Pancreatitis Flashcards
pancreatitis
the inappropriate activation of pancreatic enzymes, inflammation of the pancreas resulting in autodigestion of the pancreas and damage to peri-pancreatic tissues and vascular network
______ response causes further damage to the pancreas
inflammatory response
causes and risk factors of pancreatitis
- gallstones
- alcohol
- pregnancy
- administration of TPN
- surgery
- AIDS
- medication complications
- hypercalcemia and or significant hypertriglyceridema
- specific genetic mutations
chronic pancreatitis
progressive obstruction of exocrine functions
- irreversible
- may demonstrate diabetes
- malabsorption syndrom
why might chronic pancreatitis demonstrate diabetes
b/c of destruction of insulin producing cells
acute pancreatitis has a _____ onset
sudden onset
symptoms of acute pancreatitis
- abdominal pain
- abdominal tenderness
- hypotension
- respiratory distress
- abdominal distention
- poor urine output
- tachycardia
- signs of hypocalcemia
3 forms of acute pancreatitis are
mild form, more severe form, severe form
mild form of acute pancreatitis
- called institutional or edematous pancreatitis
- resolves in 5-7 days
more severe form of acute pancreatitis
extensive necrosis
severe form of acute pancreatitis
- local and systemic complications
- 25-30% mortality rate with complications and co morbidities
1st phase of pancreatitis
trypsin and other enzymes released
2nd phase of pancreatitis
intrapancreatic inflammation
3rd phase of pancreatitis
- extrapancreatic / systemic injury
- kallikrein
in pancreatitis hypocalcemia results from
necrosis
kallikrein is part of the _______ process
inflammatory process
kallikrein causes
vasodilation and increases permeability of blood vessels, pain, and leukocyte invasion
kallikrein is activated by
trypsin
trypsin is responsible for
causing bradykinin formation and can lead to systemic hypotension and shock
4 ways to diagnose pancreatitis
(1) pancreatic enzyme levels
(2) liver and gallbladder tests
(3) elevated C Reactive protein
(4) elevated WBC
how to minimize pancreatic stimulation
- GI tract rest
- nutrition support (enteral, total parenteral)
- psychosocial support
what to look for on integumentary assessment on pt with pancreatitis
- Cullens sign
- Grey Turners sign
- Jaundice
- edema
- pale, moist, cold
what is Cullens sign
bruising around umbilical
why does Jaundice occur in pt with pancreatitis
all enzymes are breaking down and extending the damage to the liver
common fluid and electrolyte imbalances in pts with pancreatitis
- hypocalcemia
- hypokalemia
- hypomagnesmia
2 signs that occur with hypocalcemia
(1) chvostek’s sign
(2) trovsseau’s sign
what is chvostek’s sign
facial nerve trapped in front of ear -
positive when muscles contract on same side of face
trovesseau’s sign
bp cuff inflated on upper arm to a level directly above pt sbp for 2 min - hand flexes in response to test
what renal assessments should be done on a pt with pancreatitis
- monitor for acute tubular necrosis
- urine output can become brownish and foamy
- assess BUN and creatinine levels
what endocrine signs may show in a pt with pancreatitis
- hyperglycemia
- high serum glucose levels
- metabolic acidosis
what neurological symptoms might a pt show with pancreatitis
- confused, decreased LOC
- restlessness
- agitation
- should assess GCS
in pancreatitis it is important to correct the
underlying problem
in some pancreatitis the underlying problem may subside with supportive therapy such as
binge drinking
when the underlying problem of pancreatitis is a mechanical obstruction how may this be fixed
surgery
- cholecystectomy
- ERCP
when the underlying problem of pancreatitis is infected pancreatic necrosis how may this be fixed
surgical debridement
when the underlying problem of pancreatitis is a pancreatitis abscess how might this be fixed
drainage
local complications of pancreatitis
- pancreatic abscess
- pancreatic necrosis
- pseudocyst
- abdominal compartment syndrome (ACS)
pulmonary complications of pancreatitis
- hypoxemia
- respiratory failure
- acute respiratory distress syndrome (ARDS)
- pneumonia
- pleural effusion (COMMON)
systemic complications of pancreatitis
- systemic inflammatory response syndrome (SIRS)
- vasoactive substances (vasodilation, decreased systemic vascular resistance (hypotension), increased permeability of vessel linings)
- hemorrhage
- hypovolemia
