PANCREATITIS ACC, RNSG 1247. Acute Pancreatitis Definition An acute inflammatory process of the...
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PANCREATITIS
ACC, RNSG 1247
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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
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Acute Pancreatitis: Risk Factors
Primary risk factors are ________ ____ ______ (women)
Gallbladder disease
_____________ (men)
* May stimulate production of digestive
enzymes
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Pancreatitis from gallstones
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(AP) Acute Pancreatitis:PathophysiologyTrypsinogen
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?
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Acute Pancreatitis: pathophysiologic results of autodigestion
Fig. 44-14Fig. 44-14
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Acute Pancreatitis: “Degree of involvement”
Edematous pancreatitisMild and self-limiting
Necrotizing pancreatitisDegree of necrosis correlates with severity of manifestations
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Acute PancreatitisClinical Manifestations
Abdominal pain is predominant symptomPain 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
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Acute PancreatitisClinical Manifestations
Cyanosis, DyspneaEdemaN/V, Bowel sounds decreased or absentLow-grade fever, LeukocytosisHypotension, TachycardiaJaundice FlushingAbdominal tenderness, distentionAbnormal lung sounds - CracklesGrey Turner’s or Cullen’s sign
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Acute PancreatitisComplications
Two significant local complicationsPseudocyst
Abscess
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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
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Pancreatic pseudocysts
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Acute Pancreatitis Complications (local)
Pancreatic abscessA large fluid-containing cavity within pancreas
Results from extensive necrosis in the pancreas
Upper abdominal pain
Abdominal mass
High fever
Leukocytosis
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Acute PancreatitisComplications : Systemic
Main systemic complicationsPulmonary
Pleural effusion
Atelectasis
Pneumonia
CardiovascularHypotension
Tetany (caused by hypocalcemia)
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Acute PancreatitisDiagnostic Studies
History and physical examinationLaboratory tests
Serum amylaseSerum lipase2-hour urinary amylase and renal amylase clearanceBlood glucoseSerum calciumTriglycerides
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Acute PancreatitisDiagnostic Studies
Flat plate of abdomenAbdominal/endoscopic ultrasoundEndoscopic retrograde cholangiopancreatography (ERCP)Chest x-rayCECT of pancreasMagnetic resonance cholangiopancreatography (MRCP)
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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 solution3. Suppress __________ _______ - NPO, NG suction, antacids, H2 receptor antagonist4. Prevent ________
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Acute PancreatitisTreatment and Nursing Care
Surgical therapy – if related to gallstones
ERCP
Endoscopic sphincterotomy
Stent placement
Laparoscopic cholecystectomy
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Endoscopic Sphincterotomy
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Acute PancreatitisTreatment and Nursing Care
Nutritional therapyNPO status initially
IV lipids - monitor triglycerides
Enteral or parenteral feeding
Small, frequent feedings if allowed
High-carbohydrate, low-fat, high-protein
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Acute PancreatitisNursing Diagnoses
Acute pain
Deficient fluid volume
Imbalanced nutrition: Less than body requirements
Ineffective therapeutic regimen management
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Acute Pancreatitis:Home Care
Pain control/prevention Dietary teaching
High-carbohydrate, low-fat dietAbstinence from alcohol, also caffeine, smoking
Patient/family teaching * Signs of infection, high blood glucose, steatorrhea
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Chronic Pancreatitis: DefinitionContinuous, prolonged inflammatory, and fibrosing process of the pancreas
Pancreas becomes destroyed as it is replaced by fibrotic tissue
Strictures and calcifications can also occur
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Chronic PancreatitisEtiology and Pathophysiology
May follow acute pancreatitis
May occur in absence of any history of acute condition
Two major typesChronic obstructive pancreatitis
Chronic calcifying pancreatitis
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Chronic Pancreatitis: Types and risk factors
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.
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Chronic PancreatitisClinical Manifestations
Abdominal painLocated in the same areas as in AP Heavy, gnawing feeling; burning and cramp-like
Malabsorption with weight lossConstipationMild jaundice with dark urineSteatorrheaFrothy urine/stoolDiabetes mellitus
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Chronic PancreatitisClinical Manifestations
Complications includePseudocyst formation
Bile duct or duodenal obstruction
Pancreatic ascites
Pleural effusion
Splenic vein thrombosis
Pseudoaneurysms
Pancreatic cancer
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Chronic PancreatitisDiagnostic Studies
Laboratory testsSerum amylase/lipase
May be ↑ slightly or not at all
↑ Serum bilirubin
↑ Alkaline phosphatase
Mild leukocytosis
Elevated sedimentation rate
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Chronic PancreatitisDiagnostic Studies
CT
MRI
MRCP
Transabdominal ultrasound
Endoscopic ultrasound
Secretin stimulation test
ERCP
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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
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Chronic PancreatitisTreatment and Nursing Care
SurgeryIndicated when biliary disease is present or if obstruction or pseudocyst develops
Divert bile flow ( Ex: choledochojejunostmy)
Or relieve ductal obstruction ( Ex: sphincterectomy)
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Chronic PancreatitisHome/Ambulatory Care
Focus is on chronic care and health promotion
Dietary controlNo alcohol
Control of diabetes
Taking pancreatic enzymes
Patient and family teaching
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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
Highest mortality rate
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The End