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PANCREATITIS

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					PANCREATITIS



      ACC, RNSG 1247
Acute Pancreatitis
Definition & Etiology
    An acute inflammatory process of the
    pancreas
    Degree of inflammation varies from mild
    to edema to severe necrosis
    Most common in middle-age
    African American rate three times
    higher than for whites
Acute Pancreatitis
Etiology and Pathophysiology
Primary etiologic factors are
  Biliary tract disease
    Most common: Gallbladder disease
  Alcoholism
   * May stimulate production of digestive
     enzymes
Pancreatitis from gallstones
Acute Pancreatitis
Etiology and Pathophysiology
Caused by auto digestion of pancreas
Etiologic factors
  Injury to pancreatic cells
  Activate pancreatic enzymes
Acute Pancreatitis




                     Fig. 44-14
(AP) Acute Pancreatitis
Etiology and Pathophysiology
Trypsinogen
  Normally released into the small
  intestine, where it is activated to trypsin
  In AP, activated trypsin is present or
  released in pancreas thus auto
  digestion of pancreas
Acute Pancreatitis
Etiology and Pathophysiology
Edematous pancreatitis
  Mild and self-limiting
Necrotizing pancreatitis
  Degree of necrosis correlates with
  severity of manifestations
Acute Pancreatitis
Clinical Manifestations
    Abdominal pain is predominant
    symptom
      Pain located in LUQ
      Pain may be in the midepigastrium
      Commonly radiates to the back
      Sudden onset
      Severe, deep, piercing, steady
      Aggravated by eating
      Not relieved by vomiting
Acute Pancreatitis
Clinical Manifestations
    Cyanosis, Dyspnea
    Edema
    N/V, Bowel sounds decreased or absent
    Low-grade fever, Leukocytosis
    Hypotension, Tachycardia
    Jaundice
    Flushing
    Abdominal tenderness, distention
    Abnormal lung sounds - Crackles
    Grey Turner’s or Cullen’s sign
Acute Pancreatitis
Complications
 Two significant local complications
   Pseudocyst
   Abscess
Acute Pancreatitis
Complications (local)
Pseudocyst
  Cavity surrounding outside of pancreas
  filled with necrotic products and liquid
  secretions
  Abdominal pain
  Palpable epigastric mass
  Nausea, vomiting, and anorexia
  Elevated serum amylase
Acute Pancreatitis
Complications (local)

