PANCREATITIS Flashcards
Inflammation of the pancreas
Pancreatitis
Medical emergency with high mortality rate
Acute Pancreatitis
Undetectable in early stage
Chronic Pancreatitis
What is the main problem of Acute Pancreatitis?
The main problem in Acute Pancreatitis is AUTODIGESTION OF PANCREAS
Digests CHO
Amylase
Digests fats
Lipase
Digests CHON
Trypsin
More common yet milder form
Interstitial Edematous Pancreatitis
(-) necrosis but pancreas become enlarged due to inflammatory edema
Interstitial Edematous Pancreatitis
Patient at risk for hypovolemic shock, F&E imbalances, and sepsis
Interstitial Edematous Pancreatitis
(+) Necrosis within and/or around the pancreas
Necrotizing Pancreatitis
More widespread and complete enzymatic digestion of gland
Necrotizing Pancreatitis
Acute Pancreatitis causes “I GET SMASHED”
I- idiopathic
G- Gall stones
E- Ethanol (Alcohol)
T- Trauma
S- Steroids
M- Mumps/Malignancy
A- Autoimmune
S- Scorpion stings
H- Hypercalcemia/Hypertriglyceridemia
E- ERCP
D- Drugs
Obstruction of the common bile duct
Acute Pancreatitis
Acute Pancreatitis Clinical Manifestations
C- Cullen’s sign
H- Hyperglycemia, Hypocalcemia
A- Abdominal Pain (main symptom)
G- Grey-turner’s sign
S- Sympathetic Nervous System Stimulation
Medical Management of Acute Pancreatitis
- NPO – to inhibit pancreatic stimulation
- Nasogastric suction if with abdominal distention and paralytic ileus
- Enteral feeding (preferred route to meet nutritional needs)
-Total Parenteral Nutrition (TPN), if enteral route is not tolerated
Pain management for Acute Pancreatitis
- Opiod analgesics, as ordered
- Antibiotics, if with infection only
- Intensive insulin therapy/continuous insulin infusion if with hyperglycemia
- IV calcium gluconate if with tetany
What medications do we need to give if hypovolemic shock is present in Acute Pancreatitis?
-Give plasma or plasma volume expanders (e.g dextran or albumin) (the purpose is to increase blood volume)
- Dopamine IV (to increase systemic vascular resistance)
- PLR (fluid of choice to correct electrolyte imbalance
Surgical Management of Acute Pancreatitis
- ERCP with/without lap chole if gall stones are the cause
- Laparotomy
- Pancreatic Surgery
Performed by making a large incision in the abdomen to gain access to the peritoneal cavity.
Laparotomy
Resect or debride an infected, necrotic pancreas
Pancreatic surgery
Nursing Management of Acute Pancreatitis (GOAL: Pain Control)
-Assess pain score regularly
Administer opioids, as ordered
-Institute non- pharmacologic pain relief interventions
- Facilitate and maintain NPO
Institute bed rest - to decrease the metabolic rate and reduce the secretion of pancreatic and gastric enzymes.
-Refer increasing severity of pain to physician ASAP
Nursing Management of Acute Pancreatitis (GOAL: Improvement of Breathing Pattern)
- Place in semi- Fowler’s position (to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion)
-Change positions frequently (to prevent atelectasis and pooling of secretions)
-Facilitate DBE and coughing, instruct on use of incentive spirometry
Nursing Management of Acute Pancreatitis (GOAL: Improvement of Nutritional Status)
- Monitor daily weights
- Administer enteral/parenteral nutrition, as prescribed
- Monitor blood glucose q4-6H or as ordered
- Facilitate high protein, low fat diet once acute symptoms subside
- Instruct to avoid heavy meals and alcoholic beverages
Nursing Management of Acute Pancreatitis (GOAL: Maintaining Skin Integrity)
-Assess surgical wound, drainage sites, and skin for signs of infection, inflammation, and breakdown
- Provide wound care as prescribed
- Prevent contact of intact skin with drainage
- Facilitate turning to sides q2H
Use specialty beds as indicated to prevent skin breakdown
What is the causes of Chronic Pancreatitis?
-Alcohol Consumption
- Smoking
Chronic Pancreatitis Clinical Manifestations (PAWIS)
P- Pain (upper abdominal and back)
A- Anorexia/ Avoidance behavior
W- Weight loss
I- Impaired CHON and fat metabolism
S- Steatorrhea
WHO three-step Ladder for Chronic Pain
Step 1: Non-opiod analgesic + adjuvant
Step 2: Weak opiod + non-opiod + Adjuvant
Step 3: Strong opioid + non opioid + Adjuvant
What is the other alternatives of medical management of Chronic Pancreatitis?
PERT (Pancreatic Enzyme Replacement Therapy)
If with malabsorption and steatorrhea what appropriate medical management must be administer?
Pecutaneous Enzyme Replacement Therapy (PERT)
Nursing Care for Patients Taking Pancreatic Enzyme Replacement (PERT
- Swallow capsules with cold or room temperature liquid
- DO NOT crush or chew capsules
- Taken with the first bite of each meal and snack
- The only foods that do not require you to take enzymes are fruit juice and fruit (fresh and dried fruit) when eaten alone.
- DO NOT stop taking PERT even when symptoms persist
Surgical Management of Chronic Pancreatitis
-Roux-en–Y
- Whipple Resection
Also known as pancreaticoduodenectomy
Whipple Resection
Pancreaticojejunostomy with side-to-side anastomosis
Roux-en-Y
