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Pathopharmacology I > Wk 4 Pancreas Problems > Flashcards

Wk 4 Pancreas Problems Flashcards

1
Q

What is the severity of acute pancreatitis?

A

Can be from mild edema to severe hemorrhagic necrosis

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2
Q

What are the risk factors for acute pancreatitis?

A

Middle aged
3x more likely in African Americans

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3
Q

Acute pancreatitis may go…

A

Undiagnosed unless caught by chance during a CT of the abdomen

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4
Q

Women typically develop acute pancreatitis from…

A

Biliary tract disease (gallstone blockage)
Cancer in bile duct

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5
Q

Men typically develop acute pancreatitis from…

A

Alcohol abuse

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6
Q

What other two potential causes of acute pancreatitis?

A

GI procedures
medications

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7
Q

How does the pathogenesis start of pancreatitis?

A

Cells are injured in some way

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8
Q

What are the 4 steps of pancreatitis pathogenesis

A

Cells are injured
Pancreatic enzymes activated
Autodigestion
Mild to severe pancreatitis results

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9
Q

What is the endocrine function of the pancreas?

A

Releases insulin and glucagon to help with BS control

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10
Q

What is the exocrine function of the pancreas

A

Releases enzymes that help with digestion

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11
Q

What causes autodigestion?

A

Pancreas releases enzymes inappropriately and they start to digest the pancreas

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12
Q

What are the enzymes that the pancreas releases? (5)

A

Trypsin
Elastase
Phospholipase A
Kallikrein
Lipase

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13
Q

What does the release of trypsin cause? (3)

A

Edema
Necrosis
Hemorrhage

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14
Q

What does the release of elastase cause?

A

Hemorrhage

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15
Q

What does the release of phospholipase A cause?

A

Fat necrosis

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16
Q

What does the release of kallikrein cause? (4)

A

Edema
Vascular permeability
Smooth muscle contraction
Shock

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17
Q

What does the release of lipase cause?

A

Fat necrosis

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18
Q

Kallikrein can cause __ which is fluid leaking into the spaces of the abdomen

A

ascites

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19
Q

Where is the anatomical placement of the pancreas?

A
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20
Q

Where is the pain from pancreatitis?

A

LUQ or epigastric pain

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21
Q

What is the onset of pancreatitis?

A

Sudden onset

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22
Q

Where does pancreatitis pain radiate to?

A

Back

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23
Q

Patients will have tenderness upon…

A

palpation of their abdomen

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24
Q

A patient with pancreatitis may have abdominal distention due to…

A

Fluid seeping into peritoneal cavity

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25
Q

What are the accompanying s/s of pancreatitis?

A

N/V

Abdominal distention

Hypoactive bowel sounds

Fever

Hypotension

Tachycardia

Jaundice

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26
Q

Why do patients with pancreatitis become hypotensive and tachycardic?

A

Loss of fluids

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27
Q

If a patient with pancreatitis is tachycardic because of pain then their blood pressure would be…

A

slightly elevated instead of hypotensive

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28
Q

If a patient has a blocked bile duct and that is what is causing the pancreatitis, what symptom will they present with?

A

Jaundice (build up of bile)

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29
Q

What two enzymes will be increased with pancreas damage?

A

Amylase

Lipase

30
Q

If the pancreas isn’t working effectively, what may become elevated?

A

Glucose

31
Q

Why are WBC elevated in pancreatitis?

A

Part of the inflammatory response

32
Q

What color might you see on the abdomen of a patient with pancreatitis?

A

Cyanosis

Green/yellow/brown discoloration

Ecchymoses

33
Q

Ecchymoses on the flank is called…

A

Grey Turner’s sign

34
Q

Periumbilical ecchymoses is called…

A

Cullen’s sign

35
Q

Grey Turner’s and Cullen’s sign are both signs of…

A

Hemorrhagic pancreatitis

36
Q

List 6 complications of acute pancreatitis

A

Pseudocyst

Abscess

Pulmonary complications

Hypotension

Tetany from hypocalcemia

Increased risk for clotting

37
Q

What are the possible pulmonary complications from acute pancreatitis?

