Pancreatitis Flashcards
Acute Pancreatitis
causes women and men?
- gallbladder disease “cholelithisis” (WOMEN)
- chronic alcohol (MEN)
Acute Pancreatitis Abdominal pain signs
- 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
Other signs of acute pancreatitis
Cyanosis 🔵 Dyspnea N/V 🤮 Low grade fever 🥵 Leukocytosis Hypotension/ tachycardia Jaundiced 🟡
Pseudocyst
What is it?
Signs?
Treatment?
- 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
Pancreatic abscess
What is it and signs?
- infected pseudocyst
- result from extensive necrosis
- may rupture
SIGNS: upper abd pain, palpable mass, high fever 🤒 , leukocytes
Need print surgical drainage
Systemic complications
🫁 •Pleural effusion, pulmonary embolism •Atelectasis •Pneumonia •ARDS ❤️/🩸 •Hypotension •Thrombi, DIC •Hypocalcemia: tetany
Laboratory tests
** 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
Diagnostic Studies
•Abdominal ultrasound
•X-ray
CT scan is the best test for pancreatitis and related complications
•Endoscopic retrograde cholangiopancreatography (ERCP)*
Acute pancreatitis GOALS include
- Relief of pain
- Prevention or alleviation of shock
- Decrease pancreatic secretions
- Correction of fluid/electrolyte imbalances
- Prevention/treatment of infections
- Removal of precipitating cause
Pain relief
- IV Opioids (MSO4)
- Antispasmodics like Bentyl
- Carbonic anhydrase inhibitor (Acetazolamide)
- PPIs (Prilosec)
- NPO status
- NGT
- Position changes
Prevention or alleviation of shock
- IVF and nutrient replacement
- Blood volume replacements
- Central Venous Pressure (CVP) Monitoring
- Vasoactive drugs: Dopamine
Decrease pancreatic secretions
•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)
Correction of fluid/electrolyte imbalances
- Aggressive IVF; nutrient replacement
- CVP
- Blood volume replacements
Prevention/treatment of infections
- Enteral feedings
- Abx
- Endoscopic gram stain and gx
- Ultrasound/CT/physical exams for pseudocyst/abcess
Removal of precipitating cause
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
Nutritional Therapy
- NPO status initially
- Enteral versus parenteral nutrition (NG vs IV) prn
- Small, frequent feedings when able
- High-carbohydrate
- NO alcohol
- Supplemental fat-soluble vitamins
Acute care
What to monitor ?
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
Dietary teaching
•Low-fat diet
•high-carbohydrate
-less stimulating to pancreas
•No crash or binge diets as they precipitate attacks
Chronic Pancreatitis causes
- continuous prolonged inflammatory and fibrous process
- alcohol, gallstones, tumor, pseudocyst, trauma
Chronic Pancreatitis
- 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.
Chronic OBSTRUCTIVE pancreatitis causes
1) Inflammation of sphincter of Oddi
2) Cancer of ampulla of Vater, duodenum, or pancreas
Chronic NON-OBSTRUCTIVE pancreatitis
What is the most common cause ?
- Inflammation and sclerosis in head of pancreas and around duct
- Most common cause is alcohol abuse
Chronic signs
- 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
Chronic Pancreatitis labs
•Amylase and lipase may be slightly increased or normal ⬆️ bilirubin level ⬆️alkaline phosphatase level ****Mild leukocytosis ⬆️sedimentation rate
Chronic diagnostic studies
CT
MRI
ultrasound
can show enlargement, ductal dilation, and pseudocysts
Chronic care
What kind of thing does the patient need to take ?
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
Chronic surgery
Indicated for obstruction or pseudocyst present
1) Endoscopic procedures:
- Pancreatic drainage-to divert bile flow or relive obstruction
- ERCP with sphincterotomy and/or stent placement
Chroincic pancreatitis other signs
- 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
Pain assessment and management
- Opioids
- Position changes
- Frequent oral/nasal care esp. with NGT
- Proper administration of antacids to neutralize gastric secretions
- Hold oral feeds
