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Pancreatitis C & A
| Question | Answer |
|---|---|
| Acute Pancreatitis | Acute Pancreatitis |
| NHP (necrotizing hemorrhagic pancreatitis) | diffuse bleeding of pancreatic tissue, fibrosis, tissue death |
| Pancrease (exocrine function) | secrete enzymes responsible for metabolizing starches, proteins, fats |
| Early activation | Enzyme activation of pancreatic enzymes in the pancreas; Results in inflammatory process |
| Lypolysis | Fat necrosis by lipase; Fatty acids + ionized Ca=soap; Parathyroid gland unable to compensate and hypocalcemia develops |
| Proteolysis | Autodigestion of parenchyma |
| Trypsin | activates all proteolytic enzymes |
| Blood vessel necrosis | Elastase (activated by trypsin) dissolves blood vessels & ducts; release of vasoconstrictive peptides, bradykinin and kallidin furthers hemorrhagic process |
| Inflammatory stage | Leukocytes cluster around necrotic/hemorrhagic tissue |
| Complications | Pancreatic infection, hypovolemia, hemorrhage, ARF, paralytic ileus, shock, pleural effusion, ARDS, atelectasis, MODS, DIC, DM |
| Causes | Trauma (external/operative), pancreatic obstruction, renal disturbance, s/p ERCP |
| Prevention | drink in moderation, treat gallbladder disease immeidatly, antisecretory meds w/ ERCP |
| History | increased pain after alcohol/food ingestion, alcohol usage |
| Family Hx | alcoholism, pacreatitis, biliary tract disease, previous ABD surgery |
| PMH | PUD, ARF, vascular disorders, hyperparathyroidism, Hyperlipidemia, recent viral infection |
| Physical | boaring ABD px in epigastrum/LUQ radiating to back/L flank/L shoulder, N/V, jaundice, cullen’s sign, turner’s sign |
| Cullen’s sign | Periumbilical bruising |
| Turner’s sign | bruisind of flanks due to pancreatic enxyme leakage to cutaneous tissue |
| Serum amylase | increased |
| Serum lipase | increased |
| Serum trypsin | increased |
| Serum elastase | Increased |
| Blood glucose | elevated due to impaired carb metabolism and decreased insulin release |
| Serum Mg | decreased (fat necrosis) |
| Serum Ca | decreased (fat necrosis); consistently < 8 associated w/ poor prognosis |
| Bilirubin | elevated (w/ biliary dysfunction) |
| ALT (alanine aminotransferase) | increased (3x normal is dx of biliary pancreatitis) |
| Leukocytes | increased (inflammatory response) |
| ABD X-ray | Gass-filled duodenum |
| Chest X-ray | Elevation of L diaphragm; Pleural Effusion |
| CT w/ contrast | Dx of pancreatitis; R/O pancreatic pseudocyst or ductal calculi |
| Non-surgical management | NPO, meds, comfort measures |
| NPO | Admin IV fluids, Mg/Ca replacement, NG for continuous comiting/biliary obstruction |
| Meds | Analgesics, Anticholinergics, Antibiotics |
| Anticholinergics | Decrease vagal stimulation, decrease GI motility, inhibit pancreatic secretions |
| Antibiotics | Indicated for acute necrotizing pancreatis |
| Comfort | fetal position, frequent oral hygiene (w/ NG), lower pt anxiety |
| ERCP w/ sphincterotomy (endoscopic retrograde cholangiopancreatography) | Urgent/emergent procedure for pancreatitis caused by gall stones; Sphincterotomy opens up sphincter of Oddi; Unsuccessful ERCP requires surgery |
| Laparoscopic cholecystectomy | Performed following unsuccessful ERCP |
| Pseydocystojejunostomy | draining pseudocyst into jejunum |
| Pseudocystogastrostomy | draining pseudocyst into stomach |
| Post-op care | monitor drainage tubes for patency, record output, meticulous skin care/dressing changes |
| Acute pancreatitis diet | NPO; If NPO >7-10 days requires TPN/TEN |
| Recovery diet | Moderate-high carbohydrates, high-protein, low-fat meals (small & frequent); Bland, caffeine-free, alcohol-free |
| Teaching goal | avoid further episodes & prevent progression to chronic disease |
| Patient teaching | abstain from alcohol; If alcohol is consumed, autodigestion will result in chronic pancreatitis & chronic pain; Notify HCP of acute ABD px, jaundice, clay-colored stools, darkened urine |
| Chronic Pancreatitis | Chronic Pancreatitis |
| Chronic pancreatitis | Progressive, destructive disease characterized by remissions and exacerbations; Inflammation & fibrosis -> pancreatic insufficiency |
| CCP (chronic calcifying pancreatitis | Protein plug -> ductal obstruction, atrophy, dilation |
| Chronic obstructive pancreatitis | Inflammation, spasm, obstruction of Oddi -> obstruction & backflow of pancreatic enzymes |
| Pancreatic exocrine activity | 2 parts - aqueous bicarb & enzymes |
| Aqueous | neutralizes duodenal contents & pancreatic enzymes |
| Enzyme secretion | Reduction of > 80% -> steatorrhea (pale, bulky, frothy, offensive) |
| Endocrine function | decrease -> frank DM |
| Assessment | Continuous & burning/gnawing severe ABD px; ABD tenderness; Ascites; LUQ mass (w/ pseudocyst); Respiratory compromise (diminished, orthopnea, dyspnea); Steatorrhea; Weightloss |
| Amylase & Lipase | normal to moderately elevated |
| Definitive Dx | ID of calcification by biopsy |
| Meds | Analgesics, Enzyme replacement, Insulin therapy, H2 antagonist |
| Diet | Same as acute pancreatitis; 4000-6000 calories/day |
| Pt Preventative teaching | Avoid things that cause symptoms; No alcohol, nicotine; Rest frequently |
| Pancrelipase (Indication) | chronic pancreatitis (aid in digestion/absorption of fat & protein) |
| Pancrelipase (Interventions/Pt Education) | Take before/with meals/snacks; mix w/ applesauce/fruit juice at pt request; Wipe lips after taking; Do not mix w/ protein containing foods; Do not inhale |
| H2 Blockers (Indication) | To enhance effectiveness of non-enteric coated enzyme replacers |
| Octreotide (Sandostatin) (Indications) | Growth hormone given w/ persistent px & diarrhea |
Created by:
jlee12406
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