Pancreatitis Flashcards
what is pancreatitis?
inflammation of the pancrease that ranges from mild to life-threatening
autodegestion
pancreatic enzymes destroy its own tissue
what sex is pancreatitis more common in?
males
why do males usually get pancreatitis?
alcoholism
acute pancreatitis pathology
-enzymes normally excrete in the duodenum are activated and in the pancreas or its ducts and start to auto digest pancreatic tissue
-consequent inflammation causes intense pain, 3rd spacing of fluid, pancreatic fat necrosis, & occasionally hemorrhage
chronic pancreatitis pathology
-progressive inflammatory changes lead to permanent structural damage
-exocrine and endocrine functions of the pancreas are disrupted
common causes of acute pancreatitis
-gallstones
-alcohol abuse
-hypertriglyceridemia
-genetic mutations
-drugs (antibiotics/antivirals)
-trauma to abdomen
-obstruction
-hypercalcemia
-infections
-idiopathic
-ERCP
common causes of chronic pancreatitis
-usually combination of factors
-genetic mutations
-idiopathic
acute pancreatitis risk factors
-smoking
-obesity
-biliary cysts
-abnormal organ obstruction
-family history of pancreatitis or pancreatic cancer
chronic pancreatitis risk factors
-alcohol abuse
-smoking
-recurrent acute pancreatitis
-ductal obstruction
-systemic disease (Lupus)
-obesity
complications of pancreatitis
-DM
-massive hemorrhage
-shock
-coma
-ARDS
-atelectasis or pleural effusion
-pneumonia
-paralytic ileus
-pancreatic abscess and cancer
-GI bleeding and obstruction
-chronic pancreatitis
-malnutrition
-pseudocysts
-acute kidney injury
-death
assessment of pancreatitis - history
-nausea
-vomiting
-predisposing factors
-history of alcohol or medication use
-myalgia & arthralgia
assessment of acute pancreatitis
-sudden, steady intense epigastric pain
-pain aggravated by consuming fatty foods or alcohol, walking or lying down, relieved by sitting up
-bloating
-diarrhea
assessment - physical findings
-hypotension
-tachycardia
-dyspnea or orthopnea
-basilar crackles
-pale complexion, diaphoresis, and listlessness (severe cases)
-confusion
-pleural effusion
-generalized jaundice
-hypoactive bowel sounds
-Cullen sign
-turner sign
-abnormal tenderness, distention, rigidity, and guarding
assessment of chronic pancreatitis
-intermittent or constant dull, to severe pain in mid to upper left abdomen, possibly radiating to back lasting for several hours
-pain aggravated by consuming fatty foods or alcohol
-weight loss
-steatorrhea
cullen sign
bruising around belly button
turner sign
bruising around love handles
acute pancreatitis lab values
-amylase & lipase elevated
-WBC and differential elevated
-bilirubin elevated
-hyperglycemia and glycosuria
-c-reative protein elevated
-urine amylase elevated
chronic pancreatitis lab values
-alkaline phosphate and bilirubin elevated
-amylase and lipase may be normal or decreased (serum)
-glucose elevated
-lipid & trypsin in stool elevated
-cbc with differential is normal
treatment - general
-emergency treatment of shock
-blood transfusions
-nasogastric suctioning
-venous thromboembolism prophylaxis
-nothing by mouth
-advance to low fate, low protein diet, avoid spicy food
-total parenteral nutriton (or enteral)
-abstain from alcohol or caffeine (b/c dehydration)
-activity as tolerated
acute pancreatitis medications for treatment
-IV fluids for hydration (aggressive)
-analgesics IV, IM, PCA, or epidural cath
-antibiotics (acute)
-electrolyte therapy
-supplemental oxygen
chronic pancreatitis medications for treatment
-analgesics
-pancreatic enzyme supplements
-octreotide acetate to reduce exocrine secretion
-medium-chain triglycerides for fat absorption
-fat-soluable vitamins
-insulin therapy to address glucose intolerance
treatment -surgery
-not indicated in acute unless gallstones, cholecystectomy indicated
-for chronic, sphinerectomy, duct drainage, or pacreatomy
-pancreaticjejunostomy
-endoscopic or percutaneous aspiration of pseudocysts when systemic or larger than 7 cm
nursing interventions
-screen & treat pain
-administer IVF
-give pancreatic enzyme replacement with meals
-obtain fingerstick blood glucose and administer insulin
-maintain NPO status
-provide emotional support
-NG tube insertion, care, and maintenance
-administer enteral and parenteral feedings
-daily weights
-foley catheter
-HOB elevated
-encourage deep breathing & coughing
-turn & reposition
-apply anti embolism stockings
-obtain labs
monitoring
-VS
-NG tube function & drainage
-respiratory status
-acid-base balance (acidosis)
-serum glucose levels
-amylase & lipase levels
-fluid and electrolyte balance
-daily weight
-pain level, effectiveness of interventions
-nutritional status & metabolic requirements
-kidney function
-postop status
