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High Acuity Ex.1 Study Material > Pancreatitis > Flashcards

Pancreatitis Flashcards

1
Q

What do the delta cells do?

A

◦secrete Somatostatin: Inhibits pancreatic Exocrine secretions, Insulin and Glucagon

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1
Q

What would you educate a patient on that has chronic pancreatitis?

A

◦Pancreatic enzyme supplements may be prescribed, take before meals

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2
Q

What do the beta cells do?

A

secrete Insulin: Decreases glucose, moves it into cell

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3
Q

What are some cardiovascular complications associated with acute pancreatitis?

A

Pancreatic enzymes released into the blood stream–>

Hemorrhage, Shock, Pericardial Effusion, Pericardial Tamponade

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3
Q

What type of pain is associated with acute pancreatitis?

A
  • Sudden onset
  • Sharp, knifelike, twisting deep, upper abdominal (epigastric, LUQ)
  • Frequently radiates to back , associated with Nausea and Emesis
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3
Q

What arr some pulmonary assessment findings associated with acute pancreatitis?

A

◦Pleural effusion –> diminished breath sounds
◦Respiratory Failure –> hypoxia, hypercapnea
◦Pneumonia and/or ARDS –> crackles heard (usually left-side)

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5
Q

What would you educate a patient over Gallstone related acute pancreatitis?

A

◦Teach patients to follow low-fat diet to reduce gallbladder stimulation.
◦Notify healthcare providers at first sign of recurrent pain, nausea or vomiting.

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6
Q

What is Chvostek’s sign?

A

Occurs when the facial muscles contract on the same side of the face as the tapping.

Happens because of hypocalcemia and is due to fat necrosis

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6
Q

What is Trousseau’s sign?

A

(+) result when the hand flexes (carpopedal spasm) using a blood pressure cuff is inflated in the upper arm to a level directly above the patient’s systolic BP for 2 mins

Happens because of hypocalcemia and is due to fat necrosis

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7
Q

What are some symptoms of myocardial depression associated with acute pancreatitis?

A

–Myocardial depressant factor -> ↓ cardiac output w/↑ systemic vascular resistance

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7
Q

What arr some neurologic assessment findings associated with acute pancreatitis?

A

◦Pancreatic Encephalopathy –> decreased Glasgow Coma Scale and LOC

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9
Q

What are some pulmonary complications associated with acute pancreatitis?

A
  • ARDS (acute respiratory distress syndrome)
  • Hypoxemia
  • Respiratory insufficiency & Failure (the release of pancreatic enzymes phospholipase A- destroys a component of surfactant)
  • Pneumonia
  • Pleural Effusion
  • Atelectasis
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10
Q

How are Abdominal x-ray used to diagnose pancreatitis?

A
  • Differentiates Pancreatitis from other disorders with similar sx
  • Detects Pleural Effusions, Atelectasis associated with Pancreatitis
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10
Q

What are the order of interventions for pancreatitis?

A

1.Stabilize patient’s hemodynamic status

  • –Hypovolemia → aggressive fluid resuscitation
    • –Initial Several-liter fluid bolus followed by 250-500mL/hr continuous infusion,
    • –May consist of up to 10-20L of fluid during the first 24 hours, as required. see table 23-5, p. 584
  • –Inotropic Support
    • –Hypotension→ vasopressor
    • –Poor tissue perfusion→ Dobutamine
  • –Respiratory
    • –If PaO₂ < 60mmHg and/or RR> 30/min → early intubation and mechanical ventilation with sedation and analgesia
  • –Renal → Fluid resuscitation & respiratory support
  • –Nutrition → NPO, Nasojejunal enteral feeding (NJ-tube) or TPN
    • –Monitor glucose (150mg/dL),
    • High dose Insulin may be necessary d/t severe insulin resistance

2. Control the patient’s pain

  • –Morphine (DOC)
    • Increases pressure in Sphincter of Oddi, potentially decreasing pancreatic and biliary flow into Small bowel.
  • Fentanyl (Sublimaze), Hydromorphone (Dilaudid) used
  • –Meperidine is NOT considered a drug of choice.

3. Minimize pancreatic stimulation

  • –Keeping the GI tract at rest minimizes pancreatic secretion and reduces pain.
  • NPO
  • GI suction

4. Provide psychosocial support

5. Correct the underlying problem

  • –Alcohol abuse: sufficient rest time
  • –Gallstones: cholecystectomy, certain surgical procedures

6. Prevent or treat complications

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12
Q

How is a Image-guided aspiration biopsy used to diagnose pancreatitis?

A
  • Diagnosies severity of pancreatic tissue damage or
  • Distinguishes sterile from infected necrosis
  • To drain pseudocysts (loculated fluid collec-tions from pathologic inflammation, necrosis, or hemorrhage)
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14
Q

What arr some renal assessment findings associated with acute pancreatitis?

A

◦Acute tubular necrosis –> BUN/Creatinine levels
◦Bile stone –> Urine brownish color and foamy

15
Q

What are some clinical manifestations of acute pancreatitis?

