Pancreatic Problems Flashcards
Acute Pancreatitis
-Cause
Cause: 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
Usually mild and resolves spontaneously
-20% develop severe acute
Backup of enzymes leads to:
AUTODIGESTION of pancreatic cells (causes
inflammation= pancreatitis)
Causes vascular damage, coagulopathy, necrosis, fat necrosis
Pancreatic enzymes (5)
Trypsin, Elastase, Phospholipase A, Kallikrein, Lipase
Trypsin causes:
Edema, Necrosis, hemorrhage
Elastase causes:
Hemorrhage
Phospholipase A causes:
Fat necrosis
Kallikrein causes:
Edema, vascular permeability, smooth muscle contraction, shock
Can develop a larger abdomen from fluid leaking into space (ascites)
Lipase causes:
Fat necrosis
Acute Pancreatitis: Clinical manifestations
Epigastric Pain: SEVERE
◦Timing – sudden onset
◦Radiation – may radiate to back
◦Tenderness (gaurding abdomen)
Accompanying symptoms:
◦N/V, abdominal distention, hypo BS
◦Fever
◦Hypotension, tachycardia, jaundice
◦ Amylase (high), lipase (high), glucose (high/low), WBC (high)
Severe hemorrhagic complications (2)
Ecchymoses
-Flanks (Grey Turner’s sign)
-Periumbilical (Cullen’s sign)
Acute Pancreatitis: Complications
◦ Pseudocyst*
◦ Abscess*
◦ Pulmonary complications (fluid in lungs)
◦ Hypotension leads to shock
◦ Tetany from hypocalcemia (patient losing calcium)
Complications: Pseudocyst
Fluid-filled cavity that surrounds the outside of the pancreas
◦ Necrotic products and secretions
◦ Results in inflammation and scarring of areas near the pancreas
◦ Clinical presentation similar to pancreatitis plus a palpable epigastric mass
◦ May perforate (peritonitis)
Complication: Pancreatic abscess
◦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
Chronic Pancreatitis
-Definition
◦ Progressive, fibrotic disease of the pancreas
Most common cause of chronic pancreatis
Alcohol abuse most common cause
◦ Toxic metabolites release inflammatory cytokines and cause destruction of acinar cells and islet of Langerhans
Risk factors for pancreatitis (other than alcohol abuse)
◦ Other risk factors: genetics, gallstone obstruction, smoking
◦ Pancreatic cysts
What are pancreatic cysts?
Walled-off areas of pancreatic juice, necrotic debris, or blood
Chronic Pancreatitis: Clinical manifestations
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
Pancreatitis and opiods
Relief of pain
Pancreatitis and Dicyclomine (Bentyl)
Antispasmodic (anticholinergic agent)
Pancreatitis and Antacid
Decrease HCl secretion in the stomach which decreases secretion of pancreatic enzymes
Enzymes are just digesting the pancreas
Pancreatitis and H2-receptor antagonists
Decrease HCl secretion in the stomach which decreases secretion of pancreatic enzymes
Pancreatitis and Insulin
Treatment for DM if it occurs
Pancreatitis and Pancrelipase (Creon)*
Replacement therapy for pancreatic enzymes (Chronic pancreatitis only)
Pancrelipase (Creon)
Indication:
◦ Reduced secretion of pancreatic enzymes
Adverse effects:
◦ Rare
Nursing implications:
◦ Take with every meal and snack
