Pancreatic Problems

Question 1

Acute Pancreatitis
-Cause

Answer 1

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

Question 2

Backup of enzymes leads to:

Answer 2

AUTODIGESTION of pancreatic cells (causes
inflammation= pancreatitis)

Causes vascular damage, coagulopathy, necrosis, fat necrosis

Question 3

Pancreatic enzymes (5)

Answer 3

Trypsin, Elastase, Phospholipase A, Kallikrein, Lipase

Question 4

Trypsin causes:

Answer 4

Edema, Necrosis, hemorrhage

Question 5

Elastase causes:

Answer 5

Hemorrhage

Question 6

Phospholipase A causes:

Answer 6

Fat necrosis

Question 7

Kallikrein causes:

Answer 7

Edema, vascular permeability, smooth muscle contraction, shock

Can develop a larger abdomen from fluid leaking into space (ascites)

Question 8

Lipase causes:

Answer 8

Fat necrosis

Question 9

Acute Pancreatitis: Clinical manifestations

Answer 9

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)

Question 10

Severe hemorrhagic complications (2)

Answer 10

Ecchymoses
-Flanks (Grey Turner’s sign)
-Periumbilical (Cullen’s sign)

Question 11

Acute Pancreatitis: Complications

Answer 11

◦ Pseudocyst*
◦ Abscess*
◦ Pulmonary complications (fluid in lungs)
◦ Hypotension leads to shock
◦ Tetany from hypocalcemia (patient losing calcium)

Question 12

Complications: Pseudocyst

Answer 12

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)

Question 13

Complication: Pancreatic abscess

Answer 13

◦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 14

Chronic Pancreatitis
-Definition

Answer 14

◦ Progressive, fibrotic disease of the pancreas

Question 15

Most common cause of chronic pancreatis

Answer 15

Alcohol abuse most common cause
◦ Toxic metabolites release inflammatory cytokines and cause destruction of acinar cells and islet of Langerhans

Question 16

Risk factors for pancreatitis (other than alcohol abuse)

Answer 16

◦ Other risk factors: genetics, gallstone obstruction, smoking
◦ Pancreatic cysts

Question 17

What are pancreatic cysts?

Answer 17

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

Question 18

Chronic Pancreatitis: Clinical manifestations

Answer 18

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 19

Pancreatitis and opiods

Answer 19

Relief of pain

Question 20

Pancreatitis and Dicyclomine (Bentyl)

Answer 20

Antispasmodic (anticholinergic agent)

Question 21

Pancreatitis and Antacid

Answer 21

Decrease HCl secretion in the stomach which decreases secretion of pancreatic enzymes

Enzymes are just digesting the pancreas

Question 22

Pancreatitis and H2-receptor antagonists

Answer 22

Decrease HCl secretion in the stomach which decreases secretion of pancreatic enzymes

Question 23

Pancreatitis and Insulin

Answer 23

Treatment for DM if it occurs

Question 24

Pancreatitis and Pancrelipase (Creon)*

Answer 24

Replacement therapy for pancreatic enzymes (Chronic pancreatitis only)

Question 25

Pancrelipase (Creon)

Answer 25

Indication:
◦ Reduced secretion of pancreatic enzymes
Adverse effects:
◦ Rare
Nursing implications:
◦ Take with every meal and snack