Pancreatitis Flashcards
What is pancreatitis?
This is inflammation of the pancreas, causing abdominal pain
What are the two types of pancreatitis? Describe acute pancreatitis.
Two types: Acute vs chronic. Acute pancreatitis is an exocrine disorder. It is the premature activation of pancreatic enzymes inside the pancreas leading to auto digestion and fibrosis. Severity: mild to severe with diffusely necrotizing hemorrhagic pancreatitis.
What are the two main causes of acute pancreatitis?
Alcohol and bile obstruction
What are other causes of acute pancreatitis?
Abdominal surgery, trauma, infections, drug use, spider bites, hypertriglyceridemia, idiopathic
What are signs and symptoms of acute pancreatitis
Sudden onset pain in LUQ or mid abdomen
Pain radiates to back and shoulder
Mild to severe
Worsened in supine position and lessened in fetal position
More intense after eating fatty foods
ETOH pancreatitis pain occurs hours or days after binge drinking
Nausea and vomiting
Abdominal distention
Jaundice
High grade fever
Hypovolemic shock: tachycardia and hypotension
Cullen sign
Grey turner’s sign
Also: potential for ARDS since enzymes can travel to the thoracic cavity and irritate the diaphragm
What key labs are used for dx? What are some special
Characteristics would you expect to see with each lab?
Serum Amylase (increase) NL: 25-125 u/L. Up within 24 hours of onset. And normalize within 72 hours
Serum lipase (increase) NL: 0-110. Up after 48 hours and stays elevated for 1-2 weeks.
What other labs would you look at?
CBC : WBC, Hgb and Hct
CMP: AST, ALT,Direct Bilirubin, Renal fx, Calcium
What are some potential complications of acute pancreatitis
Jaundice
Hyperglycemia ( insufficient release of insulin)
Renal failure d/t hypovolemia
Electrolyte imbalance
Coagulation defects
Sepsis and septic shock
Paralytic ileus due to peritoneal irritation
Hypovolemic shock due to fluid shift and hemorrhage
Nursing implications for acute pancreatitis
Fluid replacement: monitor for signs of compromised perfusion- VS and UO
Pain control: pain is the most common symptom of pancreatitis- morphine, Dilaudid
Pulmonary assessment and support: respiratory rate and effort, auscultation, O2 sat, ABGs, TCDB, ICS
Abdominal assessment: peritonitis, rigid board like abdomen, exquisitely painful, signs of Hypovolemia, sepsis
Nutrition: NPO, NGT, TPN enteral or PO - check peristalsis
Bed rest, semi Fowlers, fetal
Chronic Pancreatitis: What are the defining characteristics of this type of pancreatitis?
This is persistent inflammation with periods of remission and exacerbation. Scarring and damage to pancreas and surrounding tissues are involved
Chronic Pancreatitis: Etiology
Heavy alcohol use ( most common)
Autoimmune, genetic, cystic fibrosis
Clinical implications: What changes do you anticipate to see with exocrine and endocrine functions.
Pancreatic enzymes are used up. Pancreas has shriveled to the point where it has no longer produced adequate enzymes.
Clinical Manifestations
Upper abdominal pain (radiating to the back, worsening after eating or drinking alcohol
Elevated lipase and amylase
Nausea and vomiting
Weight loss!
Pale or clay colored stools, steatorrhea and ascites potential!
Patient care
Emphasis: nutrition, blood glucose, hydration, pain, preventative care
High calorie diet: high protein, carb and low fat
Possible TPN or J tube for enteral feeding
Pancreatic enzyme replacement therapy
What is pancreatic enzyme therapy?
Pancreatic enzyme replacement therapy involves taking supplemental enzymes thst contain Pancreatin - mixture of lipase protease and amylase.
Doses vary from person to person
Most adults take 2-4 25,000 unit capsules per meal
Should be taken with first mouthful of food. Spread throughout your meal.
Must be swallowed with a cold drink
When not to take enzyme supplements:
On a empty stomach
With drinks that contain less than half milk like tea, squash and fizzy drinks
If you eat small quantities of fruit, vegetables, dried fruit and fat free sweets like wine gums or mints
If you eat a very small quantity of food such as individual chocolate or biscuit
Note: if you are eating a high fat meal like takeout you will need to take more capsules. Your doctor will show you how to do this.
