Pancreas Flashcards
Acute Pancreatitis S/S
- abdominal pain (LUQ or mid-epigastric; radiates to the back; aggravated by eating)
- n/v
- flushing
- cyanosis
- low-grade fever
- leukocytosis
- shock s/s (hypotension/tachycardia)
- jaundice
- crackles in lungs
- bowel sounds may be decreased or absent
- paralytic ileus may occur
- possibly Grey Turner sign or Cullen sign
Local Complications of Acute Pancreatitis
- pseudocyst
- abscess
Pseudocyst
- fluid, enzyme debris, and exudates surrounded by wall
- abdominal pain, palpable mass, n/v, anorexia
- detected with imaging
- resolves spontaneously or may perforate and cause peritonitis
- surgical or endoscopic drainage
Abscess
- infected pseudocyst
- may rupture or perforate
- upper abdominal pain, mass, high fever, leukocytosis
- requires prompt surgical drainage
Systemic Complications of Acute Pancreatitis
- pleural effusion
- atelectasis
- PNA
- ARDS
- hypotension
- thrombi, pulmonary embolism, DIC
- hypocalcemia: tetany
Acute Pancreatitis Dx Studies: Lab Tests
- serum AMYLASE level: elevated early; remains elevated 24-72 hours
- serum LIPASE level: remains elevated longer; more specific
- liver enzyme levels
- triglyceride levels
- glucose level
- bilirubin level
- serum calcium level
Acute Pancreatitis Dx Studies: Imaging
- US
- X-ray
- CT scan
- ERCP
Acute Pancreatitis: Conservative Therapy (non-pharm)
- aggressive hydration
- pain management
- management of metabolic complications
- O2, glucose levels
- minimizing pancreatic stimulation
Acute Pancreatitis: Shock Management
- plasma or plasma volume expanders (dextran or albumin)
- fluid/electrolyte imbalance
- LR solution
Acute Pancreatitis: Ongoing Hypotension Management
- Vasoactive drugs: dopamine
Acute Pancreatitis: Med for Infection
ABX
Acute Pancreatitis: Nutritional Therapy
- NPO initially
- enteral vs. parenteral nutrition
- monitor triglycerides if IV lipids given
- small, frequent feedings when able
- high carbohydrate diet
- no alcohol
- supplemental fat-soluble vitamins (A, ,D, E, K)
Nursing Dx for Acute Pancreatitis
- Acute pain
- Deficient fluid volume
- Imbalanced nutrition
Acute Pancreatitis: Drug Therapy
- IV morphine
- Antispasmodics
- Carbonic anhydrase inhibitors
- Antacids
- PPIs
Acute Pancreatitis: Acute Care Nursing Interventions (Assessment)
- monitor VS (BP, HR, Temp.)
- monitor response to IV fluids
- closely monitor fluid and electrolyte balance
- assess respiratory function
- monitor for tetany
- pain assessment/management
- oral/nasal care
- Positioning! –> lying flat can exacerbate pain
Acute Pancreatitis: Ranson’s Criteria vs. BISAP Score
- They look at mortality for patients with pancreatitis
- Ranson’s is for alcohol related
- BISAP is for biliary related
Chronic Pancreatitis S/S
- abdominal pain (same location as acute; heavy, gnawing feeling; burning and cramp-like)
- malabsorption w/ weight loss
- constipation
- mild jaundice w/ dark urine
- steatorrhea (oily, fatty stool)
- DM
Chronic Pancreatitis: Complications
- pseudocyst formation
- bile duct or duodenal obstruction
- pancreatic ascites
- pleural effusion
- splenic vein thrombosis
- pseudoaneurysm
- pancreatic cancer
Chronic Pancreatitis: Dx Lab Studies
- serum amylase/lipase levels
- May be ↑ slightly or not at all
- ↑ Serum bilirubin level
- ↑ Alkaline phosphatase level
- Mild leukocytosis
- ↑ Sedimentation rate
Chronic Pancreatitis: Dx Imaging and labs
- ERCP
- CT, MRI, MRCP, and/or endoscopic US
- Decreased fat-soluble vitamins (A, D, E, K) and cobalamin levels
- glucose intolerance/diabetes
- secretin stimulation test
Chronic Pancreatitis: Medical Management
- analgesics for pain relief (morphine or fentanyl patch)
- Diet: bland, low-fat; small, frequent meals
- no smoking, alcohol, or caffeine
- pancreatic enzyme replacement (Pancrealipase) aids with digestion –> taken with every meal
- Bile salts to help absorb fat soluble vitamins
- insulin or oral hypoglycemic agents
- acid-neutralizing and acid-inhibiting drugs
- antidepressants
Chronic Pancreatitis: Patient Teaching
- dietary control
- pancreatic enzyme with meals/snack
- observe for steatorrhea
- monitor glucose levels
- antacids after meals and at bedtime
- no alcohol
Pancreatic Cancer: Risk Factors
- smoking/ETOH
- age
- family hx
- high fat diet
- diabetes
- chronic pancreatitis
- exposure to chemicals
- african american
Pancreatic Cancer: S/S
- abdominal pain
- anorexia
- rapid/progressive weight loss
- nausea
- jaundice
Pancreatic Cancer: Dx Studies
- US
- CT scan (for metastasis/vascular involvement)
- ERCP
- MRI/MRCP
Pancreatic Cancer: Management
- surgery, if possible
- Whipple for tumors in the head of pancreas
- distal pancreatectomy in the body
- chemo
- radiation for pain relief
- palliative measures
Pancreatic Cancer: Nursing Management
- like that of pancreatitis
- adequate nutrition/pain relief
- coping with diagnosis and prognosis
