Pancreatitis

Question 1

what is pancreatitis?

Answer 1

inflammation of the pancrease that ranges from mild to life-threatening

Question 2

autodegestion

Answer 2

pancreatic enzymes destroy its own tissue

Question 3

what sex is pancreatitis more common in?

Answer 3

males

Question 4

why do males usually get pancreatitis?

Answer 4

alcoholism

Question 5

acute pancreatitis pathology

Answer 5

-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

Question 6

chronic pancreatitis pathology

Answer 6

-progressive inflammatory changes lead to permanent structural damage

-exocrine and endocrine functions of the pancreas are disrupted

Question 7

common causes of acute pancreatitis

Answer 7

-gallstones
-alcohol abuse
-hypertriglyceridemia
-genetic mutations
-drugs (antibiotics/antivirals)
-trauma to abdomen
-obstruction
-hypercalcemia
-infections
-idiopathic
-ERCP

Question 8

common causes of chronic pancreatitis

Answer 8

-usually combination of factors
-genetic mutations
-idiopathic

Question 9

acute pancreatitis risk factors

Answer 9

-smoking
-obesity
-biliary cysts
-abnormal organ obstruction
-family history of pancreatitis or pancreatic cancer

Question 10

chronic pancreatitis risk factors

Answer 10

-alcohol abuse
-smoking
-recurrent acute pancreatitis
-ductal obstruction
-systemic disease (Lupus)
-obesity

Question 11

complications of pancreatitis

Answer 11

-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

Question 12

assessment of pancreatitis - history

Answer 12

-nausea
-vomiting
-predisposing factors
-history of alcohol or medication use
-myalgia & arthralgia

Question 13

assessment of acute pancreatitis

Answer 13

-sudden, steady intense epigastric pain
-pain aggravated by consuming fatty foods or alcohol, walking or lying down, relieved by sitting up
-bloating
-diarrhea

Question 14

assessment - physical findings

Answer 14

-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

Question 14

assessment of chronic pancreatitis

Answer 14

-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

Question 15

cullen sign

Answer 15

bruising around belly button

Question 16

turner sign

Answer 16

bruising around love handles

Question 17

acute pancreatitis lab values

Answer 17

-amylase & lipase elevated
-WBC and differential elevated
-bilirubin elevated
-hyperglycemia and glycosuria
-c-reative protein elevated
-urine amylase elevated

Question 18

chronic pancreatitis lab values

Answer 18

-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

Question 19

treatment - general

Answer 19

-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

Question 20

acute pancreatitis medications for treatment

Answer 20

-IV fluids for hydration (aggressive)
-analgesics IV, IM, PCA, or epidural cath
-antibiotics (acute)
-electrolyte therapy
-supplemental oxygen

Question 21

chronic pancreatitis medications for treatment

Answer 21

-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

Question 22

treatment -surgery

Answer 22

-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

Question 23

nursing interventions

Answer 23

-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

Question 24

monitoring

Answer 24

-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