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235 Med surg > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

Acute Pancreatitis

causes women and men?

A
  • gallbladder disease “cholelithisis” (WOMEN)

- chronic alcohol (MEN)

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2
Q

Acute Pancreatitis Abdominal pain signs

A
  • Radiates to back
  • Sudden onset
  • Deep, piercing, continuous, or steady
  • worse when eats
  • Starts when recumbent
  • Not relieved with vomiting
  • Generally, is unrelieved by antacids

Abdominal tenderness with muscle guarding

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3
Q

Other signs of acute pancreatitis

A 
Cyanosis 🔵
Dyspnea
N/V 🤮
Low grade fever 🥵 
Leukocytosis
Hypotension/ tachycardia 
Jaundiced 🟡
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4
Q

Pseudocyst

What is it?
Signs?
Treatment?

A
  • accumulation of fluid, pancreatic enzymes, debris and exudate surrounded by wall
  • SIGNS: abdominal pain, palpable mass, N/V, anorexia
  • detected w/ image
  • treat w/ surgical percutaneous or endoscopic drain
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5
Q

Pancreatic abscess

What is it and signs?

A
  • infected pseudocyst
  • result from extensive necrosis
  • may rupture

SIGNS: upper abd pain, palpable mass, high fever 🤒 , leukocytes

Need print surgical drainage

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6
Q

Systemic complications

A 
🫁
•Pleural effusion, pulmonary embolism
•Atelectasis
•Pneumonia
•ARDS
❤️/🩸
•Hypotension
•Thrombi, DIC
•Hypocalcemia: tetany
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7
Q

Laboratory tests

A

** Serum amylase and lipase level- elevated within 24 hours of onset of symptoms

  • Liver enzymes-elevated
  • Triglycerides-elevated
  • Glucose level-can be elevated
  • Bilirubin level-can be elevated
  • Serum calcium level-decreased
  • WBC-can be elevated
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8
Q

Diagnostic Studies

A

•Abdominal ultrasound
•X-ray
CT scan is the best test for pancreatitis and related complications
•Endoscopic retrograde cholangiopancreatography (ERCP)*

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9
Q

Acute pancreatitis GOALS include

A
  • Relief of pain
  • Prevention or alleviation of shock
  • Decrease pancreatic secretions
  • Correction of fluid/electrolyte imbalances
  • Prevention/treatment of infections
  • Removal of precipitating cause
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10
Q

Pain relief

A
  • IV Opioids (MSO4)
  • Antispasmodics like Bentyl
  • Carbonic anhydrase inhibitor (Acetazolamide)
  • PPIs (Prilosec)
  • NPO status
  • NGT
  • Position changes
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11
Q

Prevention or alleviation of shock

A
  • IVF and nutrient replacement
  • Blood volume replacements
  • Central Venous Pressure (CVP) Monitoring
  • Vasoactive drugs: Dopamine
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12
Q

Decrease pancreatic secretions

A

•Gut rest
- suppression of enzymes
- NPO status
- NGT
•Antiacids
•If unable to resume eating after treatment may need enteral feeds
•If unable to tolerate enteral feeds, then parental nutrition (TPN/IL)

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13
Q

Correction of fluid/electrolyte imbalances

A
  • Aggressive IVF; nutrient replacement
  • CVP
  • Blood volume replacements
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14
Q

Prevention/treatment of infections

A
  • Enteral feedings
  • Abx
  • Endoscopic gram stain and gx
  • Ultrasound/CT/physical exams for pseudocyst/abcess
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15
Q

Removal of precipitating cause

A

1) Stop ETOH
2) Remove gallstones
- ERCP plus endoscopic sphincterotomy
- Laparoscopic cholecystectomy

Drainage of necrotic fluid collection

•NOTE: no specific drug cures Pancreatitis; symptom management only

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16
Q

Nutritional Therapy

A
  • NPO status initially
  • Enteral versus parenteral nutrition (NG vs IV) prn
  • Small, frequent feedings when able
  • High-carbohydrate
  • NO alcohol
  • Supplemental fat-soluble vitamins
17
Q

Acute care

What to monitor ?

A

1) Monitoring
- Vitals (Hypotension, fever, tachypnea)
- response to IV fluids
- fluid and electrolyte balance
- serum glucose

2) Assess respiratory function
3) Observation for paralytic ileus, renal failure, mental changes

18
Q

Dietary teaching

A

•Low-fat diet
•high-carbohydrate
-less stimulating to pancreas
•No crash or binge diets as they precipitate attacks

19
Q

Chronic Pancreatitis causes

A
  • continuous prolonged inflammatory and fibrous process

- alcohol, gallstones, tumor, pseudocyst, trauma

20
Q

Chronic Pancreatitis

A
  • Inflammatory disorder with progressive destruction of the pancreas.
  • Cells are replaced with fibrous tissue with repeated attacks.
  • Results in obstruction of the pancreatic and common bile duct and duodenum.
  • Atrophy of the epithelium of the ducts, inflammation and destruction of the secreting cells of the pancreas.
  • Excessive and prolonged consumption of alcohol major cause
  • Long-term consumption of alcohol damages the cells of the pancreas, causes hypersecretion of protein in pancreatic secretions which results in protein plugs and calculi in the pancreatic ducts.
21
Q

Chronic OBSTRUCTIVE pancreatitis causes

A

1) Inflammation of sphincter of Oddi

2) Cancer of ampulla of Vater, duodenum, or pancreas

22
Q

Chronic NON-OBSTRUCTIVE pancreatitis

What is the most common cause ?

A
  • Inflammation and sclerosis in head of pancreas and around duct
  • Most common cause is alcohol abuse
23
Q

Chronic signs

A
  • Abdominal pain
    • same area as Acute
    • heavy, gnawing feeling
    • more freq
- malabsorption/ weight loss
💩constipation
🟨mild jaundice/ dark urine
💩steatorehea- foul smelling fatty stool
- diabetes
24
Q

Chronic Pancreatitis labs

A 
•Amylase and lipase may be slightly increased or normal
⬆️ bilirubin level
⬆️alkaline phosphatase level
****Mild leukocytosis
⬆️sedimentation rate
25
Q

Chronic diagnostic studies

A

CT
MRI
ultrasound

can show enlargement, ductal dilation, and pseudocysts

26
Q

Chronic care

What kind of thing does the patient need to take ?

A

1) pancreatic enezyme replacement
- pancrelipase (take w meals)
2) bile salts to help fat soluble vit
3) insulin if diabetic
4) acid neutralizing agent for gastric activity
5) antidepressant to reduce neuropathic pain

27
Q

Chronic surgery

Indicated for obstruction or pseudocyst present

A

1) Endoscopic procedures:
- Pancreatic drainage-to divert bile flow or relive obstruction
- ERCP with sphincterotomy and/or stent placement

28
Q

Chroincic pancreatitis other signs

A
  • Decreased or absent bowel sound
  • 🟩🟨skin discoloration
  • Grey Turner’s spots or sign-bluish flank discoloration
  • Cullen’s sign-bluish periumbilical discoloration
  • Shock-may occur from hemorrhage into the pancreas
29
Q

Pain assessment and management

A
  • Opioids
  • Position changes
  • Frequent oral/nasal care esp. with NGT
  • Proper administration of antacids to neutralize gastric secretions
  • Hold oral feeds

235 Med surg (12 decks)

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