NURS 405A Exam 3
Acute pancreatitis - ✔️✔️acute inflammation of the pancrease that can range from mild
to severe, severe can be life threatening
pancreatic enzymes spill into surrounding tssues and organs causing autodigestion and
pain
pancreas typically recovers from an acute episode
Nursing assessment for acute pancreatitis - ✔️✔️abdomen is painful, guarded,
distended
bowel sounds decreased or absent
crackles in bases of lungs
Grey Turner's (flank: bruise like sign on skin) and Cullen's signs (preumbilical red line)
acinar cells - ✔️✔️Secrete digestive enzymes including amylase, protease and lipase
intot he pancreatic duct
Islet cells - ✔️✔️secrete insulin, glucagon, somatostatin, pancreatic polypeptide into
bloodstream
Function of insulin - ✔️✔️beta cells of the islets of langerhans move glucose from the
blood into other body tissues where it is used for energy
Function of glucagon - ✔️✔️alpha cells cause liver to convert glycogen to glucose
What does the gallbladder do? - ✔️✔️Stores and releases bile (made in the liver) to
digest fats
Anatomy of the pancreas - ✔️✔️It is both an exocrine (acinar cells) and endocrine
(islets of langerhans) organ
Most common causes of acute pancreatitis (U.S.) - ✔️✔️Gallbadder disease
(gallstones) due to high fat diet (more common in women than men)
Chronic alcohol use (more common in men)
idopathic
hypertriglyceridemia
less common causes of acute pancreatitis - ✔️✔️drug reactions (thiazide diuretics, DM
meds)
pancreatic cancer
,trauma
gallstones are... - ✔️✔️hardened deposits of undissolved cholesterol, salts or bilirubin
Clinical manifestation of acute pancreatitis - ✔️✔️abdominal pain (cause your pancreas
is digesting itself) (mid-epigastric and LUQ radiating to back, worse with eating, worse
when recumbent (lying flat))
N/V
Vital signs (resemble sepsis): dec BP, inc HR, low grad fever
Labs: inc amylase, inc lipase (Lipase more specific to pancreas) (amylase can elevate
with mumps, cerebral trauma, renal transplant)
Hyperglycemia and hypocalcemia (combining of calcium and fatty acids during fat
necrosis)
S/S of hypocalcemia - ✔️✔️Early sign of hypocalcemia is numbness/tingling around
lips and fingers
muscle twitching and tetany can also occur
postive chovstek and trousseau signs
Acute pancreatitis primarily affects what systm? - ✔️✔️cardiovascular and pulmonary
systems
Patient's with Grey Turner's and Cullen's signs - ✔️✔️less than 1% of patients have
these signs and they are associated with a high rate of mortality
Acute Pancreatitis complications - ✔️✔️Inflammation and free digestive enzymes can
affec nearby organs, vessels and lungs:
hemorrhage
shock
necrosis
peritonitis
pancreatic pseudocyst
pancreatic abscess, acute renal failure
ARDS, Hypocalcemia
DIC
pancreatic pseudocyst from acute pancreatitis - ✔️✔️a localized collection of
pancreatic juices confirned to a retoperitoneal area by a fibrous membrane
pancreatic abscess from acute pancreatitis - ✔️✔️a collection of pus and necrotic
tissue
ARF from acute pancreatitis - ✔️✔️caused by hypoxemia, release of pancreatic
amylase from injured pancreas with impairment or renal microcirculation, decrease in
,renal perfusion pressure due to abdominal compartment syndrome, intraabdominal
hypertension or hypovolemia
ARDs from acute pancreatitis - ✔️✔️due to systemic inflammation, potentially the most
serious manifestation of AP w/ mortality rate in the range of 30-40%
will see hypoxemia and tachypnea
DIC (Disseminated intravascular coagulation) from acute pancreatitis - ✔️✔️from
inflammation of bloodstream surrounding the area
Diagnosing pancreatitis - ✔️✔️Elevated serum amylase and lispase (perferred, more
specific)
Elevated WBC
Abdominal CT best imaging
ERCP
ERCP (endoscopic Retrograde Cholangiopancreatography) - ✔️✔️Has replaced
surgery in most patients with common bule duct and pancreatic disease
endoscope placed through esophagus into duodenum to access bile and pancreatic
ducts
inject dye to visulaize anatomy with xray during procedure and indentify source of
blockage/inflammation
IV sedation with lidocaine spray in throat or general anesthesia (NPO until gag reflex
present)
Can remove gallstone, dilate the blocked duct, drain cyst, stent to keep duct open
Risks of ERCP - ✔️✔️pancreatitis, infection, perforation
Pancreatitis Clincial Management - ✔️✔️supportive care (no cure)
NPO initially; advance diet as tolerated
IV fluids for hydration
NGT if ileus and to decrease pancreatic stimulation
TPN or NG feedingings
Pain relief
Managment of complications (infection- antibiotics)
Pancreatitis Nursing Diagnoses - ✔️✔️Acute pain
fluid and electrolyte imbalance
impaired nutrition
risk of infection (peritonitis/sepsis)
risk for impaired tissue perfusion (shock)
risk for impaired gas exchange (ARDS/Pneumonia)
Goals for acute pancreatitis - ✔️✔️rest pancreas, control pain, monitor for
complciations, administer meds per orders, diet education
, Pancreatitis nursing care - ✔️✔️monitor VS, administer pain meds, NPO, mouth care,
fluid/electrolyte/nutrition, monitor for complciations, monitor labs, monitor blood glucose,
prep for ERCP if gallstone suspected, prep for surgery if requires drainage of abscess
or cyst, pain education
In pancreatitis the cornerstone of pain control are.... - ✔️✔️opioids!!!
even though they can cause spasming of sphincter of Oddi
Chronic Pancreatitis - ✔️✔️It is continuous prolonged inflammation that causes fibrosis
and destroys the pancreas
Causes of chronic pancreatitis - ✔️✔️Heavy ETOH use
Gallstones
Tumor
Pseudocysts
Trauma
Systemic diseases (lupus, cystic fibrosis)
Changes in the pancreas during chronic pancreatitis - ✔️✔️Loss of function of exocrine
and endocrine cells, damage to pancreas ducts, fibrosis of tissue with cysts and
calcification which leads to:
plugging of pancreatic ducts and toxic effets on pancreatic cells
Cystic Fibrosis in Chronic Pancreatitis - ✔️✔️Lack of CFTR protein affects movement
of chloride ions to help balance salt and water
this leads to thick mucus in pancreatic ducts clogging them, activates digestive
enzymes and cause chronic inflammation
Clincial manifestations of chronic pancreatitis - ✔️✔️abdominal pain
pancreatic insufficiency (malabsorption, weight loss, diabetes, steatorrhea)
elevated bile (jaundice, dark urine)
More difficult to diagnose than acute (serum amylase and lipase may or may not be
elevated)
steatorrhea in chronic pancreatitis - ✔️✔️oily and greasy diarrhea due to decreased
pancreatic enzymes and undigested fats
Chronic pancreatitis treatment - ✔️✔️Avoid ETOH
possible ERCP to relieve obstructions
Pancreatic enzyme replacement (enteric-coated)
pain releif
caution with narcotics
low fat diet
