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Pancreatitis. Inflammation of the Pancreas. Acute Pancreatitis. Function of the pancreas is to release proteolytic enzymes that assist in the breaking down food products so that nutrients can be absorbed. Acute Pancreatitis Etiology and Pathophysiology. - PowerPoint PPT Presentation
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Pancreatitis
Acute Pancreatitis
Function of the pancreas is to release proteolytic enzymes that assist in the breaking down food products so that nutrients can be absorbed.
Acute Pancreatitis Etiology and Pathophysiology
Pancreatic Ducts Pancreatic Ducts become become obstructedobstructed
Hypersecretion of the Hypersecretion of the exocrine exocrine enzymes of pancreasenzymes of pancreas
These enzymes enter the bile These enzymes enter the bile duct, where they are activated duct, where they are activated and with bile back up into the and with bile back up into the pancreatic duct pancreatic duct
Pancreatitis
Acute Pancreatitis Etiology and Pathophysiology
Trypsinogen- (a proteolytic enzyme) Normally released into the small
intestine, where it is activated to trypsin
In AP, activated to trypsin in the pancreas causing autodigestion of pancreas
Progression of Disease Autodigestion Acute Inflammation of Pancreas
Necrosis of Pancreas
Digestion of vascular walls Thrombus and Hemorrhage
Death
Precipitating Factors
Trauma Use of alcohol * Biliary tract disease Viral or Bacterial disease Cholelithiasis * Peptic Ulcer Disease
*most common causes
Acute Pancreatitis Clinical Manifestations Severe Abdominal painAbdominal pain is predominant symptom
Pain located in LUQ and mid-epigastrium Commonly radiates to the back Sudden onset Severe, deep, piercing, steady Aggravated by fatty meal or lying recumbent
position Not relieved by vomiting
Acute Pancreatitis Clinical Manifestations
Cyanosis, Dyspnea Bowel sounds decreased or absent Low-grade fever, Leukocytosis Hypotension, Tachycardia Jaundice Flushing Abnormal lung sounds - Crackles Discoloration of abdominal wall – Turner’s or Cullen’s
sign SIGNS OF SHOCK
Acute PancreatitisDiagnostic Studies
History and physical examination Laboratory tests
Serum amylase- hallmark test Serum lipase – also elevated Blood glucose Serum calcium Triglycerides
Acute PancreatitisDiagnostic Studies
Flat plate of abdomen Abdominal/endoscopic ultrasound Endoscopic retrograde
cholangiopancreatography (ERCP) Chest x-ray CT of pancreas Magnetic resonance
cholangiopancreatography (MRCP)
Acute Pancreatitis
Can be a medical emergency associated with a risk for life-
threatening complications
Acute Pancreatitis Complications
Two significant local complications Pseudocyst
Abscess
Acute PancreatitisComplications
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
Acute Pancreatitis Complications
Pancreatic abscess A large fluid-containing cavity within pancreas Results from extensive necrosis Upper abdominal pain Abdominal mass High fever Leukocytosis
Acute PancreatitisComplications
Main systemic complications are? PulmonaryPulmonary
CardiovascularCardiovascular
Electrolyte imbalance – HypocalcemiaElectrolyte imbalance – Hypocalcemia
Acute PancreatitisGoals of Care
Relief of pain
Prevention or alleviation of shock
Decrease respiratory failure
↓ of pancreatic secretions
Maintain Fluid/electrolyte balance
Treatment and Nursing Care 1. Pain management
IV morphine or Dilaudid
Antispasmodic agent Bentyl Pro-Banthine
Spasmolytics – Nitroglycerine
Positioning – sitting up and leaning forward
Why is it important to relieve pain?
Treatment
2. Prevention of Shock – hemodynamic stability
* Administer Blood, Plasma expanders, Albumin * LR solution
What is the cause of shock?
Treatment and Nursing Care
3. Suppress pancreatic enzymes * NPO * NG suction * Antacids, H2 receptor antagonists, antispasmotics
4. Decrease respiratory distress * Oxygen; check O2 saturation levels * Semi-fowlers position, knees flexed, position
changes * C, DB; incentive spirometer
5. Antibiotics
Treatment and Nursing Care 6. Correction of electrolyte imbalance/ hypocalcemia
7. Maintain Hydration / Nutrition
Treatment and Nursing Care
Surgical therapy – if related to gallstones ERCP Endoscopic sphincterotomy Laparoscopic cholecystectomy
Follow up care Dietary teaching
High-carbohydrate, low-fat diet Abstinence from alcohol,
Patient/family teaching * Signs of infection, high blood glucose, steatorrhea
Treatment - Home Care