Pancreas Flashcards
Severity of Pancreatitis
Mild Edema
to
Severe Hemorrhagic Necrosis
Pancreatitis Risk factors
Middle Aged African American (3X)
Etiology of pancreatitis
Biliary tract disease (women)
- cancer of bile duct
- stones
- blockage/obstruction
Alcohol Abuse (men)
-Others
Pancreatitis: Pathogenesis
- Pancreatic cells are injured
- Pancreatic enzymes are activated
- Autodigestion
- Result: Mild to Severe Pancreatitis
Trypsin
- Edema
- Necrosis
- Hemorrhage
Elastase
-Hemorrhage
Lipase
-Fat necrosis
Phospholipase A
-Fat necrosis
Kallikrein
- Edema
- Vascular permeability
- Smooth muscle contraction
- Shock
Where does pancreatitis occur on body?
LUQ or Epigastric Pain
- Timing: sudden onset
- Radiation: may radiate to back
- Tenderness
Pancreatitis symptoms
- N/V, abdominal distension, hypo BS
- Fever
- Hypotension, tachycardia (loss of fluid/pain)
- Jaundice
What is increased in pancreatitis?
Amylase, Lipase, Glucose, WBC
Acute Pancreatitis: Physical manifestations
Cyanosis or green-yellow/brown discoloration of the abdomen
Ecchymoses (blood pooling)
- Flanks (Grey Tuner’s sign)
- Periumbilical (Cullen’s sign)
Acute Pancreatitis: Complications
- Pseudocyst
- Abscess
- Pulmonary complications
- Pt not taking deep breaths (pain/fluid/enzymes) - Hypotension
- leaking vessels - Tetany from hypocalcemia
- Lipase causes fat necrosis» FFA bind to calcium - Increased risk for clotting
2 Complications of pancreatitis
- Pseudocyst
2. Pancreatic abscess
Pseudocyst
Fluid-filled cavity that surrounds the outside of the pancreas
-Necrotic products and secretions
Results in inflammation and scarring of the areas near the pancreas
Pseudocyst Clinical presentation
similar to pancreatitis plus a palpable epigastric mass
If a pseudocyst perforates is can cause
Peritonitis
Pancreatic abscess
A large fluid filled cavity inside of pancreas
Result of extensive necrosis in the pancreas
May become infected or perforate
Pancreatic abscess Clinical presentation
similar to pancreatitis plus abdominal mass, high fever (likelier w/abscess), and leukocytosis
Definition of Chronic Pancreatitis
Inflammation in the pancreas that persists over weeks to months
Main cause of Chronic Pancreatitis
ETOH abuse
-present in 50% of all alcoholics
What is happening inside the pancreas with Chronic Pancreatitis?
- Destruction of tissue/necrosis
- Fibrosis
- Loss of pancreatic enzymes and insulin (Inc glucose)
- May continue even after ETOH use stops
Chronic Pancreatitis: Manifestations
Attacks of acute pancreatitis with progressive signs of dysfunction after attack subsides
Major symptom of Chronic pancreatitis
Chronic Pain
What are some other symptoms of Chronic pancreatitis?
- DM
- Malabsorption of fat
- Weight loss
Pancreatitis Treatment w/drugs
Morphine
Dicyclomine (bentyl)
-antispasmodic (anticholinergic)
Antacids (decrease HCL + pancreatic enzymes)
H2-receptor antagonists (Zantac, Pepsid)
Pancrelipase (Creon)
-replacement of enzymes
Insulin
-If DM occurs
Pancrelipase (Creon)
Class: Pancreatic enzyme replacement
Indic: Reverse secretion of pancreatic enzymes
AE: rare
Nursing Implications: Take with every meal and snack
Rationale for Pt receiving following meds
IV Fluids
- replacement (leaky vessels)
- Increased Vascular permeability due to inflammation
Fentanyl
-Strong pain control
Protonix
-PPI
Stool softener
-No straining (pain)
Lovenox
-risk for clotting (DVT/PE)
