pancreatic problems (W4) Flashcards
acute pancreatitis
ranges from mild edema to severe hemorrhagic necrosis
RF for acute pancreatitis
middle age
african american
etiology of acute pancreatitis
females- billary tract disease
males- ETOH abuse
others like meds
patho of acute pancreatitis
- pancreatic cells injured
- enzymes activated
- auto digestion
- mild-severe pancreatitis
enzymes
trypsin
elastase
phospholipase a
kalikrein
lipase
trysin
edema necrosis hemorrhage
elastase
hemorrhage
phospholipase a
fat necrosis
kalikrein
edema
vascular permeability (leads to ascites)
SM contraction
shock
lipase
fat necrosis
where is pain with acute panreatitis
LUQ
epigastric region
think about: time (acute onset), radiation (to back), tenderness
other manifestations of acute pancreatitis
N/V
abdominal distention
hypo BS
fever
hypotensin
tachycardia
jaundice
amylase/lipase- damage
glucose- not working
WBC- inflammation
cyanosis/green yellow abdomen
echymoses
types of echymoses
flank- grey turners sign
periumbilical- cullens sign
acute pancreatitis complications
pseudocyst
abscess
pulmonary complications
hypotension
tetany from hypocalcemia
increased risk of clotting
lipase
causes fat necrosis, generates FFA, binds to calcium, deposits in retroperitoneum, hypocalcemia
what is a pseudocyst
seen on scan
fluid filled sac- filled with necrotic products and secretions
results in inflammation and scarring
palpable epigastric mass
may perforate- content spills- serious- peritonitis (rigid abdomen)
complications of pancreatic abscess
large fluid filled canvity inside cavity
result of necrosis
may be infected or perforate
clinical presentation similar to pancreatitis plus abdominal mass, fever, increase WBC
how to differentiate between cyst and abscess?
present with a palpable mass
do a scan to differentiate
abscess- drain!
chronic pancreatitis
inflammation for weeks to months
main etiology of chronic pancreatitis
ETOH abuse
what happens during chronic pancreatitis
destruction/necrosis
fibrosis- scar tissue
loss of pancreatic enzyme
loss of insulin
may continue even after ETOH stops- the damage is done
bouts of acute attacks
with progressive signs of dysfunction after attack subsides
problem with chronic pancreatitis
pain
other problems with chronic pancreatitis
DM
malabsorption of fat
weight loss
drug therapy
morphine- pain
dicylomine- antipasmodic (ATC)
antiacids- decreased HCl secretions in stomach which decreases secretions of pancreatic enzymes
H2 replacement- decreased HCl secretions in stomach which decreases secretions of pancreatic enzymes
pancrelipase- replacement therapy for pancreatic enzymes for chronic only
insulin- treatment if DM occurs
pancrelipase
when pancreas no longer is producing enough or any enzymes for digestion
pancreatic enzyme replcement
when? secreations are decreased of pancreatic enzymes
AE: none
edu: take with every meal
pancreatitis meds
IVF- fluid replacement
fentanyl- pain
protonix- PPI
stool softener- don’t want them to strain with BM
lovenox- risk for blood clot
major cause
alcohol abuse (M)
gallbladder disease (F)
chronic pancreatitis can cause
DM
finding of hypotension, rigid abdomen, absent bowel sounds in client with pancreatitis
indicates peritonitis with substantial risk for sepsis and shock