A

Gastrointestinal:

  • Upper abdominal pain, radiates into back; tenderness on palpation epigastric area.
  • Nausea, vomiting
  • Bowel sounds: decreased or absent

Vital signs:

  • Fever, Tachycardia; Shock findings possible (hypotension, weak thready pulse, cold clammy skin)}

Lab:

  • Amylase↑ (peaks after 2-12 hours after onset)
  • Lipase↑** (stays elevated longer)**
  • Ca++ ↓ (active lipase and other enzymes destroy fat cell membranes and split the triglyceride estersà releasing fatty acids. Fatty acids combine with Ca++ in intercellular fluid to produce chalky white areas composed of sodium/potassium salts of long-chain fatty acids (‘soaps”) –> soaponification

Other:

  • (+) Cullen or Turner sign
  • Jaundice (possible)
16
Q

What are some GI assessment findings associated with acute pancreatitis?

A
  • Anorexia
  • –Upper abdominal tenderness
  • –Abdominal distention
  • –Nausea & vomiting
  • –Diarrhea, Steatorrhea (oily, fatty pale stool that floats)
  • –Peritoneal signs (occurs with severe acute pancreatitis AND if peritonitis develops as complication of pancreatitis)
    • –Diminished or absent bowel sounds (ileus may develop)
    • –Increased pain
    • –Abdominal rigidity, guarding, rebound tenderness
18
Q

What are some symptoms of hypovolemic shock associated with acute pancreatitis?

A

Hypotension, Tachycardia, Orthostasis

19
Q

What are some Infectious complications of acute pancreatitis?

A

Infected Pancreatic Necrosis, Sepsis, Peritonitis (bile or pancreatic enzymes leak into the lining of the abdominal cavity OR Necrotizing pancreatitis with infection of necrotic tissue)

20
Q

What are some metabolic complications associated with acute pancreatitis?

A

Hyperglycemia (due to damage to the alpha islet cells→ release glucagon), Metabolic Acidosis, Hypocalcemia

21
Q

How are CT scans used to diagnose pancreatitis?

A

Confirms dx, helps determine severity

22
Q

What are some Hematologic complications with acute pancreatitis?

A

DIC (Disseminated Intravascular Coagulation) & Vascular thrombosis

24
Q

What would you educate a patient over alcohol related acute pancreatitis?

A

◦Avoid alcohol.

◦Refer patients to social worker about alcohol cessation programs

Screening the family for needs related to alcoholism

25
Q

What 2 assessment findings are associated with Hemorrhagic Pancreatitis?

A
  • –Cullen’s sign: Bluish discoloration around umbilicus
  • –Grey Turner’s sign: Bluish discoloration of flank region
26
Q

What do the Acinar cells secrete?

A

Secrete digestive enzymes:

  • Amylase: carbohydrates
  • Elastase, Trypsin: proteins
  • Lipase, Phospholipase A: fats
27
Q

How does ultrasound help diagnose pancreatitis?

A

◦Views bile ducts
◦Identifies gallstones more readily than CT scan

28
Q

What is a Pseudocyst?

A
  • –A cavity containing pancreatic enzymes, necrotic tissue and possibly blood
  • –May rupture into peritoneal cavity, which can precipitate chemical peritonitis (PAIN)
29
Q

What are Ranson’s criteria to diagnose acute pancreatitis?

A

On adission to the hospital:

  • –Age>55 years
  • –WBC>16,000 mm³
  • –Serum glucose > 200 mg/dL
  • –Serum LDH > 350 IU/L (350U/L)
  • –AST > 250 U/mL

Within 48 hours of hospital admission:

  • –Decrease Hematocrit > 10%
  • –BUN increase > 5 mg/dL
  • –Serum calcium < 8mg/dL
  • –Base Deficit > 4 mEq/L
  • –Fluid retention or sequestration > 6L
  • –PO2 < 60 mmHg

Patients presenting with >3 Ranson’s criteria are considered to have severe acute pancreatitis and BEST managed in ICU with an Intensivist, Surgeon, and Gastroenterologist

30
Q

What does autodigestion mean in refernce to the pancreas?

A

Normally, digestive enzymes secreted by Pancreas are NOT active until they reach Small Intestine. But, when Pancreas inflamed, Digestive enzymes attack and damage pancreatic tissues = Autodigestion

30
Q

What are some endocrine assessment findings associated with acute pancreatitis?

A

◦Monitor serum glucose levels –> hyperglycemia because of decreased insulin lvls

31
Q

What do the Alpha cells do?

A

secrete Glucagon : Increases glucose by converting glycogen

33
Q

What are some Neurologic complications with acute pancreatitis?

A

Pancreatic Encephalopathy in severe pancreatitis (Sensorium may be blunted to the point of semicoma)

34
Q

What are some signs of systemic inflammation associated with acute pancreatitis?

A

◦Leukocytosis
◦Tachycardia
◦Fever
◦Decreased mental status/confusion
◦Hypoxemia

35
Q

What are the most common causes of acute pancreatitis?

A

Chronic alcohol abuse and gallstone account for approximately 80% of cases

Chronic Alcohol abuse:

  • –Triggers spasms of the sphincter of Oddi –> transient obstruction

Gallstones:

  • Obstructs outflow of digestive enzymes from pancreatic duct
  • –Causes reflux of bile into pancreatic duct –> activates powerful enzymes within pancreas
36
Q

What are some GI complications of acute pancreatitis?

A

Bleeding & Pancreatic Pseudocyst

37
Q

What are some renal complications of acute pancreatitis?

A

Acute Tubular Necrosis & Acute Renal Failure

High Acuity Ex.1 Study Material (7 decks)

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