Pancreatitis

Pancreas Anatomy
Divided into the head, body and tail
Endocrine functions
Islet of Langerhans
Exocrine functions
Acinar cells
Pancreatitis: Defined as
an autodigestion of the pancreas. This occurs due to a premature activation of pancreatic enzymes.
Can lead to inflammation, necrosis, and hemorrhage
Acute mortality is 10-20%
Chronic mortality is 50%
Acute Pancreatitis: Etiology
alcoholism
biliary tract disease
infection (viral)
trauma
drugs
postop GI surgery (ERCP)
Acute Pancreatitis: Manifestations
•Abrupt onset of continuous severe epigastric and LUQ pain (relieved by sitting up and leaning forward, radiates to back)
•N/V
•Abd distention and rigidity
•Decreased bowel sounds or absent
•Hypotension (fluid shift)
•Fever, cold clammy skin (shock)
•Jaundice
•Bruising in flanks or around umbilicus
Acute Pancreatitis: Complications
Hypovolemia (fluid shift, renal failure)
Chronic Pancreatitis
Hypocalcemia (?)
Pancreatic Infection (cyst)
Type I Diabetes
pulmonary effusion, atelectisis
Acute Pancreatitis: Ranson’s Criteria
•Ranson Score of 0-2, minimal mortality
•Ranson Score of 3-5, 10%-20% mortality
•Ranson Score of >5 has more than 50% mortality and is associated with more systemic complications (renal, acute respiratory distress)
Acute Pancreatitis: Diagnostics
•Serum Amylase and Lipase
•Ultrasound (tissue)
•ERCP (bile duct, in pancreas)
•CBC (WBC, H&H)
Edemitus Pancreatitis
mild inflamation, edema
Necrotizing Pancreatitis
cell death, tissue damage, systemic complications
Turner’s sign
bruising on flank
risk for hemorrhage and shock
Cullen’s Sign
bruising around the umbilicusrisk for hemorrhage and shock
Acute Pancreatitis: Goals
•Pain Relief (PCA)
•Prevention or alleviation of shock (ARF)
•Reduce pancreatic secretions (NPO)
•Control of fluid/electrolyte imbalances (Hydration)
•Prevention or tx of infections
Chronic Pancreatitis
•Defined as progressive destruction of the pancreas (calcifies and becomes necrotic) Alcohol causes 80%
•Mortality can be as high as 50%
Chronic Pancreatitis: Manifestations
•Abdominal pain
•Nausea/Vomiting
•Fever
•Bloating/Flatulence
•Steatorrhea (oily stools) enzymes in pancreas not breaking down fats
•Jaundice with dark urine (dehydration)
Chronic Pancreatitis: Etiology
•Obstruction (gall stones)
•Genetics
•Trauma (or ERCP)
•Toxic Metabolic Process (alcohol, immunosuppresives)
•Increased Triglycerides (toxic to acinar cells)
•Infectious Agents (bacterial, viral)
Chronic Pancreatitis: Chronic Complications
•Malabsorption, Malnutrition (TPN, Lipids)
•Pancreatic Pseudocyst (necrotic agent)
•Diabetes Mellitus
•Risk for Pancreatic Cancer
•Risk for Narcotic Addiction (PCA, assess pain, anxiety, coping)
Chronic Pancreatitis: Diagnostics
•Serum Amylase (2-3 times normal) (CHO)
•Serum Lipase (elevated 7-14 days)(lipids)
•Serum Glucose
•Serum Bilirubin and ALT (compressed bile duct)
•CBC, BUN, Cr (WBC, renal)
•Ultrasound, ERCP, Aspiration (Dx cancer, malignancy)
Chronic Pancreatitis: Collaborative Care
•Bland diet: low fat, high carbs, no alcohol
•Pancreatic Enzyme replacement (with meals)
•Control Diabetes
Chronic Pancreatitis: Nursing Interventions
•Rest (pancreas and bowel)
•Pain Relief
•Replace (fluid and electrolytes)
•Nutritional Support (slowly intro food back)
Chronic Pancreatitis: Nursing Diagnoses
•Acute Pain
•Imbalanced Nutrition: Less than body requirements
•Anxiety
•Ineffective Coping
•Risk for infection
•Noncompliance
Chronic Pancreatitis: Patient Teaching
•Related to Etiology
•Alcohol Abuse
•Diet (Low fat, high carb, no alcohol)
•Surgical Education
autodigestive effects of enzymes
Trypsin: edema, necrosis, hemorrhage
Elastase: hemorrhage
Phospholipase A: Fat necrosis
Lipase: fat necrosis
Kallkrein: edema, vascular permeability, smooth muscle contraction, shock
WBC
>16,000
Glucose
>200
LDH
>350
AST
>250
age
>55yrs
Reevaluate 24-48hrs
Hct drop 10% bleed
BUN increase >8 renal failure
Ca2+ <8 not absorbing
PCA
•Pain Relief
ARF, volume expanders (albumin), plasma
•Prevention or alleviation of shock
NPO with suction
•Reduce pancreatic secretions
Hydration
•Control of fluid/electrolyte imbalances
Chronic Pancreatitis: Interventions
•Antibiotics
•Imipenem (broad spec, don’t give with dextrose)
•Treatment of triglycerides
•Lipid Lowering drugs (statins)
•Surgery remove gall stones, cholecystectomy, drainage proceedures, resection
•Preparation
other: folic acid, coping,