Pancreatitis

Question 1

Pancreatitis

Answer 1

• autodigestion of the pancreas from premature activation (before reaching the intestines) of pancreatic digestive enzymes
• results in inflammation, necrosis, and hemorrhage

Question 2

Classic S&S of an acute attack

Answer 2

-severe, constant, and knife-like pain (LUQ, mid-epigastric, and/or radiating to the back) that is unrelieved by nausea and vomiting

Question 3

Acute Pancreatitis

Answer 3

• an inflammation of the pancreas from activated pancreatic enzymes autodigesting the pancreas.
• severity varies, but overal mortality is 10-20%

Question 4

Chronic Pancreatitis

Answer 4

• a progressive, destructive disease of the pancreas with the development of calcification and necrosis, possibly resulting in hemorrhagic pancreatitis
• mortality as high as 50%

Question 5

Risk Factors

Answer 5

2 primary causes:

• alcoholism
• biliary tract disease (gallstones can cause a blockage where the common bile duct and pancreatic duct meet)

other causes:

• complication of endoscopic retrograde cholangiopancreatography (ERCP)
• intake of large amounts of fat and/or alcohol
• gallbladder disease
• primary cause of chronic pancreatitis is alcoholism

Question 6

Manifestations

Answer 6

1) sudden onset of severe pain
- epigastric, radiating to back, left flank, or left shoulder
- worse when lying down or while eating
- not relieved with vomiting
- pain relieved somewhat by fetal position
2) nausea and vomiting
3) weight loss
4) ecchymoses on the flanks (Turner’s sign)
5) bluish periumbilical discoloration (Cullen’s sign)
6) generalized jaundice
7) paralytic ileus
8) hyperglycemia
9) ascites
10) tetany

Question 7

Labs and Diagnostics

Answer 7

1) serum amylase (rises within 12 hr, lasts 4 days) and serum lipase (rises slower, but lasts up to 2 wks
2) rises in enzymes indicate pancreatic cell injury
3) WBC count: elevated due to infection and inflammation
4) serum calcium and magnesium levels: decreased due to fat necrosis with pancreatitis
5) serum liver enzymes and bilirubin levels: elevated with associated biliary dysfunction
6) serum glucose level: elevated due to a decrease in insulin production from pancreas
7) computed tomography (CT) scan w/ contrast is reliably diagnostic of acute pancreatitis

Question 8

Nurse Care

Answer 8

1) rest the pancreas
- NPO–no food until pain free
- administer antiemetic as needed
- NG tube–gastric decompression
- TPN or jejunal feedings (less risk of hyperglycemia)
2) when diet is resumed: bland, low-fat diet with no stimulants (caffeine); small, frequent meals
3) no alcohol consumption
4) no smoking
5) limit stress
6) pain management
7) monitor blood glucose levels and provide insulin as needed (potential for hyperglycemia)
8) monitor hydration levels (orthostatic BP, I&O, lab values)
9) provide IV fluids and electrolyte replacement as prescribed

Question 9

Medications

Answer 9

1) opioid analgesics for acute pain: morphine sulfate (Morphine)
2) meperidine (Demerol) discouraged in older clients due to risk of seizures
3) antibiotics may be used, but are generally indicated for clients with acute necrotizing pancreatitis
4) anticholinergics: dicyclomin (Bentyl) to decrease intestinal motility and the flow of pancreatic enzymes
5) spasmolytics: papaverine (Pavabid) to relax smooth muscle
6) histamine receptor antagonists: ranitidine (Zantac) and PPIs–omeprazole (Prilosec) to decrease gastric acid secretion
7) pancreatic enzymes: pancreatin (Donnazyme), pancrelipase (Viokase) to aid with digestion of fats and proteins when taken with meals and snacks

Question 10

Therapeutic Procedures

Answer 10

1) ERCP to create an opening in the sphincter of Oddi if pancreatitis is caused by gallstones
2) cholecystectomy if pancreatitis is a result of cholecystitis and gallstones
3) pancreaticojejunostomy (Roux-en-Y) reroutes drainage of pancreatic secretions intojejunum