Pancreatic Problems

• Sudden onset of inflammation of pancreas
• Abd pain
• Pancreatic tissue edema
• Necrosis of pancreatic tissue
• Possible pancreatic hemmorhage
• Results in autodigestion of itself
• Self-limiting if mild

• Necrotizing or hemorrhagic pancreatitis
• Extensive necrosis in and around pancreas
• Pancreatic cell necrosis
• Hemmorhage
• Digestive enzymes are release when pancreas dies, eats cells tissues and vessel walls...leads to bleeding

Inital injury of acinar cells, premature enzyme activation (trypsin), overwhelms protective mechanisms, autodigestion of pancreas and surrounding tissues

• Phospholipase A: digests cell membranes
• Elastase: digests vessel walls
• Kallikrein: inflammatory mediator secreted by basophils, increases local damage; potentiates hypotension, shock, MODS

• Gallstones: most common in females, fatty greasy diet, obstruction of common bile duct
• Chronic alcohol abuse: most common in males, cause spasm of sphincter of Oddi...leads to obstruction
• Idiopathic
• Drug induced: hypersensitivity or toxix metabolism
• Metabolic Problem: hypoglycemia, hypertriglyceridemia (plaque build up, stenosis of vessel, Ca)

• Pain (constant, dull, collicky, worse when lying supine): radiation to flank, back, or both, heavy meal or drinking triggers pain
• N/V

PE: abd distention, muscle spasms, epigastric pain, LUQ tenderness, fever, tachycardia, jaundice, restless, dehydrated (N/V)

• Most widely used indicator
• Quick and inexpensive
• Lacks sensitivity and specifity
• Peaks 2-12hrs post onset, elevated for 3-5 days
• Tells us more by being negative than it does by being positive
• Highers levels doesn't mean severe

• Greater sensitivity and specifity than amalyse
• Peaks at 24hrs, elevated for 4-8hrs post onset
• Peaks 3x normal
• May remain elevated after amalyse isn't
• If both amylase and lipase elevated, more likely to be pancreatitis

Most accurate but not commonly used test

Not as accurate as trypsin or lipase

• Not reliable for testing pancreatitis
• Only want to kow if liver dysfunction associated and/or coags

• Glucose: increased; >180-200, beta cells out of pancreas aren't functioning well; associated w/ insulin
• Calcium: decreased; associated liver problems bc of low albumin and nutrition
• WBC: increased; 15,000-18,000; inflammation
• BUN: increased; dehydration
• HCT: increased; dehydration, dilutional bc of low fluid
• Albumin: decreased; liver dysfunction, malnutrition

• Pale of gray stool
• Foul smelling
• Caused by deficiency in pancreatic enzymes in the bowel
• Big indicator

• Used when biliary obstruction suspected
• Inject dye into ducts to see obstruction in pancreas
• Can precipitate acute pancreatitis
• Hydration and pain control

• Abscess
• Necrosis
• Psedocyst: encapsulated infectious material in organ, can further cause autodigestion of pancreas

• Pulmonary: Hypoxemia, insufficiency/failure, effusions, ARDS (r/t phospholipase A)
• Cardiovascular: hypovolemic shock (trypsin vasodilates)
• Renal: ARF
• Neuro: decreased LOC (pain control is difficult and pancreatic encelphalopathy, decreased perfusion)
• Hematologic: DIC (liver dysfunction, platelets/clotting factors)

• Fluid resuscitation: crystalloids, colloids, plasma expanders, monitor status
• Inotropic therapy: Dopamine

• Difficult to control
• Morphine
• Fentanyl
• Dilaudid
• May not be able to bring pain to 0

• Rest the GI track
• Meds: antacids, PPIs, anticholinergics

• Initial NPO
• Initiate nutritional support if NPO >5-7 days
• Nasal jejunal feeding: Post ligament of Treitz, preferred tip location
• Improve outcomes

• Correct underlying problem: remove gallstone, stop drinking
• Prevent/treat complications: early recognition, close multi-system monitoring

• Control of pain: PCA narcotics, monitor for non/therapeutic effects
• Maintain nutrition
• Managing N/V: antiemetic therapy
• Monitor for complications