Biliary disorders part 2 : Pancreas

Question 1

what is the function of the panceas?

Answer 1

digesting food and managing your use of sugar for energy after digestion.

Question 2

Pancreatitis

Answer 2

(inflammation of the pancreas) is a serious disorder

Question 3

pancreatitis is commonly described as

Answer 3

autodigestion of the pancreas

Question 4

forms of pancreatitis divides the disorder into categories based on duration

Answer 4

acute and chronic forms

Question 5

Acute pancreatitis is considered

Answer 5

a medical emergency associated with a high risk of life-threatening complications and mortality,

Question 6

The pancreatic acinar cells are

Answer 6

functional unit of the exocrine pancreas.

they secrete inactive digestive enzymes

Question 7

when do the inactive digestive enzymes become active?

Answer 7

once they reach the duodenum and get in contact with stomach acids

Question 8

If enzymes are not active, what happens to food in stomach?

Answer 8

food will not be digested!!!

Question 9

what is the function of Epithelial cells in the pancreas?

Answer 9

they secrete secretin which is used to digest bicarb (bicarb is used to neutralize stomach acid and pH levels)

Question 10

how many cases of Acute pancreatitis each year?

Answer 10

200k cases

Question 11

what percentage of Acute Pancreatitis is caused by cholelithiasis or sustained alcohol abuse.

Answer 11

80%

Question 12

two main types of acute pancreatitis (mild and severe) are classified as

Answer 12

interstitial edematous pancreatitis and necrotizing pancreatitis

Question 13

Interstitial pancreatitis affects the majority of patients and It is characterized by

Answer 13

a lack of necrosis.
diffuse enlargement of the gland due to inflammatory edema.
The inflammation is confined to the pancreas itself.

Question 14

what percentage of acinar cell function is lost at the diagnosis of acute pancreatitis?

Answer 14

90%

Question 15

patients with Interstitial pancreatitis are at risk for?

Answer 15

Hypovolemic shock
Sepsis
Fluid and electrolyte imbalance

Question 16

patients with Interstitial edematous pancreatitis are expected to return to normal function within?

Answer 16

6 months

Question 17

Necrotizing Pancreatitis is characterized by

Answer 17

tissue necrosis
damage to blood vessels
bleeding and thrombosis
extends beyond the pancreas

Question 18

patients with Necrotizing Pancreatitis are at risk for?

Answer 18

Organ failure
GI bleed
Shock
Fluid collection

Question 19

what are risk factors for developing pancreatitis?

Answer 19

1. blunt abdominal trauma
2. alcohol abuse
3. oral contraceptives
4. tabacco
5. use of diuretics
6. corticosteroids
7. hyperlipidemia
8. hypercalcemia

Question 20

clinical manifestation of pancreatitis

Answer 20

1. severe abdominal pain
2. cullen’s sign
3. Gary-turner’s sign
4. hypotension related to hypovolemia
5. tachycardia, cyanosis, cold clammy skin
6. respiratory distress & hypoxia

Question 21

what type of pain associate with pancreatitis?

Answer 21

severe abdominal pain,
mostly post meals (24-48 hours),
not relieved by antacids.

Question 22

abdominal rigidity is an indication of?

Answer 22

peritonitis

Question 23

gary-turners sign is?

Answer 23

bruising on the sides of the patient when you TURN them. Indicating internal bleeding.

Question 24

cullens sign is

Answer 24

C shaped bruising around the umbilicus

Question 25

clammy skin means

Answer 25

wet skin due to sweating

Question 26

The diagnosis of acute pancreatitis is based on the fulfillment of two out of the three following criteria:

Answer 26

1. a history of upper abdominal pain, 2. 3x increase in serum amylase or lipase levels 3. findings on imaging (CT, MRI)

Question 27

abscesses are seen via which imaging methods?

Answer 27

CT and MRI. Not X-rays

Question 28

what other diagnostic lab work is used to assess pancreatitis?

Answer 28

1. Hgb and Hct levels (decreased for bleeding) 2. elevated WBC 3. Hypocalcemia 4. increased levels of pancreatic enzymes

Question 29

What additional procedure might be used to visualize and treat?

Answer 29

ERCP

Question 30

there are three degrees of pancreatitis severity:

Answer 30

1. mild 2. moderately severe 3. severe acute

Question 31

(1) mild pancreatitis

Answer 31

the absence of organ failure and no local or systemic complications

Question 32

(2) moderately severe pancreatitis

Answer 32

the presence of short-term organ failure or local or systemic complications,

Question 33

(3) severe acute pancreatitis

Answer 33

characterized by persistent organ failure

Question 34

Medical management of acute pancreatitis starts with

Answer 34

1. NPO to inhibit pancreas stimulation 2. (NG) tube is used for nutrition 3. pain relief using parenteral opioids such as morphine, fentanyl 4. respiratory care 5. Biliary drainage

Question 35

respiratory care for Medical management of acute pancreatitis includes:

Answer 35

1. monitoring arterial blood gases (ABG) 2. using humidified oxygen 3. intubation & mechanical ventilation

Question 36

biliary drainage for Medical management of acute pancreatitis includes:

Answer 36

1. Placement of biliary drains (for external drainage) 2. stents (indwelling tubes) in the pancreatic duct to reestablish drainage of the pancreas. This has resulted in decreased pain.

Question 37

Surgery for pancreatitis is performed to

Answer 37

to establish pancreatic drainage; | or to resect or débride an infected, necrotic pancreas

Question 38

what type of feeding given, and medication restriction must be followed post acute pancreatitis management includes:

Answer 38

1. Oral feedings that are low in fat and protein are initiated gradually. 2. Caffeine and alcohol are eliminated from the diet. 3. discontinuing risk factor medications (corticosteroids, oral contraceptives) 4. follow-up x-ray and ERCP

Question 39

nursing bedside interventions for a hospitalized acute pancreatitis

Answer 39

1. semi-fowler position (decrease pressure on diaphragm) 2. frequent repositioning (prevent respiratory secretion pooling) 3. monitor Pulse Ox (ABG) 4. assess pain 5. monitor Blood Glucose q4-6h 6. assess drainage sites (infection) 7. assess skin (hydration/turgor, jaundice)

Question 40

a major cause of morbidity and mortality in patients with acute pancreatitis is

Answer 40

Pancreatic necrosis

Question 41

Pancreatic necrosis requires

Answer 41

surgical, percutaneous or endoscopic débridement