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Terms in this set (116)

CAUSES
gall bladder stones getting stuck in common bile or pancreatic duct, trauma, meds

ASSESSMENT
- n/v, abdominal pain (piercing, severe-like),worse when eating, fetal position, low grade fever, SIRS
- labs: increased amylase, increased lipase, decreased calcium
- CV: hypovolemic bc fluids leak into peritoneal area from inflammation/increased permeability, 3rd spacing, cardiac dysfunction
- Hematology: DIC
- GI: INcreased risk of GI bleeds, pancreatic pseudocysts that will need drain, pancreatic abcess needs drain and ABX
- renal: azotemia, oliguria, AKI --> renal failure
- Metabolic: hypocalcemia, hyperlipidemia, hyperglycemia (T3DM), metabolic acidosis, increased triglycerides
- Hemmorhagic: Cullen's sign, Turner's sign
- Respiratory: Increased diaphragm pressure --> atelectasis --> ARDS, easily on vent. Also due to pancreatic enzymes in circulation.

PANCREATIC ENZYMES and systemic effects
- Trypsin = edema, necrosis, hemorrhage
- Elastase = hemorrhage
- Phospholipase A + Lipase = fat necrosis
- Kallikrein = edema, vascular permeability, smooth muscle contraction shock

RISKS
- compartment syndrome from volume going into abdomen: Measure abdominal girth, take intraabdominal pressure readings
- Renal failure
- Hypovolemia: Fluid volume bolus, vasopressors, positive inotrope
- Hypocalcemia: Monitor throughout day q4-6h, check for Chvostek & Trusseaus, prolonged QT on ECG, circumoral paresthesia
- Monitor for hypovolemic shock, if they have infection could become septic
- Fistulas: OR, drains

TX
- NPO --> NG --> stomach
- feeding tube --> jejunum best hope for recovery
- TPN --> monitor glucose
- no morphine for pancreatitis. Give fentanyl or dilaudid.
- IV fluids
- mouth care for NPO

Post Recovery
- High carb diet, small frequent meals
- check for gastric distention, increased abdominal paid, increased amylase and lipase
- prealbumin 19-43
- monitor wound healing
- if in pain, he is not tolerating feedings: pain, N/v, abdominal distention, increased amylase and lipase
- if in no pain, tolerating feeding

Complications
- hemorrhagic pancreatitis from autodigestion --> positive cullen's and grey turner's signs
- hypovolemic shock
- pseudocysts: need immediate drainage and ABX or else pt will die of sepsis
- ARDS
- Hypocalcemia: tetany?