Title: PANCREATITIS
1PANCREATITIS
2Acute 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
3Acute Pancreatitis Risk Factors
- Primary risk factors are
- ________ ____ ______ (women)
- Gallbladder disease
- _____________ (men)
- May stimulate production of digestive
- enzymes
4Pancreatitis 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?
6Acute 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
8Acute 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
9Acute 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
10Acute PancreatitisComplications
- Two significant local complications
- Pseudocyst
- Abscess
11Acute 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
12Pancreatic pseudocysts
13Acute 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
14Acute PancreatitisComplications Systemic
- Main systemic complications
- Pulmonary
- Pleural effusion
- Atelectasis
- Pneumonia
- Cardiovascular
- Hypotension
- Tetany (caused by hypocalcemia)
15Acute 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
16Acute PancreatitisDiagnostic Studies
- Flat plate of abdomen
- Abdominal/endoscopic ultrasound
- Endoscopic retrograde cholangiopancreatography
(ERCP) - Chest x-ray
- CECT of pancreas
- Magnetic resonance cholangiopancreatography
(MRCP)
17Acute 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 ________
18Acute PancreatitisTreatment and Nursing Care
- Surgical therapy if related to gallstones
- ERCP
- Endoscopic sphincterotomy
- Stent placement
- Laparoscopic cholecystectomy
19Endoscopic Sphincterotomy
20Acute 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
21Acute PancreatitisNursing Diagnoses
- Acute pain
- Deficient fluid volume
- Imbalanced nutrition Less than body requirements
- Ineffective therapeutic regimen management
22Acute 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
-
23Chronic 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
24Chronic 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
25Chronic 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.
26Chronic 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
27Chronic PancreatitisClinical Manifestations
- Complications include
- Pseudocyst formation
- Bile duct or duodenal obstruction
- Pancreatic ascites
- Pleural effusion
- Splenic vein thrombosis
- Pseudoaneurysms
- Pancreatic cancer
28Chronic PancreatitisDiagnostic Studies
- Laboratory tests
- Serum amylase/lipase
- May be ? slightly or not at all
- ? Serum bilirubin
- ? Alkaline phosphatase
- Mild leukocytosis
- Elevated sedimentation rate
29Chronic PancreatitisDiagnostic Studies
- CT
- MRI
- MRCP
- Transabdominal ultrasound
- Endoscopic ultrasound
- Secretin stimulation test
- ERCP
30Chronic 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
31Chronic 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)
32Chronic 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
33Pancreatic 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
-
34The End