for pancreatitis?
- Opioid analgesics (morphine)
- Antibiotics
- Antiemetics
- Insulin
- Pancreatic enzymes w/ meals/snacks
What is complications is the nurse monitoring for with a pancreatitis pt?
- Chronic pancreatitis
- Pancreatic pseudocyst
- Type 1 diabetes
What is the general teaching for a pancreatic pt?
- No alcohol, get in a recovery program
- No smoking
- Low fat diet
What positions help relieve pancreatitis pain?
- Freq position changes
- Flex trunk and drawn knees to abdomen
- Side lying w/ HOB @45°
What is the pneumonic for remembering the causes of pancreatitis?
- I GET SMASHED
- I: Idiopathic
- G: Gallstones/genetic **she said she really only cares about this one**
- E: ETOH
- T: Trama, tumors
- S: Steroids (long term use)
- M: Microbiological (viruses
- A: Autoimmune (H. pylori)
- S: Shape of bacteria, surgery, scorpion sting
- H: Hyperlipidemia, hyperthyroidism, hypercalcemia
- E: Emboli or ischemia, ERCP
- D: Drugs/toxins
Who is more prone to gallstones, man or woman?
• Woman, due to estrogen, which increases biliary cholesterol secretion.
How does alcohol use cause pancreatitis?
- ↑ pancreatic secretions
- ↑ viscosity
- ↑ fatty acid in acinar cells which causes necrosis and fibrosis (autodigestion)
How would ERCP cause pancreatitis?
• Injury from catheter passage
How is Trypsin made and what does it do?
- Pancreatic acinar cells secrete trypsinogen which travels down the pancreatic duct into the duodenum.
- It is converted in the duodenum to trypsin
- Trypsin is an essential digestive enzyme
If there is a reflux of trypsin back into the pancreas, what occurs?
• Trypsin starts to digest the pancreas, which leads to inflammation, pancreatic necrosis and bleeding
What can cause trypsin to reflux into the pancreas?
• Pressure variants in the bile/pancreatic ducts caused by gallstones
How does pancreatitis affect amylase secretion?
- Rises early, within 2hrs of symptom onset
- Decreases early, within 36hrs to normal level (<85 u/L)
How does pancreatitis affect lipase secretion?
- Rises 4-8hrs post s/s onset, peaking around 24hrs and staying elevated for 14 days
- More indicative of acute pancreatitis
What are the normal levels for amylase and lipase?
- Amylase = <85 u/L
- Lipase = 10-140 u/L
What AST level indicates liver/pancreatic damage?
• > 350u/L
Why does calcium drop with pancreatitis?
• Increased free fatty acid levels ↑ update of calcium out of blood into cell
What are normal calcium levels?
• 8.5-10.5
Low calcium can result in…
• Tetany (intermittent muscle spasms)
Why is BUN elevated with pancreatitis?
• BUN rises with dehydration status (due to n/v)
Why do glucose levels rise w/ pancreatitis?
• Because the pancreas can’t secrete insulin to stimulate cellular uptake
How does pancreatitis cause fluid deficit > 6 L?
- Initial phase of acute pancreatitis is characterized by inflammation.
- This is caused by release of cytokines and other pro inflammatory mediators.
- These further cause vasodilatation, intravascular volume depletion, and end organ hypoperfusion.
- Patients of acute pancreatitis have significant fluid loss in third space.
- which decreases blood volume and results in a large drop in blood pressure, possibly causing shock
What do steroids do for pancreatitis?
• Reduces inflammation
True or False
Its ok to crush PPIs to administer to patient
• False, they will not work if they are crushed
How does Somatostatin or Octreotide reduce pain for pancreatitis?
• The suppress pancreatic secretion
What are 5 complications of pancreatitis?
- Pulmonary
- Cardiovascular
- Neurologic
- Renal
- Coagulation
What pulmonary complication can pancreatitis cause? Give patho and consequence if unresolved.
- Pleural effusion
- Fluid leaking from pancreas increases fluid in the pleural space (pleural effusion)
- If not remedied, the build up in pressure on the lungs will cause breathing and cardiac issues
What cardiovascular complication can pancreatitis cause? Give patho
- Shock
- hypovolemia (fluid 3rd spacing) and vasodilation
- Emboli
- Inflammation process causes changes in clotting systemincreasing risk of thrombus formation
- This can result in MI or stroke
What renal complication can pancreatitis cause? Give patho
• Acute renal failure (ARF) due to hypovolemia
How can pancreatitis result in DIC?
- Trypsin is necessary for hemostasis by activating the prothrombin needed for clot formation and activating plasminogen involved in clot lysis
- ↓ trypsin decreases both of these clotting factors and can lead to DIC
What is calcium soap?
- When the pancreas is damaged, free fatty acids are generated by pancreatic lipase.
- The free fatty acids bind to the calcium insoluble calcium salts of the pancreas resulting in calcium deposition in the retroperitoneum
What is a pancreatic pseudocyst?
- A pancreatic pseudocyst is a fluid-filled sac that forms in the abdomen comprised of pancreatic enzymes, blood, and necrotic (dead) tissue.
- Pancreatic pseudocysts account for approximately 75% of all pancreatic masses and typically are complications of chronic pancreatitis.
- No pancreatitis pt leaves the hospital w/out a CT scan for pseudocysts
What are the complications associated with a pancreatic pseudocyst?
- Hemorrhage
- Obstruction/rupture
- Cardiac tamponade
What is the main difference between acute and chronic pancreatitis?
- Acute pancreatitis damage can generally be reversed
- Chronic pancreatitis cannot due to the constant damage over tim
