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T3: Pancreatitis

QuestionAnswer
An acute inflammation of the pancreas? acute pancreatitis
What is the most common cause of pancreatitis in the US? gallbladder disease (gallstones) which is more common in women
What is the second most common cause of pancreatitis? chronic alcohol intake which is more common in men
This is a mixture of cholesterol crystals & calcium salts and is found in 20-40 % of patients w/acute pancreatitis. biliary sludge or microlithiasis; the formation of biliary sludge is seen in pts w/bile stasis
Acute pancreatitis attacks are also associated with? hypertriglyceridemia (serum levels >1000 mg/dL)
What are some less common causes of pancreatitis? certain drugs (corticosteroids, thiazide diuretics, oral contraceptives, sulfonamides, NSAIDs), metabolic disorders (hyperparathyroidism, RF), & vascular diseases; trauma, viral infections, penetrating duodenal ulcer, cysts, abscesses, CF, kaposi sarcoma
Pancreatitis may occur after what procedures? Surgical procedures on the pancreas, stomach, duodenum, or biliary tract; can also occur after endoscopic retrograde cholangioprancreatography (ERCP).
What is the most common pathogenic mechanism of pancreatitis? Autodigestion of the pancreas causes injury to pancreatic cells or activation of the pancreatic enzymes in the pancreas rather than in the intestine.
This is an inactive proteolytic enzyme produced by the pancreas that's released into the small intestine via the pancreatic duct and there its activated to tyrpsin by enterokinase. trypsinogen
Normally, trypsin inhibitors in the pancreas & plasma bind & inactivate any trypsin that is inadvertently produced. In pancreatitis activated trypsin is present in the pancreas. This enzyme can digest the pancreas & produce what? bleeding
What are some etiologic factors for acute pancreatitis? alcoholism, biliary tract disease, trauma, infection, drugs, postop GI surgery
Pathophysiology map of acute pancreatitis Etiologic factors->injury to panc cells & activation of panc enzymes->autodigestion effects of panc enzymes: trypsin: edema, necrosis, hem., elastase: hem.; phoshpolipase A & lipase: fat necrosis, Kalikrein: edema vas. perm. smooth muscle contract & shock
Mild pancreatitis is also known as? edematous or interstitial pancreatitis
Severe pancreatitis is also known as? necrotizing pancreatitis
In severe pancreatitis, what occurs in half of affected patients and what are they at high risk for? Permanent decreases in endocrine & exocrine function & are at risk for developing pancreatic necrosis, organ failure, & septic complications.
CM of acute pancreatitis LUQ pain or midepigastrium can radiate to the back, pain is sudden, severe, deep, piercing, & continuous or steady. Pain is aggravated by eating & starts when pt is recumbent. It isn't relieved by vomiting.
Abdominal pain is the predominant manifestation of acute pancreatitis. Why? Due to distention of the pancreas, peritoneal irritation, & obstruction of the biliary tract.
Besides pain what are some other CM of acute pancreatitis? flushing, cyanosis, dyspnea, N/V, low grade fever, leukocytosis, hypotension, tachycardia, jaundice, abdominal tenderness w/guarding, dec. or absent bowel sounds, crackles, Grey Turner's or Cullen's sign, shock
A bluish flank discoloration (ecchymoses) associated with acute pancreatitis. Grey Turner's spots or sign
A bluish periumbilical discoloration (ecchymoses) associated with acute pancreatitis. Cullen's sign
What could cause shock in acute pancreatitis? Hemorrhage into the pancreas, toxemia from the activated pancreatic enzymes, or hypovolemia as a result of fluid shift into the retroperitoneal space (massive fluid shifts).
What are 2 significant local complications of acute pancreatitis? pseudocyst and abscess
An accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates surrounded by a wall. pancreatic pseudocyst
What are manifestations of pseudocyst? abdominal pain, palpable epigastric mass, N/V, and anorexia
How are pseudocysts detected? CT, MRI, & endoscopic ultrasonography (EUS); serum amylase levels frequently remain elevated
Pseudocysts usually resolve spontanteously within a few weeks but what else can happen to them? May perforate causing peritonits, or rupture into the stomach or duodenum.
What are some treatment options for pseudocysts? surgical drainage procedure, percutaneous catheter placement and drainage, and endoscopic drainage
This is a collection of pus that can occur in acute pancreatitis. a pancreatic abscess
Pancreatic abscess results from this in the pancreas and may become infected or perforate into adjacent organs. extensive necrosis
What are some manifestations of an abscess? upper abdominal pain, abdominal mass, high fever, and leukocytosis
How do you treat pancreatic abscesses? Need prompt surgical drainage to prevent sepsis.
What are the main systemic complications of acute pancreatitis? pulmonary (pleural effusion, atelectasis, pneumonia, & ARDS) and cardiovascular (hypotension), & tetany caused by hypocalcemia
The pulmonary complications in acute pancreatitis are due to what? the passage of exudate containing pancreatic enzymes from the peritoneal cavity through transdiaphragmatic lymph channels
When hypocalcemia occurs in acute pancreatitis, it is a sign of severe disease due to what? To the combining of calcium & fatty acids during fat necrosis.
What are the primary diagnostic tests for acute pancreatitis? serum amylase and lipase measurements
In acute pancreatitis serum amylase levels are usually? elevated early and remains elevated for 24-72 hours
In acute pancreatitis serum lipase levels are? Why is this test important? elevated; other disorders (mumps, cerebral trauma, renal transplantation) may increase serum amylase levels
Besides serum amylase & lipase levels what are some other lab findings? increase in liver enzymes, triglycerides, glucose, & bilirubin levels and a decrease in calcium level
What are some diagnostic studies for acute pancreatitis? abdominal ultrasonography, xray, contrast CT scan; endoscopic retrograde cholangiopancreatography (ERCP), endoscopic US, MRCP, angiography, chest xray
These diagnostic can be used to identify pancreatic problems. abdominal ultrasonography, xray, contrast enhanced CT scanning
This is the best imaging test for pancreatitis and related complications such as cysts and abscesses. CT scanning
In acute pacreatitis, chest xrays may show what? pulmonary changes, including atelectasis and pleural effusions
What are some goals of collaborative care for acute pancreatitis? relief of pain; prevention or alleviation of shock; reduction of pancreatic secretions; correction of fluid & electrolyte imbalances; prevention or treatment of infections; removal of the precipitating cause, if possible
Treatment for acute pancreatitis is focused primarily on supportive care such as? aggressive hydration; pain mgmt; mgmt of metabolic complications; and minimizing pancreatic stimulation
Treatment and control of pain in acute pancreatitis are very important. What pain medications may be used? IV morphine, antispasmodic agents, meds that relax smooth muscles (spasmolytics) such as nitroglycerin or papaverine
What drugs should be avoided with acute pancreatitis and why? Atropine and other anticholinergic drugs should be avoided when paralytic ileus is present b/c they can decrease GI mobility, thus contributing to the problem.
Why is it important to reduce or suppress pancreatic enzymes? To decrease stimulation of the pancreas and allow it to rest.
What are some ways to reduce or suppress pancreatic enzymes? Pt is NPO; NG suction to reduce vomiting & gastric distention & prevent gastric acidic contents from entering the duodenum; enteral nutrition needed if severe; certain drugs to suppress gastric acid secretion
If shock is present in acute pancreatitis how is it treated? Blood volume replacement: plasma or plasma volume expanders such as dextran or albumin; F&E imbalances are corrected w/LRs or other electrolyte solutions (CVP may be used to assist in determining fluid replacement requirements).
Created by: eblanc1