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Pancreatitis

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.

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Pancreatitis

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  1. Pancreatitis Inflammation of the Pancreas

  2. 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.

  3. Acute PancreatitisEtiology and Pathophysiology Pancreatic Ducts become obstructed Hypersecretion of the exocrine enzymes of pancreas These enzymes enter the bile duct, where they are activated and with bile back up into the pancreatic duct Pancreatitis

  4. Acute PancreatitisEtiology 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

  5. Progression of Disease Autodigestion Acute Inflammation of Pancreas Necrosis of Pancreas Digestion of vascular walls Thrombus and Hemorrhage Death

  6. Precipitating Factors Trauma Use of alcohol * Biliary tract disease Viral or Bacterial disease Cholelithiasis * Peptic Ulcer Disease *most common causes

  7. Acute PancreatitisClinical Manifestations • Severe Abdominal painis 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

  8. Acute PancreatitisClinical 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

  9. Acute PancreatitisDiagnostic Studies • History and physical examination • Laboratory tests • Serum amylase- hallmark test • Serum lipase – also elevated • Blood glucose • Serum calcium • Triglycerides

  10. Acute PancreatitisDiagnostic Studies Flat plate of abdomen Abdominal/endoscopic ultrasound Endoscopic retrograde cholangiopancreatography (ERCP) Chest x-ray CT of pancreas Magnetic resonance cholangiopancreatography (MRCP)

  11. Acute Pancreatitis Can be a medical emergency associated with a risk for life-threatening complications

  12. What do they die of?

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

  14. 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

  15. Acute Pancreatitis Complications • Pancreatic abscess • A large fluid-containing cavity within pancreas • Results from extensive necrosis • Upper abdominal pain • Abdominal mass • High fever • Leukocytosis

  16. Acute PancreatitisComplications • Main systemic complications are? • Pulmonary • Cardiovascular • Electrolyte imbalance – Hypocalcemia

  17. Acute PancreatitisGoals of Care Relief of pain Prevention or alleviation of shock Decrease respiratory failure ↓of pancreatic secretions Maintain Fluid/electrolyte balance

  18. 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?

  19. Treatment 2. Prevention of Shock – hemodynamic stability * Administer Blood, Plasma expanders, Albumin * LR solution

  20. What is the cause of shock?

  21. 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

  22. Treatment and Nursing Care 6. Correction of electrolyte imbalance/ hypocalcemia 7. Maintain Hydration / Nutrition

  23. Treatment and Nursing Care • Surgical therapy – if related to gallstones • ERCP • Endoscopic sphincterotomy • Laparoscopic cholecystectomy

  24. Treatment - Home Care • Follow up care • Dietary teaching • High-carbohydrate, low-fat diet • Abstinence from alcohol, • Patient/family teaching * Signs of infection, high blood glucose, steatorrhea

  25. The End

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