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PANCREATITIS

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PANCREATITIS ACC, RNSG 1247 * The End * * * Alcohol supposedly increases sensitivity to hormone cholecystokinin which stimulates production of pancreatic enzymes ... – PowerPoint PPT presentation

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Title: PANCREATITIS


1
PANCREATITIS
  • ACC, RNSG 1247

2
Acute PancreatitisDefinition
  • An acute inflammatory process of the pancreas
  • Degree of inflammation varies from ___ edema to
    ______ necrosis
  • Most common in middle-age
  • African American rate three times higher than for
    whites

3
Acute Pancreatitis Risk Factors
  • Primary risk factors are
  • ________ ____ ______ (women)
  • Gallbladder disease
  • _____________ (men)
  • May stimulate production of digestive
  • enzymes

4
Pancreatitis from gallstones
5
(AP) Acute PancreatitisPathophysiology
  • 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
  • What happens in autodigestion?

6
Acute Pancreatitis pathophysiologic results of
autodigestion
Fig. 44-14
7
Acute Pancreatitis Degree of involvement
  • Edematous pancreatitis
  • Mild and self-limiting
  • Necrotizing pancreatitis
  • Degree of necrosis correlates with severity of
    manifestations

8
Acute PancreatitisClinical 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

9
Acute PancreatitisClinical 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 Turners or Cullens sign

10
Acute PancreatitisComplications
  • Two significant local complications
  • Pseudocyst
  • Abscess

11
Acute PancreatitisComplications (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

12
Pancreatic pseudocysts
13
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

14
Acute PancreatitisComplications Systemic
  • Main systemic complications
  • Pulmonary
  • Pleural effusion
  • Atelectasis
  • Pneumonia
  • Cardiovascular
  • Hypotension
  • Tetany (caused by hypocalcemia)

15
Acute PancreatitisDiagnostic Studies
  • History and physical examination
  • Laboratory tests
  • Serum amylase
  • Serum lipase
  • 2-hour urinary amylase and renal amylase
    clearance
  • Blood glucose
  • Serum calcium
  • Triglycerides

16
Acute PancreatitisDiagnostic Studies
  • Flat plate of abdomen
  • Abdominal/endoscopic ultrasound
  • Endoscopic retrograde cholangiopancreatography
    (ERCP)
  • Chest x-ray
  • CECT of pancreas
  • Magnetic resonance cholangiopancreatography
    (MRCP)

17
Acute Pancreatitis Goals of Treatment and
Nursing Care
  • 1. Manage _____
  • IV morphine, Hydromorphone
  • Combined with antispasmodic agent
  • 2. Prevent or alleviate _____
  • - Plasma or volume expanders
  • - LR solution
  • 3. Suppress __________ _______
  • - NPO, NG suction, antacids, H2
    receptor
  • antagonist
  • 4. Prevent ________

18
Acute PancreatitisTreatment and Nursing Care
  • Surgical therapy if related to gallstones
  • ERCP
  • Endoscopic sphincterotomy
  • Stent placement
  • Laparoscopic cholecystectomy

19
Endoscopic Sphincterotomy
20
Acute PancreatitisTreatment 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

21
Acute PancreatitisNursing Diagnoses
  • Acute pain
  • Deficient fluid volume
  • Imbalanced nutrition Less than body requirements
  • Ineffective therapeutic regimen management

22
Acute PancreatitisHome Care
  • Pain control/prevention
  • Dietary teaching
  • High-carbohydrate, low-fat diet
  • Abstinence from alcohol, also caffeine, smoking
  • Patient/family teaching
  • Signs of infection, high blood
    glucose,
  • steatorrhea

23
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

24
Chronic PancreatitisEtiology 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

25
Chronic Pancreatitis Types and risk factors
  • Chronic obstructive pancreatitis
  • Associated with biliary disease commonly
    associated with cholelithiasis
  • Other causes include
  • Cancer of ampulla of Vater, duodenum, or
    pancreas
  • Chronic calcifying
  • pancreatitis
  • AKA alcohol induced
  • Inflammation and sclerosis
  • in the head of the pancreas
  • and around the pancreatic duct
  • Ducts are obstructed with protein
    precipitates blocking
  • the pancreatic duct causing it to calcify then
    fibrosed and atrophied.

26
Chronic PancreatitisClinical 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

27
Chronic PancreatitisClinical Manifestations
  • Complications include
  • Pseudocyst formation
  • Bile duct or duodenal obstruction
  • Pancreatic ascites
  • Pleural effusion
  • Splenic vein thrombosis
  • Pseudoaneurysms
  • Pancreatic cancer

28
Chronic PancreatitisDiagnostic Studies
  • Laboratory tests
  • Serum amylase/lipase
  • May be ? slightly or not at all
  • ? Serum bilirubin
  • ? Alkaline phosphatase
  • Mild leukocytosis
  • Elevated sedimentation rate

29
Chronic PancreatitisDiagnostic Studies
  • CT
  • MRI
  • MRCP
  • Transabdominal ultrasound
  • Endoscopic ultrasound
  • Secretin stimulation test
  • ERCP

30
Chronic Pancreatitis Goals of Treatment and
Nursing Care
  • Prevention of attacks
  • Follow acute therapy during acute attack
  • Relief of pain
  • Control of pancreatic exocrine and endocrine
    insufficiency
  • Pancreatic enzyme replacement bile salts
  • Acid-neutralizing and acid-inhibiting drugs
  • Bland, low-fat, high-carbohydrate diet

31
Chronic PancreatitisTreatment and Nursing Care
  • Surgery
  • Indicated when biliary disease is present or if
    obstruction or pseudocyst develops
  • Divert bile flow ( Ex choledochojejunostmy)
  • Or relieve ductal obstruction ( Ex
    sphincterectomy)

32
Chronic PancreatitisHome/Ambulatory Care
  • Focus is on chronic care and health promotion
  • Dietary control
  • No alcohol
  • Control of diabetes
  • Taking pancreatic enzymes
  • Patient and family teaching

33
Pancreatic Cancer
  • Highest mortality rate
  • Other risk factors smoking, DM, family history
  • Cause of high mortality hard to detect when
    surgical removal is still possible
  • Signs/Symptoms weight loss, nausea, changes in
    stool , diabetes
  • TX surgery, chemotherapy
  • Highest mortality rate

34
The End
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