Pancreatic abscess
  A large fluid-containing cavity within
  pancreas
  Results from extensive necrosis in the
  pancreas
  Upper abdominal pain
  Abdominal mass
  High fever
  Leukocytosis
Acute Pancreatitis
Complications : Systemic
    Main systemic complications
      Pulmonary
        Pleural effusion
        Atelectasis
        Pneumonia
      Cardiovascular
        Hypotension
      Tetany (caused by hypocalcemia)
Acute Pancreatitis
Diagnostic Studies
    History and physical examination
    Laboratory tests
      Serum amylase
      Serum lipase
      2-hour urinary amylase and renal amylase
      clearance
      Blood glucose
      Serum calcium
      Triglycerides
Acute Pancreatitis
Diagnostic Studies
    Flat plate of abdomen
    Abdominal/endoscopic ultrasound
    Endoscopic retrograde
    cholangiopancreatography (ERCP)
    Chest x-ray
    CECT of pancreas
    Magnetic resonance
    cholangiopancreatography (MRCP)
Acute Pancreatis:
Goals of Care
 Relieve pain
 Prevent or alleviate shock
 Reduce pancreatic secretions
 Maintain fluid and electrolyte balance
 Remove precipitating cause
Acute Pancreatitis:
Treatment and Nursing Care
1. Pain management
          – IV morphine
          – Combined with antispasmodic agent
2. Prevention of Shock
           - Plasma or volume expanders
•         - LR solution
3. Suppress pancreatic enzymes
         - NPO, NG suction, antacids, H2 receptor antagonist
4.   Antibiotics
Acute Pancreatitis
Treatment and Nursing Care
Surgical therapy – if related to
gallstones
  ERCP
  Endoscopic sphincterotomy
  Stent placement
  Laparoscopic cholecystectomy
Acute Pancreatitis
Treatment and Nursing Care
 Nutritional therapy
   NPO status initially
   IV lipids - monitor triglycerides
   Enteral or parenteral feeding
   Small, frequent feedings if allowed
   High-carbohydrate, low-fat, high-protein
Acute Pancreatitis
Nursing Diagnoses
Acute pain
Deficient fluid volume
Imbalanced nutrition: Less than body
requirements
Ineffective therapeutic regimen
management
Acute Pancreatitis:
Home Care
  Follow up care
  Dietary teaching
       High-carbohydrate, low-fat diet
       Abstinence from alcohol,
  Patient/family teaching
     * Signs of infection, high blood glucose,
  steatorrhea
Chronic Pancreatitis
Definition
Continuous, prolonged inflammatory,
and fibrosing process of the pancreas
  Pancreas becomes destroyed as it is
  replaced by fibrotic tissue
  Strictures and calcifications can also
  occur
Chronic Pancreatitis
Etiology and Pathophysiology
May follow acute pancreatitis
May occur in absence of any history
of acute condition
Two major types
  Chronic obstructive pancreatitis
  Chronic calcifying pancreatitis
Chronic Pancreatitis
Etiology and Pathophysiology
 Chronic obstructive pancreatitis
   Associated with biliary disease
      Most common cause
       – Inflammation of the sphincter of Oddi associated with
         cholelithiasis
   Other causes include
     Cancer of ampulla of Vater, duodenum, or
     pancreas
Chronic Pancreatitis
Etiology and Pathophysiology
Chronic calcifying pancreatitis
  Also called alcoholic induced
  Inflammation and sclerosis
    Mainly in the head of the pancreas and
    around the pancreatic duct


   *** Ducts are obstructed with protein
     precipitates which block the
     pancreatic duct causing it to calcify
     then fibrosed and atrophied.
Chronic Pancreatitis
Clinical Manifestations
    Abdominal pain
      Located in the same areas as in AP
      Heavy, gnawing feeling; burning and
      cramp-like
    Malabsorption with weight loss
    Constipation
    Mild jaundice with dark urine
    Steatorrhea
    Frothy urine/stool
    Diabetes mellitus
Chronic Pancreatitis
Clinical Manifestations
 Complications include
   Pseudocyst formation
   Bile duct or duodenal obstruction
   Pancreatic ascites
   Pleural effusion
   Splenic vein thrombosis
   Pseudoaneurysms
   Pancreatic cancer
Chronic Pancreatitis
Diagnostic Studies

    Laboratory tests
      Serum amylase/lipase
        May be ↑ slightly or not at all
      ↑ Serum bilirubin
      ↑ Alkaline phosphatase
      Mild leukocytosis
      Elevated sedimentation rate
Chronic Pancreatitis
Diagnostic Studies
CT
MRI
MRCP
Transabdominal ultrasound
Endoscopic ultrasound
Secretin stimulation test
ERCP
Chronic Pancreatitis
Goals of Care
Prevention of attacks
  During acute attack follow acute therapy
Relief of pain
Control of pancreatic exocrine and
endocrine insufficiency
Bland, low-fat, high-carbohydrate diet
Chronic Pancreatitis
Treatment and Nursing Care Cont.
Bile salts
Control of diabetes
No alcohol
Pancreatic enzyme replacement
Acid-neutralizing and acid-inhibiting
drugs
Chronic Pancreatitis
Treatment and Nursing Care
Surgery
  Indicated when biliary disease is present
  or if obstruction or pseudocyst develops
  Divert bile flow or relieve ductal
  obstruction
Chronic Pancreatitis
Home/Ambulatory Care
Focus is on chronic care and health
promotion
  Dietary control
    No alcohol
  Control of diabetes
  Taking pancreatic enzymes
  Patient and family teaching
The End

				
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posted:12/14/2011
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