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What is pancreatitis?
- Inflammatory process of the pancreas
- Premature activation of pancreatic enzymes
- Destruction of ductal tissue/pancreatic cells via Autodigestion/fibrosis of pancreas
- Pathophysiologic processes
- 1. Lipolysis
- 2. Proteolysis
- 3. Necrosis of blood vessels
- 4. Inflammation
Functions of pancreas?
- Pancreas has both endocrine and exocrine functions
- Exocrine: secretions of enzymes into pancreatic duct
- Endocrine: Islets of Langerhan secrete hormones into BS.
What do you need to know about sphincter of oddi?
Is pretty much the only use for demorol.
What are some exocrine enzymes
- (DIGESTIVE ENZYMES)
Which enzyme test is more reliable indicator of pancreatic function, lipase or amylase?
Who is at risk
- Chronic wasting diseases
- Drug use
- Anything that causes body to produce/collect toxins faster than they can be eliminated.
What is acute haemorrhagic pancreatitis
Acute inflammation of the pancreas accompanied by the formation of necrotic areas on the surface of the pancreas and in the omentum and, frequently, also accompanied by hemorrhages into the substance of the gland.
- Progressive, destructive
- Inflammation/fibrosis: looses its endo/exocrine fxns.
- Repeated episodes of alcohol/drug-induced acute pancreatitis
- Types of chronic:
- --Calcifying pancreatitis (CCP) (alcohol/drug-induced)
- --Obstructive pancreatitis: can also kill off GB and liver with obstruction. Always assess for multiple organ failure, ie jaundice, dark urine, etc.
Other conditions associated with pancreatitis?
- POSTOPERATIVE OR TRAUMA
- ISCHEMIA (generalized. kidneys can withstand 20-40 minutes of poor perfusion before starts showing organ failure.)
How might gallstone cause pancreatitis?
Acute pancreatitis clinical manifestations
- N&V: NPO, gastric emptying
- Abdominal pain!!!!!: narcotics-->v BP, ^n/v,
- --midepigastric/lt upper quad
- --radiates/intense, continuous
- --affected by position
- Generalized jaundice
- Gray-blue discoloration of abdomen/periumbilical area Cullen's sign)
- Gray-blue discoloration of flanks (Turner's sign)
- Decreased bowel sounds/paralytic ileus/abdominal distention
- Abdominal tenderness, rigidity/guarding
- Palpable mass
- Elevated temperature/tachycardia/↓ B/P
- Pleural effusion/ARDS
- Jaundice: liver cannot empty contents-->yellow skin color.
What is cullen's sign?
- collection of blood in abd.~2Lt blood.
- Greyish blue discoloration.
What is Turner's sign?
- Gray-blue discoloration of flanks
Referred pain for pancreatitis?
Independent vs dependent nursing interventions
- --pain assessment
- --wound assessment
- --physical assessment (WOB, sepsis?)
- --teaching (repeat back with examples, ie which food should you not be eating? Marbled meats, cheese, etc)
- --drain output
- --vitals q8h
- --npo,hydration via IV fluids
Diagnositcs for pancreatitis?
How do you check for hypocalcemia?
- Over-reactivity due to low serum calcium.
Possible nursing diagnosis with pancreatitis?
- Fluid volume deficit/Electrolyte Imbalance
- Altered nutrition: less than body requirements
- Ineffective breathing pattern r/t ards, pleural effusion.
- Risk for activity intolerance
- Sleep pattern disturbance
- Altered health maintenance
What is azotemia?
- low liver fnx-->high serum levels of BUN, Crit.
- is an indicator of pancreatitis.
Early signs of pancreatitis?
- AGE >55
- INCREASED LFT
- DURING INITIAL 48HOURS
- >6L FLUID SEQUESTERED
What are the main issues with chronic pancreatitis?
- can take replacement enzymes with food, but presents complications because must be taken with every feeding.
Chronic usually due to poor/slow/late diagnosis.
What is the Whipple procedure?
- Used to treat pancreatic cancer.
- head, body of pancreas is removed along with duodenum and gallbladder, part of jejunum, stomach bile duct and lymph nodes near pancreas.
- remaining bile duct is then attached to the small intestine to allow bile form the liver to continue entering the small intestine.