pancreatic problems (W4)

Question 1

acute pancreatitis

Answer 1

ranges from mild edema to severe hemorrhagic necrosis

Question 2

RF for acute pancreatitis

Answer 2

middle age
african american

Question 3

etiology of acute pancreatitis

Answer 3

females- billary tract disease
males- ETOH abuse
others like meds

Question 4

patho of acute pancreatitis

Answer 4

1. pancreatic cells injured
2. enzymes activated
3. auto digestion
4. mild-severe pancreatitis

Question 5

enzymes

Answer 5

trypsin
elastase
phospholipase a
kalikrein
lipase

Question 6

trysin

Answer 6

edema necrosis hemorrhage

Question 7

elastase

Answer 7

hemorrhage

Question 8

phospholipase a

Answer 8

fat necrosis

Question 9

kalikrein

Answer 9

edema
vascular permeability (leads to ascites)
SM contraction
shock

Question 10

lipase

Answer 10

fat necrosis

Question 11

where is pain with acute panreatitis

Answer 11

LUQ
epigastric region

think about: time (acute onset), radiation (to back), tenderness

Question 12

other manifestations of acute pancreatitis

Answer 12

N/V
abdominal distention
hypo BS
fever
hypotensin
tachycardia
jaundice
amylase/lipase- damage
glucose- not working
WBC- inflammation
cyanosis/green yellow abdomen
echymoses

Question 13

types of echymoses

Answer 13

flank- grey turners sign
periumbilical- cullens sign

Question 14

acute pancreatitis complications

Answer 14

pseudocyst
abscess
pulmonary complications
hypotension
tetany from hypocalcemia
increased risk of clotting

Question 15

lipase

Answer 15

causes fat necrosis, generates FFA, binds to calcium, deposits in retroperitoneum, hypocalcemia

Question 16

what is a pseudocyst

Answer 16

seen on scan
fluid filled sac- filled with necrotic products and secretions
results in inflammation and scarring
palpable epigastric mass
may perforate- content spills- serious- peritonitis (rigid abdomen)

Question 17

complications of pancreatic abscess

Answer 17

large fluid filled canvity inside cavity
result of necrosis
may be infected or perforate
clinical presentation similar to pancreatitis plus abdominal mass, fever, increase WBC

Question 18

how to differentiate between cyst and abscess?

Answer 18

present with a palpable mass
do a scan to differentiate
abscess- drain!

Question 19

chronic pancreatitis

Answer 19

inflammation for weeks to months

Question 20

main etiology of chronic pancreatitis

Answer 20

ETOH abuse

Question 21

what happens during chronic pancreatitis

Answer 21

destruction/necrosis
fibrosis- scar tissue
loss of pancreatic enzyme
loss of insulin
may continue even after ETOH stops- the damage is done

Question 22

bouts of acute attacks

Answer 22

with progressive signs of dysfunction after attack subsides

Question 23

problem with chronic pancreatitis

Answer 23

pain

Question 24

other problems with chronic pancreatitis

Answer 24

DM
malabsorption of fat
weight loss

Question 25

drug therapy

Answer 25

morphine- pain
dicylomine- antipasmodic (ATC)
antiacids- decreased HCl secretions in stomach which decreases secretions of pancreatic enzymes
H2 replacement- decreased HCl secretions in stomach which decreases secretions of pancreatic enzymes
pancrelipase- replacement therapy for pancreatic enzymes for chronic only
insulin- treatment if DM occurs

Question 26

pancrelipase

Answer 26

when pancreas no longer is producing enough or any enzymes for digestion
pancreatic enzyme replcement
when? secreations are decreased of pancreatic enzymes
AE: none
edu: take with every meal

Question 27

pancreatitis meds

Answer 27

IVF- fluid replacement
fentanyl- pain
protonix- PPI
stool softener- don’t want them to strain with BM
lovenox- risk for blood clot

Question 28

major cause

Answer 28

alcohol abuse (M)
gallbladder disease (F)

Question 29

chronic pancreatitis can cause

Answer 29

DM

Question 30

finding of hypotension, rigid abdomen, absent bowel sounds in client with pancreatitis

Answer 30

indicates peritonitis with substantial risk for sepsis and shock