Pancreatitis

Question 1

General

Answer 1

Inflammation of the pancreas

Results from alterations in the structure or function of the pancreas, commonly caused by chronic alcohol abuse (and gallstones)

Question 2

Etiology

Answer 2

Special protein (PSP) prevents calcium precipitation

Dominant hereditary trait observed in children of both sexes

Question 3

Metabolic

Answer 3

Hypercalcemia
HLD
High protein and high fat diets
Protein/fat malnutrition
Hyperparathyroidism

Question 4

Drugs

Answer 4

Corticosteroids
Thiazide diuretics
OCP
Tetracyclines
Sulfonamides
Excessive doses of Tylenol

Question 5

Mechanical

Answer 5

Trauma
Cholecystitis, cholelithiasis
Bile/duodenal reflux
Post operative complication of gastric, biliary, duodenal surgery
Ischemia following shock
Pancreatic tumor

Question 6

Infection

Answer 6

Viral Hepatitis
Mumps
Coxsackievirus

Question 7

Clinical Manifestations

Answer 7

LUQ abdominal pain
Vomiting
Fever
ARDS/pleural effusions
potential jaundice
Abdominal tenderness or guarding
Distension and tympany
Hypoactive or absent BS
Severe: dehydration or hypovolemic shock
Grey turner sign
Cullen sign
Hypocalcemia
Pseudocyst
Abscess

Question 8

Abdominal Pain

Answer 8

LUQ radiates towards back

Usually begins abruptly and commonly after a large meal or ETOH binge

Question 9

Vomiting

Answer 9

Does not relieve pain

Consists of gastric and duodenal contents

Question 10

Grey-Turner Sign

Answer 10

Discoloration of the lower abdominal flanks

Question 11

Cullen Sign

Answer 11

Discoloration around the umbilical area

Question 12

Dx criteria

Answer 12

Elevated:
Amylase
Lipase
WBC
Hyperglycemia
Bili, AST, LDH, Alk Phos
Triglyceride
Hypocalcemia
Hypoxemia

Question 13

Diagnostics

Answer 13

US
CT
MRI
IV Cholangiography
Chest Films 
UGI

Question 14

US

Answer 14

Shows organ edema or inflammatory process

Question 15

CT

Answer 15

Identifies tumors, pseudocysts, dilated/calcified pancreatic ducts

Question 16

MRI

Answer 16

Identifies soft tissue tumors, strictures, malformations

Question 17

Ranson Severity Criteria

Answer 17

Prognosis of Mortality rate of pancreatitis

Question 18

Ranson Upon admission

Answer 18

age >55
Leuk>16
Glucose>200
Lactice>350
AST>250

Question 19

Ranson upon 48 hours

Answer 19

Fall in hemocrit >10%
BUN increase >5
Ca2+<8
Fluid sequestration >6L
PaO2<60
Base deficit >4

Question 20

1% Mortality

Answer 20

Fewer than 3 signs

Question 21

15% Mortality

Answer 21

3-4 signs

Question 22

40% Mortality

Answer 22

5-6 signs

Question 23

100% Mortality

Answer 23

7 or more signs

Question 24

The scale is ____ accurate

Answer 24

96%

Question 25

Potential Complications

Answer 25

Neuro: Encephalopathy Pulm: ARDS, Pleural effusion, hypoxemia, atelectasis Heart: Hypotensive shock, Myocardial depression ARF Heme: DIC Metabolic: Hypocalcemia, metabolic acidosis GI: Pancreatic pseudocyst, abscess, GI bleed

Question 26

Collaborative Management

Answer 26

``` PANCREAS Pain Antispasmodic drugs Nasogastric suction Calcium Replacement of fluids/electrolytes Endocrine Abx Steroids (corticosteroids) ```

Question 27

Nursing DX

Answer 27

``` Pain: epigastric or abd Fluid Volume Deficit Altered Nutrition Anxiety Ineffective therapeutic regime management ```

Question 28

Nutrition

Answer 28

No ETOH Notify HCP for acute abd pain Notify HCP for clay colored stool, darkened urine, jaundice

Question 29

#1 cause

Answer 29

alcoholism in middle aged male

Question 30

Diversity

Answer 30

Women develop pancreatitis most often after having gallstones Mortality is highest when pancreatitis accompanies alcoholism