Upgrade to remove ads
Only $2.99/month

Pancreatitis

Terms in this set (56)

Acute Pancreatitis Define
Premature activation of excessive pancreatic enzymes that destory ductal tissue and pancreatic cells, resulting in autodigestion and fibrosis of the pancreas
Exocrine function of the pancreas
Is responsible for secreting enzymes that assist in the breakdown of starches, proteins, and fats
Pancreatic enymes
Trypsin, lipase,kallikrein, and elastase
Four major pathophysiology of acute pancreatitis
Lipolysis, proteolysis, necrosis of the blood vessles, and inflammation
Hallmark of pancreatic necrosis is
Enymatic fat necrosis of the endorcrine and exocrine cells caused by lipase (during this process fatty acids are released, bind with calcium, and caused hypocalcemia)
Lipolysis
destruction of fat
Proteolysis
the hydrolysis of proteins into peptides and amino acids by cleavage of their peptide bonds
Proteolytic activity
May lead to thrombosis and gangrene of the pancrease
Elastase
breaks down elastic fibers and cleaves certain antibodies (this causes necrosis of blood vessels resulting in bleeding)
Kallikrein
Causes the release of vasoactive peptides, bradykinin, and plasma kinin. These substances contribute to vasodilation and increase vascular permeability.
The majority of deaths in patinets with acute pancreatitis occur from
Irreversible shock
Pancreatitc psuedocyst
False cyst, are named becuased they do not have epithelia lining. They are encapsulated, sac, like strucutrs that form on or surround the pancrease. Risk factors for this is acute pancreatitis, abdominal trauma, or chronic pancreatitis
Complications of acute pancreatitis
Pancreatic infection (most common cause of death), hypovolemia, hemorrhage, ARF, paralytic ileus (Do not give dicycolimine (bentyl) with paralytic ileus), pleural effusion, ARDS, atelectasis, pneumonia, DIC, multi organ system failure, and DM
Risk factors for acute pancreatitis
Alcoholism, Gallstones (biliary tract disease), trauma, operative manipulation, drug use and infection. Sometimes unknown
Obstruction may occur with
Direct toxic injury to pancreatis cells, or production and release of pancreatis enzymes
Tripson
May caused edema, necrosis, hemorrhage, and also activates other enzymes
Metabolic distrurbances that may causes pancreatitis
Hyperlipidemia, hyperparathyroidism, or hypercalcemia
Women are affected most after
Cholelithiasis and biliary tract problems. As well as 2 months after childbirth
Drugs given to reduce pancreattis are
somatostatin, octreotide (have anti-inflammatory propertise and cytoprotective properties). Secreflow (injectable secretin) has been used with success
S/s of acute pancreatits
severe abdominal pain in the midepigastric area or left upper quad, sudeden on setes and radiates to the back, left flank or shoulder. Pain is intense, boring and continuous and is worsened in supine position. Weight loss, N/V.
Lipase
Is more specific in the diagnosis of acute pancreatis
Amylase
Usually increase 12 to 24 hours and remain elevated for 3 to 4 days
Decrease ___ and __ levels are seen
Calcium and magnesium
Lab values that increase?
Amylase, lipase, bilirubine, alkaline phophatase. WBC, ESR and glusose. Trypsin, elastase. ALT
Common nursing diagnosis?
Acute pain r/t biologic and injury agents , Imblanaced nutrition r/t inability to ingest food and absorb nutrients
Nauses related to pancreatic disease
Risk for deficient fluid volume r/t necrotic pancreatic tissue
Innefective breathing pattern r/t complications or ARD
Activity intolerance r/t generalized weakness
Sleep deprivation r/t pain
Mild pancreatis treatment
Includes pain control, hydration with IV fluids, drug therapy, fasting, comfrot measures, and hemodynamic monitoring
Mild pancreatitis usually subsides in
2-4 days
Severe pancreatis may persist up to
2 weeks
Drugs to relax smooth muscles
Papaverine (pavabid, Cerespance) and nitroglycerin
Meals given during the recovery period contain
