Pancreas Flashcards
pancreas releases (pancakes are TAL)
alkaline juices that neutralize acidity in stomach. trypsin - protein, lipase - fat, amalyse - carbs.
Exocrine
Exocrine: amylase, trypsin, lipase, secretin
Endocrine
Endocrine: insulin, glucagon, somatostatin
med if your pancreas doesn’t work (and give with what)
Pancrealipase (Creon). Need to take with food. Must give with COLD water.
Pancrealipase - side effects
usually due to insulin.
pancreas also releases (pancakes are bi)
Bicarbonate and water are secreted by the epithelial cells that line the pancreatic ducts-this neutralizes the acid form the stomach
acute pancreatitis
Inflammation of pancreas…micro and macrovascular failure…resulting autodigestion…SIRS…
3 stages of acute pancreatitis
Trypsin and other enzymes prematurely activate
Amylase and lipase
Intrapancreatic inflammation
Extrapancreatic/systemic injury
result of pancreatitis
Results in pancreatic pain, tissue edema, necrosis of pancreatic tissue and possibly hemorrhage
acute pancreatitis does not mean you’ll get
chronic pancreatitis
can develop what types of shock with pancreatitis?
hypovolemic, sepsis, and hemoragic.
Chronic pancreatitis (alchys get fibrous)
Chronic: progressive inflammatory disorder with destruction of the pancreas; cells are replaced by fibrous tissue; pressure within the pancreas increases, obstructing the pancreatic and common bile ducts
acute pancreatitis (just a block)
pancreatic duct becomes obstructed, and enzymes back up, causing autodigestion and inflammation of the pancreas
acute pancreatitis causes
gallstones (30%)
Alcohol (30%)
Gall bladder disease
Drugs
Hypercalcemia, hypertryglyceridemia
Infection
IBD
PUD
Trauma
Toxins
chronic pancreatitis causes
alcohol
pancreatitis - s/sx (painful pancake in my stomach and back) (these pancakes are rigid)
Pain- upper abdominal/back
Abdominal distension/ascites
Rigid abdomen, guarding
Cullen’s or Turner’s signs (bruising)
Fever
N/V
Jaundice
Hypotension
Confusion or agitation
acute pancreatitis - labs
amylase - up (2 to 3 times normal) (releasing it bc everything is out of whack)
lipase - up (2 to 3 times normal)
glucose - up
calcium - down
wbc - up
bun - up
bilirubin - up
lDH up
albumin - down
acute pancreatitis - diagnostics (need an ultra cutie to see pancakes)
KUB (just an x-ray), CT (for fluids) , ultrasound (to see gallstones)
pancreatitis is just
autodigestion.
acute pancreatitis - skin AND the ones you need to pay attention to…(cullen and grey are a cute pancake)
Skin: Cullen’s (bruising on stomach) and Grey Turner’s signs (bruisng on stomach), jaundice, bruising, redness, irritation
acute pancreatitis - Electrolyte imbalances (can’t digest, so basically everything is low but sugar)
Electrolyte imbalances: hypocalcemia, hypokalemia, hypomagnesemia, hypo/hyperglycemia
complications of acute pancreatitis - local (a cute pancake can have an abcess)
Acute fluid collections
Pancreatic fistulae
Pancreatic pseudocyst (enclosed like a cyst)
Pancreatic abscess (mortality rate doubles, these ppl are really sick)
Pancreatic necrosis
Primary infections
d/t pancreatic necrosis
complications of acute pancreatitis - systemic
Hypoxemia
Pneumonia
Pleural effusion
Hyperglycemia
Hypocalcemia
ARDS
Hypovolemic shock
Hemorrhage
ATN
Pancreatic encephalopathy
Analgesia
DIC
main issues w/ acute pancreatitis
Fluid and electrolyte disturbances
Necrosis of the pancreas
Shock
Multiple organ dysfunction syndrome
DIC (becuase we’re not absorbing vitamin K)
plueral effusion because the acid eats through the lungs
pancreatitis - gum and losenges?
nope, will stimulate pancreatic enzymes
TPN - nursing considerations
Keep refrigerated; warm (let sit out a few minutes) prior to administration
Central line needed
Filter needed
NOTHING else should go through this line
Discontinue GRADUALLY to avoid hypoglycemia
Daily weights
May have to start insulin
Can only be hung for 24 hours
Ordered daily
Change tubing & filter with each bag
Needs to be on a pump
Most frequent complication is INFECTION
goals for pancreatitis
Stabilize hemodynamics
Control pain
Minimize pancreatic stimulation
correct underlying problem
Prevent or treat complications
chronic pancreatitis
Progressive, usually d/t alcoholism (calcification of ducts) or chronic obstructive due to obstruction of the sphincter of Oddi that causes inflammation
chronic pancreatitis - symptoms (chronic pancake is vdd -er)
S & Sx
Recurrent and severe pain (upper abdominal and back) with vomiting, diarrhea, diabetes
chronic pancreatitis - management & diet (Pancakes need protein)
NO ETOH, pain management, antiemetics, enzymes to aid in food digestion, insulin,* meds, diet (high protein, high calorie, low fat) after NPO and bowel rest
Sphincterotomy
Pancreaticjejunotomy
ppl w/ chronic pancreatitis usually have
underlying diabetes and they’ve had it for awhile
chronic pancreatitis - no opiates unless
they’re NPO.
chronic pancreatitis - treatments (pancakes can have whipcream surgery)
TREATMENTS and INTERVENTIONS
Surgical
Sphincterotomy (ERS)
Pancreaticjejunotomy (lateral or Puestow procedure)
Islet cell transplantation
Celiac nerve block
Spinal cord simulation
Whipple
Medications
Conservative: NSAID’s, acetaminophen
Opioids: morphine, meperidine, tramadol
Other
Enzyme replacement therapy
Inhibition of gastric secretions
Octreotide
Metabolic testing (glucose, insulin, C-peptide levels)
pancreatic cancer - types
Fifth most common cancer in both men and women
Types: adenocarcinoma, cyctadenocarcinoma, acinar cell carcinoma
pancreatic cancer - risk factors (pancreas in golden years)
Risk factors: >60 years, smoking (2-3x risk), diabetes, male, African American, family history, chronic pancreatitis, high fat diet
pancreatic cancer - s/sx (pancake cancer is frothy)
S & S: pain in upper back/abdominal, A, N, V, weight loss, jaundice, indigestion, dark frothy urine, ascites
pancreatic cancer - treatment
Treatment: pain management, C/R/S (Whipple)
pancreatic cancer - diagnostics
Diagnosis: Elevated amylase, alk phos, bili, CEA (carcinogenic antigen), CT, biopsy, ERCP, paracentesis
whipple procedure - for pancreatic cancer
take out 1/2 of stomach (distal part), the jejunum, 1st and 2nd portions of the duodenum, the head of the pancreas and the common bile duct; gall bladder and cystic duct-cholecystectomy. Then attach the hepatic duct and the pancreas to the jejunum.
post op whipple
ng tube - low to continous, irrigation tube (up to 4 total), 1 -2 JP drains, j-junostomy tube.
