Pancreatitis | Acute and Chronic Pancreatitis Nursing Lecture Symptoms, Treatment, Pathophysiology

Question 1

Inflammation of the pancreas
Swollen as well
Cells get irritated and start malfunctioning - can lead to digestion of pancreas by own digestive enzymes and if chronic can cause irreversible structural damage to the organ
Two types: acute and chronic

Answer 1

Pancreatitis

Question 2

Found in the upper abdomen next to duodenum - inside pancreas - pancreatic duct and have common bile duct which connected to gall bladder - secrete bile down and pancreatic duct secrete enzymes and will meet together at ampula of vader and bile and digestive enzymes come out through major duodenal papilla - surrounding: sphincter of odi: muscular valve that controls flow bile and enzymes into duodenum; also prevents reflux duodenal contents back into pancreas
Inside are special cells that secrete enzymes and hormones
Hormones - blood vessels
Enzymes - pancreatic ducts - epithelial cells
Exocrine - acinar cells: connected to pancreatic duct: secrete inactive digestive enzymes into pancreatic ducts and flow into duodenum - not active until in duodenum - biochemical change with assistance stomach acid: secretes amylase, protease, lipase
Endocrine - islets of langerhans
Pancreatitis leads to

Answer 2

Func of pancreas

Question 3

Breaks down carbs to glucose

Answer 3

Amylase

Question 4

Breaks down proteins

Answer 4

Protease

Question 5

Breaks down fats

Answer 5

Lipase

Question 6

Amylase
Protease
Lipase
Inflammation of pancreas acinar not work properly - activate inside of pancreas which start digest it
Surrounding pancreatic duct are epithelial cells secrete bicarb - helps neutralize stomach acid

Answer 6

Exocrine - acinar cells: connected to pancreatic duct: secrete inactive digestive enzymes into pancreatic ducts and flow into duodenum - not active until in duodenum - biochemical change with assistance stomach acid: secretes amylase, protease, lipase

Question 7

Secrete Insulin, glucagon, somatastatin, pancreatic polypeptide into blood stream - surrounding pancreas in stream
Play role in BG; pancreatitis if severe enough see odd BG - s&s of DM - cells inflamed and damaged - not able secrete right amount of insulin so issues with that

Answer 7

Endocrine - islets of langerhans

Question 8

Digestive enzymes not able be delivered to duodenum - seeing malabsorption; hormones not going into bloodstream normally so BG issues
Pancreas swell and leak digestive enzymes into surrounding tissues and organs - affect whole body if bad enough
See:

Answer 8

Pancreatitis leads to

Question 9

Blood sugar issues
Ascites - swelling in abdomen
Malabsorption - digestive enzymes not making it to the gut - stool oily - not digesting fats
Weight loss
Extreme pain - enzymes leaking into tissues
Diarrhea
Systemic shock
Multiorgan failure
Resp distress - lead to death if not treated
Internal bleeding - callon sign and gray turner sign from retroperitoneal bleeding
Fibrosis if bad enough (chronic - tissue necoritic and change resulting in this, cells not work at all), cyst formation - pulling of infection, abscess, rupture

Answer 9

See:- Pancreatitis leads to

Question 10

Sudden inflammation due to something that has triggered those digestive enzymes to activate inside pancreas (increase amylase and lipase) - digest itself, swell, inflamed, tissue dies, fibrosis, cyst, abscess
Come on suddenly and quickly
Pancreas working - endocrine and exocrine cells working
Digestive enzymes cause enzymes cause it to digest itself - lot pain and swelling - not treated quickly and properly tissue dies and experience fibrosis, cyst, abscess
Due to location pancreas and how surrounds other organs, inflammation and free digestive enzymes can flow to other organs and vessels around pancreas - when comes on suddenly can cause death because can cause acute resp depression, bleeding
Reversible if treated properly - limited structural change
Can lead to chronic
2 major causes: gallstones; alcohol abuse in high amounts - high ingestion alcohol
Other causes: Infection, tumors, meds, trauma

Answer 10

Acute

Question 11

Gallstones
ETOH

Answer 11

Other causes: Infection, tumors, meds, trauma - Acute

Question 12

Hardened deposits of undissolved cholesterol, salts, or bilirubin that can block common bile duct (ampulla of vater); gallbladder func not appropriate - bile stagnant and hardens - stones can come down and block common bile duct - pancreatic duct flowing in that location as well and come together at ampulla of vater - stone present and block pancreatic duct - back up pancreatic digestive enzymes and increase pressure - then get activation of enzymes; not supposed happen in pancreas - viscious cycle of pancreatitis happens until gallstone removed so juices flow out into duodenum

Answer 12

Gallstones

Question 13

Drinking binge
Damage cells of pancreas
Pancreatic (acinar) cells and pancreatic duct cells not like alcohol - messes with bicarb produced by epithelial cells and fluids - not get fluid and bicarb production; duct because viscous and can cause occlusion of pancreatic duct then get activation of digestive enzymes

Answer 13

ETOH

Question 14

Chronic reoccuring inflammation that not getting better - repeated episodes of acute but most common cause ETOH abuse - YEARS
Other causes: increased calcium and choelsterol
Damage to pancreas is irreverable
Long-term alcohol use
Cystic fibrosis

Answer 14

Chronic

Question 15

Structure changes: Loss of func to endocrine and exocrine of cells - func not as well
Amylase and lipase can be norm or slightly elevated
Damage to pancreatic ducts
Pancreas tissue experiences fibrosis with cysts and calcification (necrotic and die)