Small, frequent, moderate to high carbohydrate, high protein, low fat meals. Avoid GI stimulants (alcohol, caffeine)
S/s of chronic pancreatits
Intense abd pain that is continous, burning, or gnawing. Abdominal tenderness, ascites, left quad mass (if psudocyst is present), respiratory compromise, steatorrhea, weight loss, jaundic, dark urine, and the 3 P's from DM.
Patient education with enyme replacement therapy
Take before or with meals, and snakes with a glass of water.
Administer enzymes after antacids or H2 blockers.
Swallow tabs without chewing
Mix the powder form in applesause or fruit juice
Do not mix with protein containing foods
Wipe lips after taking enzymes to avoid skin irritation
Follow up on lab test and do not crush
S/s of acute gastritis
Rapid onset, n/v, hematemesis, dyspepsia, and anorexia
s/s of chronic gastritis
pain relieved by food, anorexia, n/v, intolerance to spicy/fat foods, and pernicious anemia
Alpha cells
Produces glucagon (promotes an increase in glucos levels
Beta cells
Produce insulin which facilitates the uptakes and us of glucose
Delta cells
Secrete somatostatin which inhibites the secretion of glucagons and insulin
F Cells
Secrete pancreatic polypeptide which inhibites the exocrine activity of the pancreas
Pancreatitic amylase
Breaks down starch
Lipase
Breaks down fats into glycerol and fatty acids
Normal serum amylase
0 - 130 (i "AM" lower than lipase)
Normal serum lipase
0-160
Whipple procedure
Radical pancreaticoduodenectomy- involves extensive surgical manipulation and is used most often to treat cancer of the head of the pancrease. Entails removal of the proximale head of the pancrease, the duodenum, a portion of the jejunum, th estomach, and the gallbladder, with anastomsis of the pancreatic duct, the common bile duct, and the stomach to the jejunum. In addition the surgeon may remove the spleen.
T Tube care
keep the drainage system below the level of the gall bladder, maintain the semi fowlers, assess q 2 to 4 then 8 hours. Green bile expected immideately after. bile about 400ml + per day. report 1000ML or more. Foul order, monitor skin.
s/s of pancreatic cancer
Jaundice, clay stools, abd. pain (usually vague, dull, or nonspecific that radiates to the back), dark urine, weight loss, anorexia, n/v, glucose intolerance, flatulence, splenomegaly, GI bleeding, ascites, leg or calf pain, and weakness of fatigue.
Causes of pancreatitis
Trauma, pancreatic obstuction (tumors, cysts, or abscessess; abnormal organ structure, renal disturbances, hyperlipidemia, hyperparathyroidism, or hypercalcemia, familial, toxicities of drugs, opiats, sulfonamides, steroids, oral contraceptives.
murphy's sign
inspiratoy arrest; person feels sharp pain and abruptly stops inspiration midway when palpating liver
Blumberg's sign
rebound tenderness, a sign of peritoneal inflammation
To decrease pain in pancreatitis the primary drug use is an?
opioid by PCA. Morphine or hydromorphone (dilaudid) are typically used. Demerol may cause seizers in older adults
Common antibiotics used with ANP?
cefuroxime (Zinacef), ceftazidime (Ceptaz), and imipenem/cilastatin (Primaxin).
Octreotide
somatostatin analog.
Use in acromegaly, carcinoid, gastrionma, glucagonoma.
Treatment for skin care with patient with Diarrhea?
The skin should be cleaned thoroughly after each stool and a soothing emollient such as Sween Cream applied.
When carring for a patient with a T tube it should not be placed?
Hihger than than tube insertion site
Priority for Pancreatitis
pain relief
Cholecystitis s/s
episodic or vague upper abdominal pain that radiates to the shoulder, pain triggered by high fat or high volume meal, anorexia, n/v, dyspepsia, blumbergs sign, fever, jaundic, eructation, abdominal fullness, and clay stools with dark urine.
Changes with aging
Atrophy of gastric mucosa, decrease peristalsis, calcification of the pancreas, decrease in hepatic cells, and fibrosis
THIS SET IS OFTEN IN FOLDERS WITH...