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Pancreatitis

Pancreatitis. Acute Pancreatitis. An acute inflammatory process of the pancreas Degree of inflammation varies from mild edema to severe necrosis. Acute Pancreatitis Etiology and Pathophysiology. Most common in middle-aged men and women

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Pancreatitis

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  1. Pancreatitis

  2. Acute Pancreatitis • An acute inflammatory process of the pancreas • Degree of inflammation varies from mild edema to severe necrosis

  3. Acute PancreatitisEtiology and Pathophysiology • Most common in middle-aged men and women • Severity of the disease varies according to the extent of pancreatic destruction • Can be life-threatening

  4. Acute PancreatitisEtiology and Pathophysiology (Cont’d) • Primary etiologic factors are • Biliary tract disease • Most common: Gallbladder disease • Alcoholism

  5. Acute PancreatitisEtiology and Pathophysiology (Cont’d) • Less common causes • Trauma (postsurgical, abdominal) • Viral infections (mumps, coxsackievirus HIV) • Penetrating duodenal ulcer • Cysts • Idiopathic

  6. Acute PancreatitisEtiology and Pathophysiology • Less common causes (cont’d) • Abscesses • Metabolic disorders • Vascular diseases • Postop GI surgery

  7. Acute PancreatitisEtiology and Pathophysiology • Less common causes (cont’d) • Drugs • Corticosteroids • Thiazide diuretics • Oral contraceptives • NSAIDs

  8. Acute PancreatitisEtiology and Pathophysiology • Caused by autodigestion of pancreas • Etiologic factors • Injury to pancreatic cells • Activate pancreatic enzymes

  9. Acute Pancreatitis

  10. Acute PancreatitisEtiology and Pathophysiology • Trypsinogen • Activated to trypsin by enterokinase • Inhibitors usually inactivate trypsin • Enzyme can digest the pancreas and can activate other proteolytic enzymes

  11. PancreatitisEtiology and Pathophysiology • Elastase • Activated by trypsin • Plays a major role in autodigestion • Causes hemorrhage by producing dissolution of the elastic fibers of blood vessels

  12. Acute PancreatitisEtiology and Pathophysiology • Phospholipase A • Plays a major role in autodigestion • Activated by trypsin and bile acids • Causes fat necrosis

  13. Acute PancreatitisEtiology and Pathophysiology (Cont’d) • Alcohol • May stimulate production of digestive enzymes • Increases sensitivity to hormone cholecystokinin • Stimulates production of pancreatic enzymes

  14. Acute PancreatitisClinical Manifestations • Abdominal pain is predominant symptom • Pain located in the left upper quadrant • Pain may be in the midepigastrium • Commonly radiates to the back

  15. Acute PancreatitisClinical Manifestations • Abdominal pain (cont’d) • Sudden onset • Severe, deep • Aggravated by eating • Not relieved by vomiting

  16. Acute PancreatitisClinical Manifestations • Flushing • Cyanosis • Dyspnea • Edema • Nausea/vomiting • Bowel sounds decreased or absent

  17. Acute PancreatitisClinical Manifestations (Cont’d) • Low-grade fever • Leukocytosis • Hypotension • Tachycardia • Jaundice • Abdominal tenderness

  18. Acute PancreatitisClinical Manifestations (Cont’d) • Abdominal distention • Abnormal lung sounds • Crackles • Discoloration of abdominal wall

  19. Acute PancreatitisComplications • Pancreatic abscess • A large fluid-containing cavity within pancreas • Results from extensive necrosis in the pancreas • Upper abdominal pain • Abdominal mass

  20. Acute PancreatitisComplications • Pancreatic abscess (cont’d) • High fever • Leukocytosis • Requires surgical drainage

  21. Acute PancreatitisDiagnostic Studies • History and physical examination • Laboratory tests • Serum amylase • Serum lipase • 2-hour urinary amylase

  22. Acute PancreatitisDiagnostic Studies • Laboratory tests (cont’d) • Blood glucose • Serum calcium • Triglycerides

  23. Acute PancreatitisDiagnostic Studies • Flat plate of abdomen • Abdominal/endoscopic ultrasound • Endoscopic retrograde cholangiopancreatography (ERCP) • Chest x-ray

  24. Acute PancreatitisDiagnostic Studies (Cont’d) • CT of pancreas • Magnetic resonance cholangiopancreatography (MRCP)

  25. Acute PancreatitisCollaborative Care • Objectives include • Relief of pain • Prevention or alleviation of shock • ↓ of pancreatic secretions • Fluid/electrolyte balance • Removal of the precipitating cause

  26. Acute PancreatitisCollaborative Care (Cont’d) • Conservative therapy • Supportive care • Aggressive hydration • Pain management • IV morphine • Combined with antispasmodic agent • Management of metabolic complications • Minimizing stimulation

