pancreas

Question 1

Define pancreatitis

Answer 1

inflammation of the pancreas

Question 2

pancreatitis: etiology

Answer 2

OBSTRUCTION of the outflow of pancreatic enzymes usually r/t pancreatic and bile duct obstruction (usually gallstone)
Can also be caused by: alcohol, drugs, viral infection

Question 3

pancreatitis: CM

Answer 3

Epigastric Pain: SEVERE, Timing – sudden onset, Radiation – may radiate to back, Tenderness
Accompanying symptoms: N/V, abdominal distention, hypo BS, Fever, Hypotension, tachycardia, jaundice
Cyanosis or green-yellow/brown discoloration of the abdomen.

Question 4

pancreatitis: patho

Answer 4

Backup of enzymes: Leads to AUTODIGESTION of pancreatic cells causes inflammation= pancreatitis

Question 5

pancreatic enzymes: name the enzyme & what they cause

Answer 5

Trypsin: edema, necrosis, hemorrhage
Elastase: hemorrhage
Phospholipase A: fat necrosis
Kallikrein: Edema, vascular permeability, smooth muscle contraction, shock
Lipase: fat necrosis

Question 6

pancreatitis: labs

Answer 6

Amylase (↑ with damage to organ), lipase (↑ with damage to organ), glucose (↑ or ↓depends on what cells are damaged), WBC (↑ d/t inflammatory state)

Question 7

pancreatitis: pulmonary complication

Answer 7

d/t pain, pleural effusion d/t edema & vascular permeability.

Question 8

pancreatitis: Describe ecchymoses (2 types)

Answer 8

Flanks (Grey Turner’s sign): d/t hemorrhagic pancreatitis, pools in flank areas.
Periumbilical (Cullen’s sign) In umbilical areas.

Question 9

pancreatitis: Pseudocyst complication

Answer 9

Fluid-filled cavity that surrounds the outside of the pancreas-Necrotic products and secretions (inside sac)
Results in inflammation and scarring of areas near the pancreas
Clinical presentation similar to pancreatitis plus a palpable epigastric mass
May perforate an cause peritonitis.

Question 10

pancreatitis: pancreatic abscess complication

Answer 10

A large fluid-filled cavity inside the pancreas; Result of extensive necrosis in the pancreas; May become infected or perforate; Clinical presentation similar to pancreatitis plus abdominal mass, high fever, & leukocytosis.

Question 11

pancreatitis: hypotenstion complications

Answer 11

HYPOTENSION→ SHOCK

Question 12

pancreatitis: Hypocalcemia complications

Answer 12

Hypocalcemia and tetany d/t lipase causing fat necrosis & it generates free fatty acids to bind to calcium & it gets deposited into the retroperitoneum

Question 13

Define chronic pancreatitis

Answer 13

progressive, fibrotic disease of the pancreas

Question 14

chronic pancreatitis: common causes

Answer 14

alcohol abuse.
Toxic metabolites release inflammatory cytokines and cause destruction of acinar cells and islet of Langerhans

Question 15

chronic pancreatitis: risk factors

Answer 15

genetics, gallstone obstruction, smoking

Question 16

Pancreatic cysts

Answer 16

walled-off areas of pancreatic juice, necrotic debris, or blood

Question 17

clinical manifestations of chronic pancreatitis

Answer 17

Attacks of acute pancreatitis with progressive signs of dysfunction after attack subsides
2 major signs: abdominal pain and weight loss
Can lead to diabetes r/t loss of islet of Langerhans
Have issues with nutritional absorption– particularly fats

Question 18

Name the drugs that are used in the treatment of pancreatitis, and why these drugs are given.

Answer 18

Opioids: relief of pain
Dicyclomine: Antispasmodic (anticholinergic agent)
Antacids: Decrease HCl secretion in the stomach which decreases secretion of pancreatic enzymes
H2-receptors antagonists: same as above
Pancrelipase (Creon)*: Replacement therapy for pancreatic enzymes (Chronic pancreatitis only)
Insulin: treatment for DM if it occurs

Question 19

Pancrelipas (Creon)

Answer 19

Classification: Pancreatic enzyme replacement
MOA: Replacement therapy for pancreatic enzymes (Chronic pancreatitis only)
Indication: Reduced secretion of pancreatic enzymes
SE: Rare
Nursing implications: Take with every meal and snack