Wk 4 Pancreas Problems Flashcards
What is the severity of acute pancreatitis?
Can be from mild edema to severe hemorrhagic necrosis
What are the risk factors for acute pancreatitis?
Middle aged
3x more likely in African Americans
Acute pancreatitis may go…
Undiagnosed unless caught by chance during a CT of the abdomen
Women typically develop acute pancreatitis from…
Biliary tract disease (gallstone blockage)
Cancer in bile duct
Men typically develop acute pancreatitis from…
Alcohol abuse
What other two potential causes of acute pancreatitis?
GI procedures
medications
How does the pathogenesis start of pancreatitis?
Cells are injured in some way
What are the 4 steps of pancreatitis pathogenesis
Cells are injured
Pancreatic enzymes activated
Autodigestion
Mild to severe pancreatitis results
What is the endocrine function of the pancreas?
Releases insulin and glucagon to help with BS control
What is the exocrine function of the pancreas
Releases enzymes that help with digestion
What causes autodigestion?
Pancreas releases enzymes inappropriately and they start to digest the pancreas
What are the enzymes that the pancreas releases? (5)
Trypsin
Elastase
Phospholipase A
Kallikrein
Lipase
What does the release of trypsin cause? (3)
Edema
Necrosis
Hemorrhage
What does the release of elastase cause?
Hemorrhage
What does the release of phospholipase A cause?
Fat necrosis
What does the release of kallikrein cause? (4)
Edema
Vascular permeability
Smooth muscle contraction
Shock
What does the release of lipase cause?
Fat necrosis
Kallikrein can cause __ which is fluid leaking into the spaces of the abdomen
ascites
Where is the anatomical placement of the pancreas?
Where is the pain from pancreatitis?
LUQ or epigastric pain
What is the onset of pancreatitis?
Sudden onset
Where does pancreatitis pain radiate to?
Back
Patients will have tenderness upon…
palpation of their abdomen
A patient with pancreatitis may have abdominal distention due to…
Fluid seeping into peritoneal cavity
What are the accompanying s/s of pancreatitis?
N/V
Abdominal distention
Hypoactive bowel sounds
Fever
Hypotension
Tachycardia
Jaundice
Why do patients with pancreatitis become hypotensive and tachycardic?
Loss of fluids
If a patient with pancreatitis is tachycardic because of pain then their blood pressure would be…
slightly elevated instead of hypotensive
If a patient has a blocked bile duct and that is what is causing the pancreatitis, what symptom will they present with?
Jaundice (build up of bile)
What two enzymes will be increased with pancreas damage?
Amylase
Lipase
If the pancreas isn’t working effectively, what may become elevated?
Glucose
Why are WBC elevated in pancreatitis?
Part of the inflammatory response
What color might you see on the abdomen of a patient with pancreatitis?
Cyanosis
Green/yellow/brown discoloration
Ecchymoses
Ecchymoses on the flank is called…
Grey Turner’s sign
Periumbilical ecchymoses is called…
Cullen’s sign
Grey Turner’s and Cullen’s sign are both signs of…
Hemorrhagic pancreatitis
List 6 complications of acute pancreatitis
Pseudocyst
Abscess
Pulmonary complications
Hypotension
Tetany from hypocalcemia
Increased risk for clotting
What are the possible pulmonary complications from acute pancreatitis?
Not wanting to take a deep breath becuase of pain
Pleural effusion from fluid build up
Why is hypocalcemia a potential complication of acute pancreatitis?
Lipase causes fat necrosis which generates free fatty acids that bind to the calcium
What is a pseudocyst?
Fluid-filled cavity that surrounds the outside of the pancreas
What is on the inside of the pseudocyst?
Necrotic products and secretions
Why are pseudocysts a problem?
They can create inflammation that leads to scar tissue and loss of function
What are pseudocysts described as on an abdominal assessment?
Palpable epigastric mass
What can happen if the pseudocyst perforates?
The necrotic products inside will leak into the peritoneal cavity causing peritonitis
What is a pancreatic abscess?
Large fluid filled cavity inside the pancreas
A pancreatic abscess is the result of what?
Extensive necrosis in the pancreas
The abscess may become..
infectious or perforate
What are the clinical presentations of a pancreatic abscess?
Similar to pancreatitis but add
Abdominal mass
High fever
Leukocytosis
A high fever is a symptom of both pancreatitis and a pancreatic abscess but it more commonly associated with…
The abscess because of the infection
What can be done for a pancreatic abscess?
A drain can be placed that leads to outside the body
Both pseudocysts and abscess can be felt on an abdominal exam, how do you differentiate?
They need to be scanned
Inflammation in the pancreas that persists over weeks to months
Chronic pancreatitis
What is the main etiology of pancreatitis?
Alcohol abuse
What percentage of alcoholics have pancreatitis?
50%
People with chronic pancreatitis can have bouts of…
acute pancreatitis where their symptoms become more severe more quickly
In chronic pancreatitis, the patient may experience digestion problems. Why?
Loss of pancreatic enzymes
In chronic pancreatitis, the patient may become hyperglycemic. Why?
Pancreas isn’t secreting enough insulin due to impaired function
Chronic pancreatitis leads to destruction of…
tissue (necrosis) and scar tissue
Medical term for scar tissue
fibrosis
If an alcoholic has chronic pancreatitis, what happens if they stop drinking?
The damage has already been done and the cycle will continue
What happens after an acute attack for a patient who has chronic pancreatitis?
Progressive signs of dysfunction after attack subsides
What is the major symptom of chronic pancreatitis?
chronic pain
What are other manifestations of chronic pancreatitis? (3)
Diabetes mellitus
Malabsorption of fat
Weight loss (due to absorption issue)
What do we give for pain to a patient with chronic pancreatitis?
Morphine
Hydromorphone
What do we give to reduce secretions and relax smooth muscles
dicyclomine (Bentyl)
What is the MOA of dicyclomine?
Antispasmodic (anticholinergic agent)
Why do we gave patients with chronic pancreatitis antacids?
Decrease hydrochloric acid secretion in the stomach which decreases secretion of pancreatic enzymes
What else can we give to decrease hydrchloric acid secretion from parietal cells?
H2-recpetor antagonists
With chronic pancreatitis we may need to replace pancreatic enzymes that are no longer being produced. What will we give?
Pancrelipase (creon)
What is the nursing implications for pancrelipase?
They will need to take it with every meal and every snack
If morphine and hydromorphone are not enough, what will we progress to?
Fentanyl
Why would we give a patient with chronic pancreatitis pantroprazole (protonix)?
It blocks gastric pump secretion of parietal cells
