Pancreatitis Flashcards
How is acute pancreatitis defined
Premature activation of excessive pancreatic enzymes that destroy pancreatic cells, resulting in autodigestion & fibrosis of pancreas.
acute pancreatitis can range from what
mild edema to severe hemorrhagic necrosis
what are the 2 most common causes of acute pancreatitis
Gallstones and ETOH
What is the best imaging for pancreatitis
CT scan
What characteristics does a CT scan show in pancreatitis
diameter,
calcifications,
pancreatic cysts
pseudocysts
2 complications of acute pancreatitis
Pseudocyst – cavity (filled w/ necrotic products) surrounding outside of pancreas (resolves spontaneously or perforates into peritoneum)
Abscess – large fluid-containing cavity within pancreas (results in extensive necrosis of pancreas); need prompt surgical drainage
Acute pancreatitis interventions to RELIEVE PAIN
IV morphine
Assume positions that flex the trunk (less stretch on peritoneum)
Acute pancreatitis interventions to maintain F&E balance
Monitor VS frequently (can be labile)
Monitor for fluid imbalances & electrolyte imbalances
Aggressive IV hydration
Acute pancreatitis interventions to rest/suppress pancreatic enzyme stimulation
NPO; meticulous oral care
NG to Low Wall Suction
What do we monitor the stool for in acute pancreatitis
steatorrhea which means the body has Impaired protein/fat metabolism. Stool will appear oily & float.
What health promotion do we want to encourage
stop ETOH intake
Diet teaching when patient is no longer NPO with acute pancreatitis
Diet teaching – CHO encouraged (less stimulating to pancreas); fat restriction
Need fluids!!!
Define Chronic Pancreatitis
Progressive, destructive – w/ remissions & flares; caused by inflammation & fibrosis of tissue
What are the Clinical Manifestations of Chronic Pancreatitis
Intense abdominal pain (tenderness less than when acute) Mass? – suspect pseudocyst or abscess Ascites Respiratory compromise Steatorrhea Dark urine
Do we use pain control in Chronic pancreatitis
Yes – opioids used;
however, to be used cautiously (some opioids might increase pain by causing spasms).
Describe Steatorrhea
oily bulky floats greasy malodorous
What is Pancreatic-enzyme replacement therapy (PERT):
Standard of care to prevent malnutrition, malabsorption, & excessive weight loss.
what is contained in pancrelipase
amylase
lipase
protease
pancrelipase is given during what
What is Pancreatic-enzyme replacement therapy (PERT):
What needs to be recorded during Pancreatic-enzyme replacement therapy (PERT):
Record number & consistency of stools per day to monitor effectiveness of enzyme therapy.
What is the Goal of PERT
Goal = less frequent & less fatty stools
What are the teaching points of PERT enzyme replacement
Take pancreatic enzymes before or with meals and snacks.
Sometimes ordered to administer with antacid or H2 blockers; (because a decreased pH inactivates drug).
Tell the patient to swallow the tablets without chewing to minimize oral irritation.
Avoid lip/skin contact with enzymes. (Wipe lips prn after ingesting.)
Mix the powder form in applesauce or fruit juice at patient’s request.
Do not mix enzyme preparations in protein-containing foods.
Do not crush enteric-coated preparations.
What are some considerations with patient weight in chronic pancreatitis
Weight loss can be significant:
Sometimes a candidate for TPN
If taking PO, may need up to 4000 to 6000 calories/day to maintain weight.
What do patients need to avoid to prevent exacerbation of chronic pancreatitis
Avoid things that make your symptoms worse, such as drinking caffeinated beverages.
Avoid alcohol ingestion; refer to self-help group for assistance.
Avoid nicotine.
How do patients need to manage nutrition to prevent exacerbation of chronic pancreatitis
Eat bland, low-fat, high-protein, high carbohydrate meals; avoid gastric stimulants, such as spices.
Eat small meals and snacks high in calories.
what do patients need to consider with medications in Prevention of Exacerbation of Chronic Pancreatitis
Take the pancreatic enzymes that have been prescribed for you with meals.
Should patients exercise heavily to prevent exacerbation of chronic pancreatitis
No, they should Rest frequently; restrict your activity to one floor until you regain your strength.
T/F Hyperglycemia should be monitored in acute pancreatitis
True, due to impact to the exocrine function
Why is there low serum calcium in acute pancreatitis
Happens with fat necrosis
why is there an increase in serum triglycerides in acute pancreatitis
due to fat necrosis
why is there an increase in amylase and lipase in acute pancreatitis
pancreatic cell injury
why do we see Hypovolemia/tachycardia in acute pancreatitis
Due to plasma vol being lost as inflammatory mediators released into circulation increase vascular permeability and dilate vessels
why do we see cullen’s and turner’s sign in acute pancreatitis
pancreatic enzyme leakage into cutaneous tissue
why do we see paralytic ileus in acute pancreatitis
related peritoneal irritaion causes intestinal motility to slow down/stop
why do we see jaundice in acute pancreatitis
hepatobiliary obstructive process (elevated bilirubin)
why do we see low-grade fever/ leukocytosis in acute pancreatitis
inflammatory process
why do we see N/V in acute pancreatitis
associated with any pain originating in viscera
why do we see pain in acute pancreatitis
due to distention of pancreas, peritoneal irritation and related inflammation
Clinical manifestations in acute pancreatitis
pain
N/V
low grade fever/ leukocytosis
jaundice
paralytic ileus
cullen’s & turner’s sign
hypovolemia/tachycardia
increase serum amylase & lipase
increase serum triglycerides
decrease in serum calcium
