Pancreatic Issues Flashcards
Etiology of Acute Pancreatitis
Biliary tract disease (women)
ETOH abuse (men)
Risk factors for Acute pancreatitis
Age – Middle Age
Race – 3xs more likely in African Americans
Severity of acute pancreatitis can range from…
mild edema to hemoorhagic necrosis
What 3 things does the pancreas release
insulin
glucagon
digestive enzymes
4 steps of patho in pancreatitis
Pancreatic cells are injured
Pancreatic enzymes are activated
Autodigestion – enzymes digest pancreas
Result? Mild to severe pancreatitis
What are the 5 pancreatic enzymes and their causes
Trypsin - Edema, necrosis, hemorrhage
Elastase - Hemorrhage
Phospholipase A - Fat necrosis
Kallikrein - Edema, Vascular permeability, smooth muscle contraction, shock
Lipase - Fat necrosis
Where is the pain location, timing, radiation, and tenderness in acute pancreatitis
LUQ or Epigastric Pain
sudden onset
May radiate to back
May be tender to palpation
What are some accompanying symptoms of acute pancreatitis
N/V Abdominal distention Hypo Bowel Sounds Fever Hypotension Tachycardia Jaundice
What labs can be increased in acute pancreatitis
Amylase
Lipase
Glucose
WBC
What 2 signs do we see in hemorrhagic pancreatitis
Grey Turner’s sign - flanks
Cullen’s sign - periumbilical
disctinct discoloration in pancreatitis
cyanosis or green-yellow/brown discoloration of the abdomen
6 Complications of Acute pancreatitis
Pseudocyst
Abcess
Pulmonary complications
Hypotension
Tetany from hypocalcemia
increased risk for clotting
what is a psudocyst
fluid filled cavity that surrounds outside of the pancreas that is filled with necrotic products and secretions
what does a pseudocyst result in
inflammation and scarring of areas near the pancreas
can present as a palpable epigastric mass
If a psudocyst perforates what can it cause
periontinitis
What is a pancreatic abscess
large fluid-filled cavity inside the pancreas resulting in extensive necrosis in the pancreas.
May become infected or perforate.
clinical presentation of pancreatic abcess
similar to pancreatitis plus abdominal mass, high fever, and leukocytosis.
what is chronic pancreatitis
Inflammation in the pancreas that persists over weeks-months
what is the main etiology of Chronic pancreatitis
ETOH abuse
present in about 50% of all alcoholics
What is the patho of chronic pancreatitis
Destruction of tissue/necrosis
Fibrosis (scar tissue)
Loss of pancreatic enzymes and insulin
May continue even after ETOH use stops
Clinical manifestations of chronic pancreatitis
Attacks of acute pancreatitis with progressive signs of dysfunction after attack subsides
major symptom of chronic pancreatitis
chronic pain
3 other symptoms of chronic pancreatitis
DM - no longer generating insulin
Malabsorption of fat
Weight loss
Why is morphine given for pancreatitis
relief of pain
why is Dicyclomine given for pancreatitis
Antispasmodic (anticholinergic agent)
why are antacids given for pancreatitis
Decrease HCl secretion in the stomach which decreases secretion of pancreatic enzymes
Why are H2-receptor antagonists given for pancreatitis
Decrease HCl secretion in the stomach which decreases secretion of pancreatic enzymes
why is Pancrelipase given for pancreatitis
Replacement therapy for pancreatic enzymes (Chronic pancreatitis only)
What is insulin used for in pancreatitis
Treatment for DM if it occurs
Class of Pancrelipase
Pancretic enzyme replacement
Indication of pancrelipase
reduced secretion of pancreatic enzymes
adverse effects of pancrelipase
Rare
nursing implications with pancrelipase
take with every meal and snack
