Unit 3: Chronic Pancreatitis Flashcards
Most common cause of Chronic Pancreatitis
heavy, prolonged alcohol use
Causes of Chronic Pancreatitis
- Heavy alcohol use
- Hereditary disorders of the pancreas
- Cystic fibrosis
- Hypertriglyceridemia
- Hyperlipidemia
- hypercalcemia
Chronic Pancreatitis
- inflammation of the pancreas that occurs when digestive enzymes autodigest the pancreas and surrounding tissues for a prolonged period of time
- not reversible; both exocrine and endocrine functions are altered
Pathophysiology
- digestive enzymes autodigest the pancreas and surrounding tissues for a prolonged period of time
- b/c of inflammation and scarring, the pancreas is unable to make the digestive enzymes necessary to regulate glucose (insulin and glucagon)
- fibrosis of the pancreas secondary to the chronic inflammation is associated w/ chronic pancreatitis and further contributes to the loss of normal pancreatic function
Clinical Manifestations
- upper abdominal pain, which can spread to the back and feels worse after eating or drinking
- pain is constant; prevents patient from normal daily activities; described as recurring epigastric and LUQ pain
- pain is exacerbated by alcohol consumption and overeating
- N/V
- weight loss
- diarrhea
- pale or clay-colored stools
- steatorrhea or oily stools
Why does weight loss occur?
b/c the pancreas is no longer secreting pancreatic enzymes to digest food, leading to decreased absorption of nutrients and malnourishment
Diagnostic Work-up of Chronic Pancreatitis
- Abdominal CT, ultrasound, or ERCP to visualize the pancreas, as well as to verify structural or obstructive changes
- Lab analysis: amylase, lipase, alkaline phosphate, bilirubin, and glucose
Laboratory Analysis
- Lipase and amylase; elevated
- Serum alkaline phosphate; elevated
- Bilirubin; elevated
- Glucose; elevated d/t lack of insulin
Treatment of Chronic Pancreatitis
- Pain management
- IV fluid replacement
- Electrolyte management
- Nutritional support
- Insulin Therapy
- Cared for in ICU
- GI prophylaxis with histamine blockers or proton pump inhibitors
- Total parenteral nutrition (TPN)
- modification of risk factors (heavy tobacco an alcohol use)
Surgical Management
-may provide symptomatic relief of pain
-not appropriate for all patients
-Puestow procedure
-Laparoscopic draining
-Resection of the pancreas
>b/c of the irreversible nature of chronic pancreatitis, these procedures address issues r/t pain, inflammation, and obstruction; not curative
Puestow Procedure
- for pain relief
- opens the pancreatic ducts and redirects the flow of pancreatic enzymes into the intestine
Laparoscopic Drainage
- indicated in patients with abscesses or pseudocysts
- relieves pain
Nursing Management: Assessment and Analysis
> chronic pancreatitis is characterized by pain and weight loss; irreversible disease process
Manifestations:
-constant, burning pain; exacerbations of intense, unrelenting pain
-anorexia
-nausea/vomiting
-constipation
-flatulence
-steatorrhea (fatty stools)
-elevated amylase, lipase, bilirubin and alkaline phosphate
-elevated glucose
Nursing Diagnoses
- Acute pain r/t inflammation and obstruction of the pancreas
- Imbalanced nutrition, less than body requirements d/t malabsorption and altered secretion of pancreatic enzymes
- Hopelessness r/t the chronic, progressive, irreversible nature of chronic pancreatitis
Nursing Assessments for Chronic Pancreatitis
- Vital Signs
- Serum Blood Glucose
- Amylase and Lipase Levels
- Serum Bilirubin and Alkaline Phosphate
- Weight
- Pain
- Abdomen
- Skin Color
- Stool
Assessments: Vital Signs
-pulse rate (HR), respiratory rate, and BP elevations are associated with episodes of pain exacerbations
Assessments: Serum Glucose
with decreased insulin production/release with endocrine dysfunction, serum glucose is elevated
Assessments: Amylase and Lipase Levels
elevations are associated with chronic pancreatitis
Assessments: Serum Bilirubin and Alkaline Phosphate
obstruction of the bile ducts leads to increases of both bilirubin and alkaline phosphate
Assessments: Weight
because of malabsorption secondary to altered secretion of pancreatic enzymes; at risk for weight loss
Assessments: Pain
chronic pancreatitis is characterized by persistent, recurring episodes of epigastric and LUQ pain secondary to inflammation and obstruction
Assessments: Abdomen
- tenderness of the abdomen may be observed
- palpation may reveal a mass in the LUQ that may indicate a pseudocyst or abscess
Assessment: Skin color
jaundice may be observed w/ obstruction of the bile ducts
Assessments: Stool
- steatorrhea may develop w/ progressive pancreatic insufficiency
- clay-colored stools with bile obstruction
Nursing Actions
- Administer pancreatic enzymes (PERT)
- Provide GI prophylaxis as ordered
- Provide rest and a calm environment
- Implement pain-relief measures
- Collaborate with a dietician to ensure adequate nutrition
Actions: Administer Pancreatic Enzymes (PERT)
-these medications contain amylase, lipase, and protease to enhance the absorption of nutrients
Actions: Provide GI prophylaxis as ordered
histamine blockers or proton pump inhibitors to treat the increased gastric acid secretion
Actions: Provide rest and a calm environment
- decrease strain on the already-diseased pancreas
- may decrease the secretion of acids in the stomach, which can exacerbate chronic pancreatitis
Actions: Implement pain-relief measures
pain may be managed w/ the administration of opioids initially and then with nonopioids when the pain is less intense
Actions: Collaborate with dietician to ensure adequate nutrition
- may require increased caloric intake or parenteral nutrition as a result of alterations in absorption
- low-fat diet; b/c of difficulty in breaking down fats, resulting in steatorrhea
Patient Teachings
- Avoid alcohol
- Do not chew pancreatic enzymes; available as extended release or enteric coated
- Limit fat in diet
- Avoid intake of irritating foods/beverages (coffee, caffeine); increase gastric distress
- Referral to support groups such as Alcoholics anonymous or AI-Anon
Elevating Care Outcomes
- Chronic pancreatitis is a progressive, irreversible disease that results in pain, malabsorption, and weight loss
- Effectiveness of disease management is r/t pain management and minimizing weight loss secondary to the administration of opioid and nonopioid medications
- decrease in steatorrhea is associated with the actions of pancreatic enzyme replacement (PERT)
- patient and family involvement
- minimize exacerbations by avoiding alcohol intake
- seek out support groups to deal with incurable disease
