Acute Pancreatitis Parts 1 & 2 Flashcards Preview

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Flashcards in Acute Pancreatitis Parts 1 & 2 Deck (32)
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1

Acute Pancreatitis

Acute inflammatory process of pancreas
Varies from mild edema to severe necrosis
Most common in middle-aged persons and African Americans

2

Etiology

Gallbladder disease (women)
Chronic alcohol intake (men)
Smoking
Hypertriglyceridemia

3

Microlithiasis

Biliary sludge
Mixture of cholesterol crystals and calcium salts
Found in 20%-40% of pts
Formation is seen in patients with bile stasis

4

Less common causes

Drugs
Metabolic disorders
Vascular diseases
Surgery and endoscopic procedures
Idiopathic causes
Trauma (postsurgical, abdominal)
Viral infections
Penetrating duodenal ulcer
Cysts
Abscesses
Cystic fibrosis
Kaposi sarcoma

5

Pathophysiology

Autodigestion of pancreas
Lipolysis (hypocalcemia)
Proteolysis (gangrene)
Necrosis of blood vessels
Inflammation

6

Lipolysis

Breakdown of fats and other lipids by hydrolysis to release fatty acids

7

Proteolysis

Breakdown of proteins or peptides into amino acids by by the action of the enzyme

8

Predominant abdominal pain

Clinical manifestations
LUQ or midepigastrium
Radiates to back
Sudden onset
Deep, piercing, continuous or steady
Aggravated by eating
Starts when recumbent
Not relieved w/ vomiting

9

Clinical Manifestations

Flushing
Cyanosis
Dyspnea
Nausea/Vomiting
Low-grade fever
Leukocytosis
Hypotension, Tachycardia
Jaundice
Abdominal tenderness w/ guarding
Decreased/absent bowel sounds
Crackles
Abdominal skin discoloration (Grey Turner's or Cullen's sign)
Shock

10

Grey Turner's Sign

Back or flank discoloration (bluish)

11

Cullen's Sign

Periumbilical discoloration (bluish)

12

Pseudocyst

*Complicaiton
Fluid, enzyme, debris, exudates surrounded by wall
Abdominal pain, palpable mass, N/V, anorexia
Detected w/ imaging
Resolves spontaneously or may perforate and cause peritonitis
Surgical or endoscopic drainage

13

Peritonitis

Inflammation of the peritoneum

14

Pancreatic Abscess

*Complication
Collection of pus
Results from extensive necrosis
May perforate
Upper abdominal pain, mass, high fever, leukocytosis
Surgical drainage

15

Systemic Complications

Pleural effusion
Atelectasis
Pneumonia
ARDS
Hypotension
Hypocalcemia: tetany

16

Lab Tests

Serum amylase level
Serum lipase level
Liver enzyme levels
Triglyceride levels
Glucose level
Bilirubin level
Serum calcium level

17

Diagnostic Studies

Abdominal ultrasonography
X-ray
Contrast-enhanced CT scan
ERCP
ADDITIONAL STUDIES:
Endoscopic Ultrasonography
MRCP
Angiography

18

Objectives of Collaborative Care

Relief of pain
Prevention of shock
Decrease pancreatic secretions
Correction of fluid/electrolyte imbalance
Prevention/treatment of infection
Removal of precipitating cause

19

Supportive Care (Collaborative Care)

Aggressive hydration
Pain management
Management of metabolic complications
Minimizing pancreatic stimulation

20

Conservative Therapy
(Collaborative Care)

Shock
Fluid/Electrolyte imbalance
Prevention infection

21

Surgical Therapy

For gallstones
-ERCP
-Cholecystectomy
Uncertain diagnosis
Not responding to conservative therapy
Drainage of necrotic fluid collections

22

Drug Therapy

IV Morphine
Antispasmodics
Carbonic anhydrase inhibitors
Antacids
Proton pump inhibitors

23

Nutritional Therapy

NPO status initially
Enteral vs parenteral nutrition
Monitor triglycerides if IV lipids given
Small, frequent feedings when able (high-carbs)
No alcohol
Supplemental fat-soluble vitamins

24

Objective Data

Low-grade fever, anxiety, restlessness
Flushing, diaphoresis
Discoloration of abdomen/flank
Cyanosis
Jaundice
Decreased skin turgor
Dry mucous membranes
Tachypnea
Basilar crackles
Tachycardia
Hypotension
Abdominal distention/tenderness
Diminished bowel sounds

25

Abnormal lab findings

Increase serum amylase/lipase levels
Leukocytosis
Hyperglycemia
Hypocalcemia
Abnormal findings on ultrasonography/CT scans
Abnormal findings on ERCP

26

Planning

Relief of pain
Normal fluid/electrolyte balance
Minimal to no complications
No recurrent attacks

27

Health Promotion

Assessment and early treatment of predisposing/etiologic factors
Early diagnosis/treatment of biliary tract disease
Elimination of alcohol intake

28

Acute Interventions

Monitoring VS
Assess respiratory function
Monitor IV fluids
Pain assessment/management
Frequent oral/nasal care
Proper administration of antacids
Observe for signs of infection
TCDB, semi-Fowler's position
Wound care
Observe for paralytic ileus, renal failure, mental changes
Monitor serum glucose
Post-op wound care

29

Monitor fluid and electrolyte balance

Chloride, sodium, potassium
Hypocalcemia
-Tetany
-Calcium gluconate to treat
Hypomagnesemia

30

Chvostek's Sign

Contraction of facial muscles in response to light tap over facial nerve in front of ear