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Acute Pancreatitis

 Acute inflammation of pancreas
 Digestion of pancreas by its own enzymes, mainly trypsin (enzyme needed for digestion, found in sm. intestine) can be mild to severe, mild inflammation to severe necrosis. Auto digestion of the pancreas.

Acute Pancreatitis-Etiology & Pathophysiology


 Alcohol ingestion (common in men)
 Biliary tract disease (more common in women)
 Other causes
 Any situation in which the pancreatic cells are injured can lead to pancreatitis
 Trauma, viral infection, abscess/cysts, drugs: steroids, diuretics, NSAIDS (ibprofuen

Acute Pancreatitis-Clinical Manifestations

  Severe mid epigastric pain radiating to back (retroperitoneal)
 Pain described as piercing
 Vomiting does not relieve pain
 LUQ abdominal pain/tenderness, rigid abdomen
 Increased temperature, increased pulse, decreased BP
 Grey Turner sign - bluish discoloration in the flank area
 Cullen sign - bluish discoloration in the umbilicus
 *bleeding inside the area or retroperitoneal area
 Clinical Manifestations (cont'd)
 N/V -usually given antiemetics d/t vomiting not relieving pain/nausea
 Fever
 Leukocytosis - increase in WBC( anything greater than 10,000
 What would the bowel sounds be?
 Hypoactive - less than 5 bowel sounds in a min
 Normal is 5-35 in a min

Complications

  Pancreatic pseudocyst - cavity surrounding the pancreas is filed with necrotic products. A cyst forms outside. Has ABD pain, might feel a mass - may need drained (surgeon). Can lead to perforation leading to - Peritonitis: fatal, need very high doses of ATB to get rid of the infection.
 Pancreatic abscess - may need drained. Mass filled with fluid within the pancreas
 Mild to severe (necrotizing) pancreatitis
 Pulmonary complications - pneumonia, atelectasis (collapse of the lung), pleural effusion (abnormal amount of fluid within the pleural space around the lung)
 Cardiac complications - hypotension leading to shock
 Tetany - muscle twitching decreased by calcium. Hypocalcemia - cramps, spasms.

Diagnostic Studies

  Increased LABS
 Amylase - digestive enzyme made primarily by the pancreas and salivary glands.
 Lipase - digestive enzyme made primarily by the pancreas.
 Glucose
 CT Scan best imaging test
Normal Values
 Plasma amylase: 70-200 U/L.
 Plasma lipase: 7-58 U/L.
 Urine amylase: Less than 1200 U/L.
 Amylase creatinine clearance ratio: 1-4%.

Collaborative Care


 NPO/NG tube to suction (decrease pancreatic secretions)
 IV hydration( d/t dehydration, F&E imbalances) TPN if severe
 Meds
 Analgesics
 Antacids, anticholinergics, proton pump inhibitors
 Blood glucose monitoring
 Insulin coverage if needed

Nursing Management

Assist with positioning of comfort - usually on their side, head slightly elevated
 Teach about diet
 What type of foods/drinks should be avoided?
 No alcohol
 Avoid high fat foods
 Caffeine
 Monitor for S/S hypocalcemia
 Normal Calcium level 8.5 to 10.3
 What are neuromuscular signs of calcium?
 Numbness around lips, fingers
 Tetany, twitching, spams
 Trousseau's sign - b/p cuff reaction
 Chvostek's sign - tap facial nerve near in front of ear lobe or corner of mouth. Should spasm facial muscles.

Chronic Pancreatitis

 Progressive, continuous inflammation & destruction of pancreas
 Pancreas replaced with fibrotic tissue (scar tissue)
 Can be obstructive or non-obstructive

Etiology & Pathophysiology: Chronic Pancreatitis

 Long-term alcohol use (80% of the time)
 Other
 Biliary disease
 Cancer

Clinical Manifestations
Chronic Pancreatitis

  Recurrent attacks of burning or gnawing abdominal pain- LUQ
 Steatorrhea - pale color
 Diarrhea
 *malodorous - bad smell
 Weight loss - fat is being excreted and not absorbed
 Jaundice with dark urine
 S/S diabetes mellitus
 Patient unable to absorb & digest nutrients from their GI tract

Diagnostic Studies- Chronic Pancreatitis


 LABS
 Elevated OR normal amylase & lipase
 ERCP - Endoscopic retrograde cholangiopancreatography
 Visualize pancreatic & common bile ducts
 Imaging studies

Collaborative Care-Chronic pancreatitis


 Supportive tx/chronic care
 Relieve pain
 NPO
 IV fluids
 Meds
 Analgesics
 Pancreatic enzymes - replacement therapy (take with every meal and snacks)

Nursing Management
Chronic pancreatitis

  Monitor stools to determine effective enzyme replacement
 Teach about diet
 Monitor for S/S diabetes mellitus
 3 P's polyphagia, polydipsia, polyuria

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