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326 (Exam 2) Kidney, liver, gallbladder... > Pancreas > Flashcards

Pancreas Flashcards

1
Q

Severity of Pancreatitis

A

Mild Edema

to

Severe Hemorrhagic Necrosis

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2
Q

Pancreatitis Risk factors

A 
Middle Aged
African American (3X)
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3
Q

Etiology of pancreatitis

A

Biliary tract disease (women)

  • cancer of bile duct
  • stones
  • blockage/obstruction

Alcohol Abuse (men)

-Others

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4
Q

Pancreatitis: Pathogenesis

A
  1. Pancreatic cells are injured
  2. Pancreatic enzymes are activated
  3. Autodigestion
  4. Result: Mild to Severe Pancreatitis
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5
Q

Trypsin

A
  • Edema
  • Necrosis
  • Hemorrhage
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6
Q

Elastase

A

-Hemorrhage

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7
Q

Lipase

A

-Fat necrosis

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8
Q

Phospholipase A

A

-Fat necrosis

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9
Q

Kallikrein

A
  • Edema
  • Vascular permeability
  • Smooth muscle contraction
  • Shock
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10
Q

Where does pancreatitis occur on body?

A

LUQ or Epigastric Pain

  • Timing: sudden onset
  • Radiation: may radiate to back
  • Tenderness
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11
Q

Pancreatitis symptoms

A
  • N/V, abdominal distension, hypo BS
  • Fever
  • Hypotension, tachycardia (loss of fluid/pain)
  • Jaundice
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12
Q

What is increased in pancreatitis?

A

Amylase, Lipase, Glucose, WBC

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13
Q

Acute Pancreatitis: Physical manifestations

A

Cyanosis or green-yellow/brown discoloration of the abdomen

Ecchymoses (blood pooling)

  • Flanks (Grey Tuner’s sign)
  • Periumbilical (Cullen’s sign)
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14
Q

Acute Pancreatitis: Complications

A
  1. Pseudocyst
  2. Abscess
  3. Pulmonary complications
    - Pt not taking deep breaths (pain/fluid/enzymes)
  4. Hypotension
    - leaking vessels
  5. Tetany from hypocalcemia
    - Lipase causes fat necrosis» FFA bind to calcium
  6. Increased risk for clotting
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15
Q

2 Complications of pancreatitis

A
  1. Pseudocyst

2. Pancreatic abscess

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16
Q

Pseudocyst

A

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

17
Q

Pseudocyst Clinical presentation

A

similar to pancreatitis plus a palpable epigastric mass

18
Q

If a pseudocyst perforates is can cause

A

Peritonitis

19
Q

Pancreatic abscess

A

A large fluid filled cavity inside of pancreas

Result of extensive necrosis in the pancreas

May become infected or perforate

20
Q

Pancreatic abscess Clinical presentation

A

similar to pancreatitis plus abdominal mass, high fever (likelier w/abscess), and leukocytosis

21
Q

Definition of Chronic Pancreatitis

A

Inflammation in the pancreas that persists over weeks to months

22
Q

Main cause of Chronic Pancreatitis

A

ETOH abuse

-present in 50% of all alcoholics

23
Q

What is happening inside the pancreas with Chronic Pancreatitis?

A
  • Destruction of tissue/necrosis
  • Fibrosis
  • Loss of pancreatic enzymes and insulin (Inc glucose)
  • May continue even after ETOH use stops
24
Q

Chronic Pancreatitis: Manifestations

A

Attacks of acute pancreatitis with progressive signs of dysfunction after attack subsides

25
Q

Major symptom of Chronic pancreatitis

A

Chronic Pain

26
Q

What are some other symptoms of Chronic pancreatitis?

A
  • DM
  • Malabsorption of fat
  • Weight loss
27
Q

Pancreatitis Treatment w/drugs

A

Morphine

Dicyclomine (bentyl)
-antispasmodic (anticholinergic)

Antacids (decrease HCL + pancreatic enzymes)

H2-receptor antagonists (Zantac, Pepsid)

Pancrelipase (Creon)
-replacement of enzymes

Insulin
-If DM occurs

28
Q

Pancrelipase (Creon)

A

Class: Pancreatic enzyme replacement

Indic: Reverse secretion of pancreatic enzymes

AE: rare

Nursing Implications: Take with every meal and snack

29
Q

Rationale for Pt receiving following meds

A

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)

326 (Exam 2) Kidney, liver, gallbladder... (11 decks)

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