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PANCREATITIS

PANCREATITIS. ACC, RNSG 1247. Acute Pancreatitis Definition & Etiology. An acute inflammatory process of the pancreas Degree of inflammation varies from mild to edema to severe necrosis Most common in middle-age African American rate three times higher than for whites.

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PANCREATITIS

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  1. PANCREATITIS ACC, RNSG 1247

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

  3. Acute PancreatitisEtiology and Pathophysiology • Primary etiologic factors are • Biliary tract disease • Most common: Gallbladder disease • Alcoholism * May stimulate production of digestive enzymes

  4. Pancreatitis from gallstones

  5. Acute PancreatitisEtiology and Pathophysiology • Caused by auto digestion of pancreas • Etiologic factors • Injury to pancreatic cells • Activate pancreatic enzymes

  6. Acute Pancreatitis Fig. 44-14

  7. (AP) Acute PancreatitisEtiology and Pathophysiology • 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

  8. Acute PancreatitisEtiology and Pathophysiology • Edematous pancreatitis • Mild and self-limiting • Necrotizing pancreatitis • Degree of necrosis correlates with severity of manifestations

  9. 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

  10. 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 Turner’s or Cullen’s sign

  11. Acute PancreatitisComplications • Two significant local complications • Pseudocyst • Abscess

  12. 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

  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 Pancreatis:Goals of Care • Relieve pain • Prevent or alleviate shock • Reduce pancreatic secretions • Maintain fluid and electrolyte balance • Remove precipitating cause

  18. Acute Pancreatitis: Treatment and Nursing Care 1. Pain management • IV morphine • Combined with antispasmodic agent 2. Prevention of Shock - Plasma or volume expanders • - LR solution 3. Suppress pancreatic enzymes - NPO, NG suction, antacids, H2 receptor antagonist 4. Antibiotics

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

  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 Pancreatitis:Home Care • Follow up care • Dietary teaching • High-carbohydrate, low-fat diet • Abstinence from alcohol, • Patient/family teaching * Signs of infection, high blood glucose, steatorrhea

  23. Chronic PancreatitisDefinition • 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 PancreatitisEtiology and Pathophysiology • Chronic obstructive pancreatitis • Associated with biliary disease • Most common cause • Inflammation of the sphincter of Oddi associated with cholelithiasis • Other causes include • Cancer of ampulla of Vater, duodenum, or pancreas

  26. Chronic PancreatitisEtiology and Pathophysiology • Chronic calcifying pancreatitis • Also called alcoholic induced • Inflammation and sclerosis • Mainly in the head of the pancreas and around the pancreatic duct *** Ducts are obstructed with protein precipitates which block the pancreatic duct causing it to calcify then fibrosed and atrophied.

  27. 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

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

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

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

  31. Chronic PancreatitisGoals of Care • Prevention of attacks • During acute attack follow acute therapy • Relief of pain • Control of pancreatic exocrine and endocrine insufficiency • Bland, low-fat, high-carbohydrate diet

  32. Chronic PancreatitisTreatment and Nursing Care Cont. • Bile salts • Control of diabetes • No alcohol • Pancreatic enzyme replacement • Acid-neutralizing and acid-inhibiting drugs

  33. Chronic PancreatitisTreatment and Nursing Care • Surgery • Indicated when biliary disease is present or if obstruction or pseudocyst develops • Divert bile flow or relieve ductal obstruction

  34. 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

  35. The End

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