Answer 15

Damage to pancreas is irreverable - Chronic

Question 16

Pancreas not like alochol
Damages pancreas
Consumes over yrs and recurrent inflammation on pancreas and structures start deform, malfunction, cells quit doing what supposed to do and get chronic

Answer 16

Long-term alcohol use - Chronic

Question 17

Cause of chronic
Lot resp issues
Affects pancreas
Lack CFTR protein - plays a role in movement of Cl ions to help balance salt and water in epithelial cells that line pancreatic ducts - secrete bicarb and fluids that help keep fluid thin which mix with digestive enzymes secreted by acinar cells and allow easily flow through pancreatic duct through ampulla of vater thent o duodenum
Happens: bicarb production decreases - mucus thickens in pancreatic ducks and blockage of ducts and digestive enzymes activate and chronic inflammation and pancreas starts die and get fibrosis of tissue
End result: no longer produce pancreatic digestive enzymes by acinar cells - admin pancreatic enzymes to digest fats and carbs

Answer 17

Cystic fibrosis - Chronic

Question 18

Blood tests: amylase lipase levels: acute: elevated; increased electrolytes
CT/US - imaging pancreas - assess and look at structure
ERCP: scope used to assess pancreas, bile ducts, gallbladder - diagnosis pancreatitis with this and treat some causes: remove gall stone, dilate blocked duct/balloon/stent, drain cyst

Answer 18

Diagnosed

Question 19

Majority func of cells so more pain - increased amylase, lipase levels
Sudden, very painful mid-epigastric pain of LUQ (pancreas location) and radiate to back - hurts when lying flat
Pain will just come on after binge drinking or eating fatty meal
Worse: fever (inflammation), increase HR - shock, decreased BP - shock
N&V - pain worse
Increased glucose (islets of langerhans not working properly - monitor BG); increase amylase and lipase
Cullen’s sign: bluish discoloration umbilicus; severe cases of pancreatitis; around umbilicus; digestive enzymes free and going to surrounding tissues damaging vessels, tissues, etc and causing bleeding and seeping down and collecting around belly button and flanks - blood from retroperitoneal hemorrhage
Grey Turner’s sign: bluish discoloration on flank/side of abdomen; digestive enzymes free and going to surrounding tissues damaging vessels, tissues, etc and causing bleeding and seeping down and collecting around belly button and flanks - blood from retroperitoneal hemorrhage

Answer 19

s&s with acute

Question 20

On for awhile; lost majority func of pancreas; more long-term effects
Chronic mid-epigastric pain (may have no pain if acinar cells damaged completely) - not releasing digestive enzymes because that is where majority pain coming from
Pain increase after drinking ETOH or eating
May have swelling or mass abdomen “pseudocyst” - where fibrosis; palpate that
Steatorrhea - diarrhea of oil/greasy stools - float to top; residue of grease in water (decreased pancreatic enzymes - why admin pancreatic enzymes); cannot breakdown fats so come out in stool
Weight loss: cannot digest foods properly
Jaundice - late cases; yellowing skin, white eyes; damage to bile duct that helps remove bile from liver - damage from liver and inflammation - not remove bile from liver and back up and have s/s of backup
Dark urine - excessive bile in body - leaks into kidneys
DM - damaged islets of langerhans; insulin to cover BG

Answer 20

s&s with chronic

Question 21

Goal: allow pancreas rest - not stimulated so not release digestive enzymes; control pain; monitor for comps; administer meds per MD order (pancreatic enzymes, antibiotics, stomach acid blockers), provide diet edu
NPO initially (let pancreas rest, no stimulation to produce enzymes) - as improve carefully introduce liquids; typ no liquids with fats - requires lot digestive enzymes to break down and via MD orders
Maintain IV hydration - not eating/drinking - dehydration cause worsening condition; long time heal may need TPN through central line
Insert and maintain NG tube - remove stomach contents and gas thereby decreasing vomiting; not stimulating pancreas
Monitor BG; high because cells not working - insulin via MD orders
Monitor stools - oily, greasy look - taking pancreatic enzymes want ensure proper amount pancreatic enzymes because if still greasy something wrong
Monitor urinary output and color - looking for dark brown (showing bile collecting and leaking into kidneys)
Admin pain meds (typ IV route) - morphine usually avoided - causes spasms at sphincter of Oddi - makes worse
Nonpharm - reposition - lean forward or sit up so not supine
Administer drugs to decrease acid secretion and activating digestive enzymes: PPIs, H2 blockers, antacids - decrease acid prevent digestive enzymes from being activated - how whole biochem process happens - enzymes come through pancreas where contact happens with stomach acid and increases activation and decreasing acid decreases activation
Pancreatic enzymes: creon or pancreatin - help break down fats, carbs, proteins where acinar cells not able do the job; know working right - decrease in steorrhea - admin right before meals - time eat do job and work and break down food
Mix pancreatic enzymes in acidic food: applesauce; avoid alkaline: milk, pudding, ice cream because not work properly

Answer 21

N. interventions

Question 22

No alcohol (esp chronic pancreatitis) or greasy/fatty food
Low fat, bland, small meals - not large
High protein
Limit sugars and refined carbs - high fructose corn syrup and white breads (often issues with DM so want watch sugars)
Consume more complex carbs - fruits, vegs, grains - uses less insulin - islets langerhans not produce as much insulin

Answer 22

Diet edu