Unit 3: Chronic Pancreatitis Flashcards

1
Q

Most common cause of Chronic Pancreatitis

A

heavy, prolonged alcohol use

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2
Q

Causes of Chronic Pancreatitis

A
  • Heavy alcohol use
  • Hereditary disorders of the pancreas
  • Cystic fibrosis
  • Hypertriglyceridemia
  • Hyperlipidemia
  • hypercalcemia
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3
Q

Chronic Pancreatitis

A
  • 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
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4
Q

Pathophysiology

A
  • 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
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5
Q

Clinical Manifestations

A
  • 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
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6
Q

Why does weight loss occur?

A

b/c the pancreas is no longer secreting pancreatic enzymes to digest food, leading to decreased absorption of nutrients and malnourishment

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7
Q

Diagnostic Work-up of Chronic Pancreatitis

A
  • 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
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8
Q

Laboratory Analysis

A
  • Lipase and amylase; elevated
  • Serum alkaline phosphate; elevated
  • Bilirubin; elevated
  • Glucose; elevated d/t lack of insulin
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9
Q

Treatment of Chronic Pancreatitis

A
  • 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)
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10
Q

Surgical Management

A

-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

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11
Q

Puestow Procedure

A
  • for pain relief

- opens the pancreatic ducts and redirects the flow of pancreatic enzymes into the intestine

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12
Q

Laparoscopic Drainage

A
  • indicated in patients with abscesses or pseudocysts

- relieves pain

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13
Q

Nursing Management: Assessment and Analysis

A

> 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

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14
Q

Nursing Diagnoses

A
  • 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
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15
Q

Nursing Assessments for Chronic Pancreatitis

A
  • Vital Signs
  • Serum Blood Glucose
  • Amylase and Lipase Levels
  • Serum Bilirubin and Alkaline Phosphate
  • Weight
  • Pain
  • Abdomen
  • Skin Color
  • Stool
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16
Q

Assessments: Vital Signs

A

-pulse rate (HR), respiratory rate, and BP elevations are associated with episodes of pain exacerbations

17
Q

Assessments: Serum Glucose

A

with decreased insulin production/release with endocrine dysfunction, serum glucose is elevated

18
Q

Assessments: Amylase and Lipase Levels

A

elevations are associated with chronic pancreatitis

19
Q

Assessments: Serum Bilirubin and Alkaline Phosphate

A

obstruction of the bile ducts leads to increases of both bilirubin and alkaline phosphate

20
Q

Assessments: Weight

A

because of malabsorption secondary to altered secretion of pancreatic enzymes; at risk for weight loss

21
Q

Assessments: Pain

A

chronic pancreatitis is characterized by persistent, recurring episodes of epigastric and LUQ pain secondary to inflammation and obstruction

22
Q

Assessments: Abdomen

A
  • tenderness of the abdomen may be observed

- palpation may reveal a mass in the LUQ that may indicate a pseudocyst or abscess

23
Q

Assessment: Skin color

A

jaundice may be observed w/ obstruction of the bile ducts

24
Q

Assessments: Stool

A
  • steatorrhea may develop w/ progressive pancreatic insufficiency
  • clay-colored stools with bile obstruction
25
Q

Nursing Actions

A
  • 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
26
Q

Actions: Administer Pancreatic Enzymes (PERT)

A

-these medications contain amylase, lipase, and protease to enhance the absorption of nutrients

27
Q

Actions: Provide GI prophylaxis as ordered

A

histamine blockers or proton pump inhibitors to treat the increased gastric acid secretion

28
Q

Actions: Provide rest and a calm environment

A
  • decrease strain on the already-diseased pancreas

- may decrease the secretion of acids in the stomach, which can exacerbate chronic pancreatitis

29
Q

Actions: Implement pain-relief measures

A

pain may be managed w/ the administration of opioids initially and then with nonopioids when the pain is less intense

30
Q

Actions: Collaborate with dietician to ensure adequate nutrition

A
  • 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
31
Q

Patient Teachings

A
  • 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
32
Q

Elevating Care Outcomes

A
  • 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