A

Not wanting to take a deep breath becuase of pain

Pleural effusion from fluid build up

38
Q

Why is hypocalcemia a potential complication of acute pancreatitis?

A

Lipase causes fat necrosis which generates free fatty acids that bind to the calcium

39
Q

What is a pseudocyst?

A

Fluid-filled cavity that surrounds the outside of the pancreas

40
Q

What is on the inside of the pseudocyst?

A

Necrotic products and secretions

41
Q

Why are pseudocysts a problem?

A

They can create inflammation that leads to scar tissue and loss of function

42
Q

What are pseudocysts described as on an abdominal assessment?

A

Palpable epigastric mass

43
Q

What can happen if the pseudocyst perforates?

A

The necrotic products inside will leak into the peritoneal cavity causing peritonitis

44
Q

What is a pancreatic abscess?

A

Large fluid filled cavity inside the pancreas

45
Q

A pancreatic abscess is the result of what?

A

Extensive necrosis in the pancreas

46
Q

The abscess may become..

A

infectious or perforate

47
Q

What are the clinical presentations of a pancreatic abscess?

A

Similar to pancreatitis but add

Abdominal mass

High fever

Leukocytosis

48
Q

A high fever is a symptom of both pancreatitis and a pancreatic abscess but it more commonly associated with…

A

The abscess because of the infection

49
Q

What can be done for a pancreatic abscess?

A

A drain can be placed that leads to outside the body

50
Q

Both pseudocysts and abscess can be felt on an abdominal exam, how do you differentiate?

A

They need to be scanned

51
Q

Inflammation in the pancreas that persists over weeks to months

A

Chronic pancreatitis

52
Q

What is the main etiology of pancreatitis?

A

Alcohol abuse

53
Q

What percentage of alcoholics have pancreatitis?

A

50%

54
Q

People with chronic pancreatitis can have bouts of…

A

acute pancreatitis where their symptoms become more severe more quickly

55
Q

In chronic pancreatitis, the patient may experience digestion problems. Why?

A

Loss of pancreatic enzymes

56
Q

In chronic pancreatitis, the patient may become hyperglycemic. Why?

A

Pancreas isn’t secreting enough insulin due to impaired function

57
Q

Chronic pancreatitis leads to destruction of…

A

tissue (necrosis) and scar tissue

58
Q

Medical term for scar tissue

A

fibrosis

59
Q

If an alcoholic has chronic pancreatitis, what happens if they stop drinking?

A

The damage has already been done and the cycle will continue

60
Q

What happens after an acute attack for a patient who has chronic pancreatitis?

A

Progressive signs of dysfunction after attack subsides

61
Q

What is the major symptom of chronic pancreatitis?

A

chronic pain

62
Q

What are other manifestations of chronic pancreatitis? (3)

A

Diabetes mellitus

Malabsorption of fat

Weight loss (due to absorption issue)

63
Q

What do we give for pain to a patient with chronic pancreatitis?

A

Morphine

Hydromorphone

64
Q

What do we give to reduce secretions and relax smooth muscles

A

dicyclomine (Bentyl)

65
Q

What is the MOA of dicyclomine?

A

Antispasmodic (anticholinergic agent)

66
Q

Why do we gave patients with chronic pancreatitis antacids?

A

Decrease hydrochloric acid secretion in the stomach which decreases secretion of pancreatic enzymes

67
Q

What else can we give to decrease hydrchloric acid secretion from parietal cells?

A

H2-recpetor antagonists

68
Q

With chronic pancreatitis we may need to replace pancreatic enzymes that are no longer being produced. What will we give?

A

Pancrelipase (creon)

69
Q

What is the nursing implications for pancrelipase?

A

They will need to take it with every meal and every snack

70
Q

If morphine and hydromorphone are not enough, what will we progress to?

A

Fentanyl

71
Q

Why would we give a patient with chronic pancreatitis pantroprazole (protonix)?

A

It blocks gastric pump secretion of parietal cells

72
Q
A

Pathopharmacology I (33 decks)

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