Pancreatitis Flashcards
1
Q
pancreatitis
A
- Islets of Langerhans: secrete insulin and glucagon
- Pancreatic tissues secrete digestive enzymes that break down carbs, proteins, and fats
- Pancreatitis: autodigestion of the pancreas by pancreatic digestive enzymes that activate prematurely before reaching the intestines
- MOA: unclear
- Inflammation of the pancreatic tissue causes duct obstruction, which can lead to increased pressure and duct rupture, causing the release of pancreatic enzymes into the pancreatic tissue
- Can result in pancreatic inflammation, necrosis, hemorrhage
2
Q
acute vs. chronic pancreatitis
A
- Acute pancreatitis: inflammatory process due to activated pancreatic enzymes autodigesting the pancreas ranging from mild to necrotizing hemorrhagic pancreatitis (widespread bleeding and necrosis)
- Classic presentation of acute attack: severe, constant, knifelike pain (LUQ, midepigastric, and/or radiating to the back)
- Chronic pancreatitis: progressive, destructive dz of inflammation and fibrosis of pancreas
3
Q
how can chronic pancreatitis be classified?
A
- Chronic calcifying pancreatitis: assoc with alcohol use disorder
- Chronic obstructive pancreatitis: assoc with cholelithiasis
- Autoimmune pancreatitis
- Idiopathic and hereditary pancreatitis
4
Q
pancreatitis: health promotion and dz prevention
A
- Avoid excess alcohol consumption
- Eat a low fat diet
5
Q
pancreatitis: risk factors
A
- Biliary tract dz: gallstones can cause a blockage where the common bile duct and pancreatic duct meet
- Alcohol use: primary cause of chronic pancreatitis is alcohol use disorder
- Times of inc alcohol consumption, like vacations or holidays, are assoc with acute pancreatitis
- Inc age: more common in older adults
- Endoscopic retrograde cholangiopancreaticography (ERCP): post procedure complication
- GI surgery
- Metabolic disturbances: hyperlipidemia, hyperparathyroidism, hypercalcemia
- Kidney failure or transplant
- Genetic predisposition
- Trauma
- Penetrating ulcer: gastric or duodenal
- Medication toxicity
- Viral infections: coxsackievirus B and HIV
- Cigarette smoking
6
Q
pancreatitis: expected findings
A
- Sudden onset of severe, boring pain (goes thru body)
- Epigastric, radiating to back, left flank, or left shoulder
- Worse when lying down
- Pain relieved somewhat by fetal position or sitting upright, bending forward
- n/v
- Weight loss
- Seepage of blood stained exudates into tissue as a result of pancreatic enzyme actions
- Ecchymoses on the flanks: Turner’s sign
- Bluish gray periumbilical discoloration: Cullen’s sign
- Generalized jaundice
- Absent or dec bowel sounds (possible paralytic ileus)
- Warm, moist skin and fruity breath: evidence of hyperglycemia
- Ascites
- Tetany due to hypocalcemia
- Trousseau’s sign: hand spasm when BP cuff is inflated
- Chvostek’s sign: facial twitching when facial nerve is tapped
7
Q
pancreatitis: lab findings
A
- Serum amylase: inc w/in 12 to 24 hr and remains inc for 2-3 days
- Continued elevation can indicate pancreatic abscess or pseudocyst
- Serum lipase: inc slowly but remains inc for up to 2 weeks
- Urine amylase remains inc for up to 2 weeks
- Inc in enzymes indicate pancreatic cell injury
- WBC count: inc due to infection and inflammation
- Platelets: dec
- Serum calcium and magnesium: dec due to fat necrosis w/ pancreatitis
- Serum liver enzymes and bilirubin: inc with assoc biliary dysfunction
- Serum glucose: inc due to a dec in insulin production by the pancreas
- ESR: elevated
8
Q
pancreatitis: diagnostic procedures
A
CT scan w/ contrast: reliably diagnostic for acute pancreatitis
9
Q
pancreatitis: nursing care
A
- Rest pancreas:
- NPO: no food until pain free
- For severe pancreatitis: TPN or jejunal feedings
- Contraindicated if paralytic ileus develops, less risk of hyperglycemia
- When diet is resumed: bland, high protein, low fat diet with no stimulants (caffeine)
- small, frequent meals
- Administer antiemetic as needed, as prescribed
- NG tube: gastric decompression
- For severe vomiting or paralytic ileus
- No alcohol consumption
- Smoking
- Limit stress
- Pain mgmt
- Position client for comfort: fetal, side lying, HOB elevated, sitting up or leaning forward
- Administer analgesics
- Monitor blood glucose, and provide insulin as needed: potential for hyperglycemia
- Monitor hydration status: orthostatic BP, I&O, lab values
- Administer IV fluids and electrolyte replacements
10
Q
pancreatitis: classes of medications
A
- opioid analgesics
- abx
- histamine receptor antagonists
- PPIs
- pancreatic enzymes
11
Q
pancreatitis: opioid analgesics
A
- morphine or hydromorphone
- For acute pain
- Nursing considerations: meperidine is discouraged due to risk of seizures, esp in older adult clients
12
Q
pancreatitis: abx
A
- imipenem
- Can be used but are generally indicated for clients who have acute necrotizing pancreatitis
- Nursing Considerations:
- monitor for evidence of infection
- Monitor for seizures
13
Q
pancreatitis: histamine 2 receptorantagonists
A
- ranitidine
- Dec gastric acid secretion
- Client edu:
- Take 1 hr before or 1 hr after antacid
14
Q
pancreatitis: PPI
A
- omeprazole
- Dec gastric acid secretion
- Nursing considerations:
- Monitor for hypomagnesemia
15
Q
pancreatitis: pancreatic enzymes
A
- pancrelipase
- Aid w/ digestion of fats and proteins when taken with meals and snacks
- Nursing considerations:
- Client can sprinkle contents of capsule on nonprotein foods
- Client should drink a full glass of water following pancrelipase
- Clients should wipe lips and rinse mouth after taking (to prevent skin breakdown or irritation)
- Take after antacid or histamine receptor antagonists
- Teach client to take pancrelipase with every meal and snack
