1 / 34

PANCREATITIS

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

umed
Download Presentation

PANCREATITIS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PANCREATITIS ACC, RNSG 1247

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

  3. Acute Pancreatitis: Risk Factors • Primary risk factors are • ________ ____ ______ (women) • Gallbladder disease • _____________ (men) * May stimulate production of digestive enzymes

  4. Pancreatitis from gallstones

  5. (AP) Acute Pancreatitis: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 • What happens in autodigestion?

  6. Acute Pancreatitis: pathophysiologic results of autodigestion Fig. 44-14

  7. Acute Pancreatitis: “Degree of involvement” • Edematous pancreatitis • Mild and self-limiting • Necrotizing pancreatitis • Degree of necrosis correlates with severity of manifestations

  8. 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

  9. 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

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

  11. 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

  12. Pancreatic pseudocysts

  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 Pancreatitis: Goals of Treatment and Nursing Care 1. Manage _____ • IV morphine, Hydromorphone • Combined with antispasmodic agent 2. Prevent or alleviate _____ - Plasma or volume expanders • - LR solution 3. Suppress __________ _______ - NPO, NG suction, antacids, H2 receptor antagonist 4. Prevent ________

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

  19. Endoscopic Sphincterotomy

  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 • Pain control/prevention • Dietary teaching • High-carbohydrate, low-fat diet • Abstinence from alcohol, also caffeine, smoking • Patient/family teaching * Signs of infection, high blood glucose, steatorrhea

  23. Chronic Pancreatitis: Definition • 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 obstructive pancreatitis Associated with biliary disease; commonly associated with cholelithiasis Other causes include: Cancer of ampulla of Vater, duodenum, or pancreas Chronic calcifying pancreatitis AKA alcohol induced Inflammation and sclerosis in the head of the pancreas and around the pancreatic duct *** Ducts are obstructed with protein precipitates blocking the pancreatic duct causing it to calcify then fibrosed and atrophied. Chronic Pancreatitis: Types and risk factors

  26. 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

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

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

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

  30. Chronic Pancreatitis: Goals of Treatment and Nursing Care • Prevention of attacks * Follow acute therapy during acute attack • Relief of pain • Control of pancreatic exocrine and endocrine insufficiency * Pancreatic enzyme replacement; bile salts * Acid-neutralizing and acid-inhibiting drugs • Bland, low-fat, high-carbohydrate diet

  31. Chronic PancreatitisTreatment and Nursing Care • Surgery • Indicated when biliary disease is present or if obstruction or pseudocyst develops • Divert bile flow ( Ex: choledochojejunostmy) • Or relieve ductal obstruction ( Ex: sphincterectomy)

  32. 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

  33. Highest mortality rate Pancreatic Cancer • Highest mortality rate • Other risk factors: smoking, DM, family history • Cause of high mortality: hard to detect when surgical removal is still possible • Signs/Symptoms: weight loss, nausea, changes in stool , diabetes • TX: surgery, chemotherapy

  34. The End

More Related