Pancreatitis

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  1. Acute Pancreatitis
    • Approx 200,000 cases hospitalized each year in US
    • Risk Factors/causes
    • Gender- men
    • Age- mortality inc as we age
    • African americans
    • Alcohol use, cholelithiasis*** (stones in the gall bladder)
    • infection, c/o surgery, meds
    • idiopathic- unknown
    • Alcohol incr spasms- sphrinter emodi common bile duct into deudedum
    • alcohol decr blood flow to pancreas
    • IRCP?- scope that goes thru the mother etch - to check out inflamed wall
    • Pancreas Priority
    • - fluids
    • - pain management
    • - dec fatty foods
    • - keep NPO
  2. Acute Pancreatitis
    what happens
    • Varies from mild edema to severe hemorrhagic necrosis
    • patient presents acutely ill
    • can develop complication:
    • - pulmonary c/o, shock, renal failure- (stones, dehydration, FVD- hemorraging shock)
  3. Patho of pancreatitis
    • Pancreatic enzyme release is blocked
    • Proteolyic enzymes trapped and autodigest the pancreas- triggers the release of inflammatory mediators
    • Activation of enzymes/mediators
    • auto digestion- pancreas digesting itself
    • - incr vascular permability- fluid shift
    • - necrosis, erosion, hemorrhage (severe pancreatitis)
  4. Presenting signs and symptoms
    • *** severe epigastric and abdominal pain that radiates to the back
    • - incr when lying supine, decr when sitting up/leaning forward
    • - no reliefs from antacids or vomiting
    • - increases after meal and/or alcohol peaks after 24-48 hrs
    • abd distention, bruising on abd (hemorraging), guarding
    • hypoactive bowel sounds
    • N/V
    • fever, agitation
  5. Assessments: complications
    • Warning signs:
    • - tachycardia
    • - hypotension
    • - cool clammy skin
    • jaundice- liver
    • respiratory distress/hypoxia (atelecalosis)
    • inc abd pain, boardlike abd
    • muscle spasm- due to calcium, ca likes to go to necrotic tissue
    • alot of the signs are related to shock
    • hypocalcemia
    • - numbness
    • - tingling
    • - muscle spasms
  6. diagnostic testing
    • Amylase (wnl 60-160)- rise sooner 4x more
    • lipase (wnl <200)- more specific to the pancreas 3x
    • WBC
    • Glu (wnl 60-110) damage 2 endocrine/pancreas
    • dec Ca (wnl 8.6-10.2)- bc necrotic tissue
    • dec hbg/hct- loss of blood
    • LFT- liver involved
    • CT- gold standard imaging test
  7. medical management
    • Rest the pancreas:
    • - NPO: food stimulates pancreatic enzyme
    • - +/- NGT: may need tpn/ppn, to relieve n/v and distention
    • - bedrest, semi fowler's: to decrease pressure of the diaphragm
  8. medical managment
    support patient pain
    • analgesics: opiods
    • acurate pain assessment
    • prompt pain management- pharmacologic and non pharmacologic
    • positioning
    • H2 blocker, PPI- dec gastic acid
    • antiemetics- prevent vomiting- zofran
  9. Support pt's fluid and electrolytes
    • monitor VS
    • acurate I&O, daily weights
    • hydration- IVF, lytes, colliods PRN
    • monitor CBC, glucose, lytes, renal fx
    • may need insulin
  10. nursing management
    support the patient infection
    • antibiotics
    • Primaxin (carbapenem)
    • - 3rd generation cyclosporin
    • - able to diffuse into pancreatic tissues
    • - s/e: think penicillin- n/v, hypersensitivity
  11. Nursing management
    support the pt: respiratory
    • T/C/DB/IS
    • accurate respiratory assessment
    • emotional support
  12. Patient teaching
    • diet choices, improve nutrition: incr carb (less stimulate to pancreas), decre fats (bc it stimulate pancreas enzymes), moderate protein
    • avoid alcohol, smoking cessation
    • pain control
    • safety: weakness, fatigue
    • Clear liquid diet, once pain free for 24 hrs
  13. Surgical intervention
    • ERCP
    • - review post care
    • Cholecystectomy
    • drainage of necrotic fluid collections
    • - drains and/or stents
  14. Complications
    • Shock:
    • - hypovolemic
    • - hemorrhagic
    • - septic
    • can lead to MODS (multi organ dysfx)
    • *** tx is aggressive***
  15. complications
    • Hypocalcemia
    • - signs of severe disease
    • - Ca++ and fatty acids combine during fat necrosis, decre circulating level
    • - assess for tetany, muscle spasm
    • - positive Chvosteks and Trosseau sign
    • - treated with calcium gluconate IV
  16. complications
    respiratory failure
    • elevated diaphragm- doesn't descend
    • atelectasis
    • alveoli and surfactant damage
    • accurate and timely resp assessment
  17. Complications
    pseudocyst
    • collection of pancreatic fluid in a layer of inflammatory tissue
    • may resolve without tx or may need to drain
  18. Chronic pancreatitis
    • continous progressive inflammatory destruction of the pancreas resulting fibrosis
    • obstruction of CBD, pancreatic ducts
    • auto digestion and inflammatory mediators are activated
  19. Chronic pancreatitis
    why it happens
    • Chronic alcohol comsumption***
    • recurring manifestation abd/back pain
    • - attacks can become more severe and freq and duration last longer
    • - can be painless- but will experience other s/s
    • also: weight loss, stearohhera
  20. chronic pancreatis
    dx, tx
    • Dx
    • ERCP
    • lab data similar to acute

    • tx: depends on cause
    • - prevent future attacks, control pain
    • - surgical and non surgical treatment

Card Set Information

Author:
Prittyrick
ID:
313947
Filename:
Pancreatitis
Updated:
2016-01-11 01:45:47
Tags:
pancreas
Folders:

Description:
problems with the gut
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