Pancreatitis Flashcards
use ERCP in
acute pancreatitis
drains common bile duct
T tube
report drainage of a T tube of greater than
500 mL/day
T tube
anticipate 300-500 mL of thick, blood tinged, brigh yellow to dark green bile drainainge the first 24 hours after surgery
digestive enzymes produced by pancreas
amylase, protease (protein), lipase (fat), bicarb
enzymes travel via pancreatic duct to the
duodenum
endocrine glands produced by the pancreas
insulin, glucagon, somatostatin (inhibits the secretion of other pancreatic hormones such as insulin and glucagon.), pancreatic peptide
if exocrine glands are released into system?
start to digest other parts of the body or the pancrease itself
when pancreas malfunctions
diarrhea, bloating, flatulence, steatorrhea, weight loss, malnutrition, poor BS control/DM
sudden onset, lasts for several hours to several days, resolves
acute pancreatitis
often undetected until symptomatic and 90 percent of cell function lost. causes scarring and inflammation
chronic pancreatits
acute pancreatits patho
blockage of ducts, digestive enzymes become activated while still in the pancreas, repeated instances may lead to chronic
causes of acute pancreatitis
gallstones, ETOH, trauma, steroids, mumps, autoimmune, snake bite, hyperlipidemia, drugs
know meds for acute
see slide page 7
S/S acute pancreatitis
pain, vomiting, fever, abdomen, labs, pain in back around L2
cullins sign
red around bell
turners sign
red at side and flank
spell ERCP
endoscopic retrograde cholangiopancreatography
labs you see in acute pancreatitis
WBC raised, glucose raised, LDH and AST raised, low calcium, increase BUN,
what is the most serious complication of acute pancreatitis
pancreatic abscess (if rupture infection and enzymes explode)
antispasmotic for acute pancreatitis
dicyclomine
NPO for acute because?
mouth starts digestion
meds for acute pancreatitis
opioids - morphine, hydromophone, fentanyl. antibiotics - imipenem, cefuroxime
assessment of chronic pancreatitis
recurrent abdominal pain/tenderness, anorexia, N/V, weight loss, steatorrhea, S/S of DM
ERCP is not done in
chronic pancreatits. can make symptoms worse
complications of chronic pancreatitis
malabsorption, malnutrition, peptic ulcer disease, pancreatic abcess, stricture of common bile duct, DM, pancreatic cancer
what is the most definitive diagnostic for pancreatic cancer
ERCP
asymptomatic until later stage and often present with DVT or PE
pancreatic cancer
non surgical management of pancreatic cancer
high doses of opioids, chemo (results not good), radiation
surgical management of pancreatic cancer
whipple
with whipple procedure never
adjust or re insert NG tube if dislodged or removed
