Pancreatic Disorders Flashcards
Pancreas
normal function involves the release of pancreatic enzymes in the duodenum to assist in the digestion of proteins, starches, and fatty acids.
Endocrine
release insulin
Exocrine
-release of potent enzymes to digest fat, protein and carbs
lipase
acts on fats
amylase
acts on starches
inactive enzymes
act on protein
Pancreas secretes…
Na+ bicarb to neutralize acid
Acute Pancreatitis
inflammation that occurs when pancreatic ductal flow becomes obstructed & digestive enzymes escape from the duct and start to digest the pancreas itself.
Etiology of Acute Pancreatitis
- biliary tract disease
- alcoholism
- trauma
- viral
- genetics
- abscess
- hypercalcemia
- hypertriglyceridemia
Manifestations of Acute Pancreatitis
- pain
- flushing, fever, tachycardia
- dyspnea
- hypotension
- jaundice
- muscle guarding, abdominal rigidity
- diminished or absent bowel sounds
- Ileus, abdominal distention, ascites
- Grey Turner’s sign
- Cullen’s sign
Pseudocyst
A cavity outside the pancreas filled with necrotic waste and fluid. Rupture causes peritonitis.
ABSCESS
Fluid filled cavity within the pancreas associated with high fever. Requires prompt surgical intervention. Can cause sepsis with rupture.
Pulmonary complications of acute pancreatitis
Pneumonia ,atelectasis, pleural effusions
Nitroglycerin
-relaxes smooth muscles and relieves pain
Fluid Resuscitation
-IVF, albumin, plasma, volume expanders
Management of Acute Pancreatitis
• Pain Management • REDUCE / SUPPRESS Pancreatic Enzymes • MONITOR Serum Electrolytes • MONITOR Respiratory Function • ADMINISTER Antibiotics As Ordered • SURGERY For Abscess, Pseudocyst Or Peritonitis
Discharge Teaching for Acute Pancreatitis
– Avoid drinking alcohol – Avoid caffeine – Avoid smoking – Avoid stressful situations – Restrict fatty foods – Encourage carbohydrates – Avoid crash or binge diets – Monitor elevated blood glucose +/or fatty stools – Take pain medication/H2 receptor blocker
Chronic Pancreatitis
progressive destruction of the pancreas with replacement of scar tissue.
Patho of Pancreatitis
– Series of remissions and exacerbations
– Chronic inflammation occurs
– Irreversible damage
– Decreases digestive enzymes
– Leads to malabsorption of nutrients, fats and calories
Manifestations of Chronic Pancreatitis
• INTENSE ABOMINAL PAIN
– Continuous gnawing feeling; burning; cramp-
like
- WEIGHT LOSS with ASCITES
- JAUNDICE
- STEATORRHEA
- DARK URINE
- DIABETES
• RESPIRATORY COMPROMISE
– Adventitious / diminished breath sounds
– Dyspnea +/or orthopnea
Goal of Chronic Pancreatitis
- manage pain
- maintain sufficient nutritional intake
- prevent recurrence
Pain management of Chronic Pancreatitis
- analgesics
- dilaudid most frequently used
- frequent large doses
- may result in dependency
- refer to pain management team
Enzyme Replacement
– Aid digestion and fat absorption
– Contain amylase,lipase & protease
– Taken before or during a meal
– Monitor consistency and number of stools daily
Insulin Therapy
– Glucose checks Q2h
– May use combination of oral
hypoglycemics and insulin
HISTAMINE RECEPTOR ANTAGONISTS
- Zantac (ranitidine)
- Decreases gastric acid
- Enhances enzyme therapy
DIET THERAPY
– Low fat, High carb, High protein,
Bland diet
– 4-6,000 calories per day
– TPN (total parenteral nutrition)
– Vitamin & mineral replacement
Surgical Management
• Not primary intervention • Indicated for:
– Intractable pain
– Incapacitating pain recurrence
– Complications of pseudocycts or abscesses
• Laparoscopic Choley
• Sphincterotomy
• Distal pancreatectomy • Pancreatic transplant
Pancreatic Cancer
- 5th leading cause of death in US
- 65 and 80
- pancreatic head
- prognosis is POOR
Etiology of Pancreatic Cancer
unknown
Regardless of the etiology of acute pancreatitis, the primary physiologic event is:
autodigestion
Primary Prevention
– Smoking (doubles risk)
– High fat diet
– Diabetes
– Exposure to chemicals
– Chronic pancreatitis
Manifestions of Pancreatic Cancer
- pain
- abdominal pain
- ascites
- anorexia
- rapid wt loss
- N/V
- Jaundice
- Clay colored stools and dark urine
Tx for Pancreatic Cancer
- usually palliative
- surgery
- radiation
- chemo
most effective tx for pancreatic
surgery
-Pancreaticoduodenectomy or Whipple
procedure