  27. Acute PancreatitisCollaborative Care • Conservative therapy (cont’d) • Shock • Plasma or plasma volume expanders (dextran or albumin) • Fluid/electrolyte imbalance • Lactated Ringer’s solution • Ongoing hypotension • Vasoactive drugs: Dopamine (Intropin) • ↑ Systemic vascular resistance

  28. Acute PancreatitisCollaborative Care • Conservative therapy (cont’d) • Suppression of pancreatic enzymes • NPO • NG suction • Prevent infections • Peritoneal lavage or dialysis

  29. Acute PancreatitisCollaborative Care • Surgical therapy indicated if • Presence of gallstones • Uncertain diagnosis • Unresponsive to conservative therapy • Abscess or severe peritonitis

  30. Acute PancreatitisCollaborative Care • Surgical therapy (cont’d) • ERCP • Endoscopic sphincterotomy • Laparoscopic cholecystectomy

  31. Acute PancreatitisCollaborative Care (Cont’d) • Drug therapy • IV morphine • Nitroglycerin • Antispasmodics • Antacids • Histamine (H2) receptor

  32. Acute PancreatitisCollaborative Care (Cont’d) • Nutritional therapy • NPO status initially to reduce pancreatic secretion • IV lipids • Monitor triglycerides • Small, frequent feedings • High-carbohydrate, low-fat, high-protein diet • Bland diet

  33. Acute PancreatitisCollaborative Care • Nutritional therapy (cont’d) • Supplemental fat-soluble vitamins • Supplemental commercial liquid preparations • Parenteral nutrition • No caffeine or alcohol

  34. Acute PancreatitisNursing Assessment • Health history • Biliary tract disease • Alcohol use • Abdominal trauma • Duodenal ulcers • Infection • Metabolic disorders

  35. Acute PancreatitisNursing Assessment (Cont’d) • Medication usage • Thiazides, estrogens, corticosteroids, NSAIDs • Surgical procedures • Nausea/vomiting • Dyspnea • Severe pain

  36. Acute PancreatitisNursing Assessment (Cont’d) • Physical examination findings • Fever • Jaundice • Discoloration of abdomen/flank • Tachycardia • Hypotension • Abdominal distention/tenderness

  37. Acute PancreatitisNursing Assessment (Cont’d) • Abnormal laboratory findings • ↑ Serum amylase/lipase • Leukocytosis • Hyperglycemia • Hyperlipidemia • Hypocalcemia • Abnormal ultrasound/ CT/ ERCP

  38. Acute PancreatitisNursing Diagnoses • Acute pain • Deficient fluid volume • Imbalanced nutrition: Less than body requirements • Ineffective therapeutic regimen management

  39. Acute PancreatitisPlanning • Overall goals • Relief of pain • Normal fluid and electrolyte balance • Minimal to no complications • No recurrent attacks

  40. Acute PancreatitisNursing Implementation • Health Promotion • Assessment of predisposing factors • Early diagnosis/treatment • Eliminate alcohol intake

  41. Acute PancreatitisNursing Implementation (Cont’d) • Acute Intervention • Monitor vital signs • IV fluids • Observe for side effects of medications • Assess respiratory function • Pain assessment and management • Frequent position changes • Side-lying with HOB elevated 45 degrees • Knees up to abdomen

  42. Acute PancreatitisNursing Implementation • Acute Intervention (cont’d) • Fluid/electrolyte balance • Blood glucose monitoring • Monitor for signs of hypocalcemia • Tetany (jerking, irritability, twitching) • Numbness around lips/fingers • Monitor for hypomagnesemia

  43. Acute PancreatitisNursing Implementation • Acute Intervention (cont’d) • NG tube care • Frequent oral/nasal care • Observe for signs of infection • Wound care • Observe for paralytic ileus, renal failure, mental changes

  44. Acute PancreatitisNursing Implementation • Ambulatory and Home Care • Physical therapy • Counseling regarding abstinence from alcohol, caffeine, and smoking • Assessment of narcotic addiction

  45. Acute PancreatitisNursing Implementation • Ambulatory and Home Care (cont’d) • Dietary teaching • High-carbohydrate, low-fat diet • Patient/family teaching • Signs of infection, high blood glucose, steatorrhea • Medications/diet

  46. Acute PancreatitisNursing Implementation • Expected outcomes • Maintains adequate fluid volume • Maintains weight appropriate for height • Food and fluid intake adequate to meet nutritional needsDescribes therapeutic regimen • Expresses commitment to lifestyle changes

  47. Chronic Pancreatitis • 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

  48. Chronic PancreatitisEtiology and Pathophysiology • May occur in absence of any history of acute condition • Two major types • Chronic obstructive pancreatitis • Chronic calcifying pancreatitis

  49. Chronic PancreatitisEtiology and Pathophysiology (Cont’d) • Chronic obstructive pancreatitis • Associated with biliary disease • Most common cause • Inflammation of the sphincter of Oddi associated with cholelithiasis • Other causes include • Cancer of duodenum, or pancreas

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