pancreas disorders Flashcards
cause of acute pancreatitis
biliary tract disease (female)
alcohol abus (male)
acute pancreatitis risk factors
middle age
African american
severity of acute pancreatitis
ranges from mild edema to severe hemorrhagic necrosis
patho of pancreatitis
- pancreatic cells are injured
- pancreatic enzymes are activated (leak)
- autodigestion (enzymes start to digest pancreas)
- mild to severe pancreatitis
what does the pancreas release?
insulin and glucagon to help with blood sugar control
release of trypsin causes…
edema
necrosis
hemorrhage
release of elastase causes…
hemorrhage
release of phospholipase A causes…
fat necrosis
release of kallikrein causes…
edema
vascular permeability
smooth muscle contraction
shock
release of lipase causes…
fat necrosis
clinical manifestations of acute pancreatitis
-LUQ or epigastric pain
-sudden onset
-pain may radiate to back
-abd tenderness
*N/V
*abd distention
*low blood sugar
*fever
*hypotension
*tachycardia
*jaundice
what effects on labs does pancreatitis have?
increase in amylase, lipase, glucose, WBC
abdominal presentation of acute pancreatitis
cyanosis or green-yellow/brown discoloration
-grey turners sign
-cullens sign
grey turners sign
flanks
Cullen’s sign
periumbilical
complications of acute pancreatitis
pseudocyst
abscess
pulmonary complications
hypotension
tetany from low Ca
increased risk for clots
pseudocyst
fluid (filled with necrotic products and secretions) that surrounds OUTSIDE of the pancreas
what does a pseudocyst result in?
inflammation and scarring near the pancreas
may perforate and lead to peritonitis (rigid abd)
clinical presentation of pseudocyst
similar to pancreatitis PLUS
palpable epigastric mass
pancreatic abscess
large fluid filled sac INSIDE pancreas due to excess tissue death in pancreas
clinical presentation of an abscess
similar to pancreatitis
PLUS
abd mass
high fever
leukocytosis
can become infected and spread
chronic pancreatitis
inflammation in the pancreas that persists over weeks to months
main cause of chronic pancreatitis
alcohol abuse - present in about 50% of alcoholics
what happens to the pancreas with chronic pancreatitis?
necrosis (tissue death)
fibrosis (scare tissue)
loss of pancreatic enzymes and insulin
may continue even after alc use stops
clinical manifestations of chronic pancreatitis
acute pancreatitis attacks with progressive sign of dysfunction after it subsides
CHRONIC pain
-DM
-malabsorption of fat
-weight loss
morphine
relief of pain
dicyclomine
antispasmodic (anticholinergic)
antacids + H2 receptor antagonists
decrease HCl secretion in stomach which decreases secretion of pancreatic enzymes
pancrelipase
replaced therapy for pancreatic enzymes
***CHRONIC pancreatitis ONLY!
insulin
DM treatment, if it occurs
pancrealipase
pancreatic enzyme replacement
used to reduce secretion of pancreatic enzymes
RARE SE
take with meals/snacks – aids in digestive process
why would a patient with pancreatitis receive IV fluids?
replace fluid from fluid shifts
why would a patient with pancreatitis receive fentanyl?
if morphine or hydromorphone is not enough for pain
why would a patient with pancreatitis receive protonix?
proton pump inhibitor
blocks gastric secretion of parietal cells
why would a patient with pancreatitis receive lovenox?
decrease risk of DVT and PE because at risk for clotting
chronic pancreatitis may lead to
DM
