Disorders of the Pancreas Flashcards
(37 cards)
Functions of the pancreas: Endocrine
secretes products directly into the bloodstream. Insulin from the beta cells. Glucagon in the alpha cells. Somatostatin inhibits pancreatic hormones
Functions of the pancreas: Exocrine
releases enzymes into the ducts in the target tissues. Amylase, tripsin and lipase (digestive enzymes)
Two types of pancreatitis
Acute
Chronic
Acute is caused by: (2)
Most common cause:
Gallstones and Alcohol
Gallstones are the most common cause
Acute Pancreatitis
An acute inflammation of the pancreas which varies from mild edema to severe hemorrhagic necrosis
Pathophysiology of acute pancreatitis:
auto digestion of the pancreas. Injury to pancreatic cells or activation of the pancreatic enzymes is caused in the pancreas rather than in the intestine. may be due to reflux of bile acids into the pancreatic ducts through an open or distended sphincter of Oddi. Tripsinogen is an inactive enzyme produced by the pancreas it
With pancreatitis the patient can be acutely ill at risk for:
1 - sepsis
2 - hypovolemic shock (pancreatic fluid and blood leak into abdominal cavity)
3 - fluid and electrolyte disturbances
Clinical Manifestations of Pancreatitis (9)
- Severe abdominal pain (predominant symptom)
- nausea and vomiting
- Low grade fever
- Leukocytosis (high WBCs)
- Abdomen can be rigid or board-like
- Ecchymosis (bruising) in the flank (grey turner’s sign) or around the umbilicus (cullens sign) in severe cases
- bowel sounds may be decreased
- crackles to lungs (causes inflammation throughout whole body)
- stools are often bulky, pale, and foul smelling (fat content is 50-90% - normal is 20%)
Characteristics of pain in pancreatitis
sudden onset and severe, aggravated by eating, worse when laying down, 24-48 hours after eating a heavy meal or drinking, pain is not relieved by vomiting.
Complications: severe pancreatitis
- complete enzymatic autodigestion of the gland
- tissue becomes necrotic
- damage extends into retroperitoneal tissues
Complications: Local complications
- pseudocyst develops. an accumulation of fluid, pancreatic enzymes and tissues debris next to the pancreas.
- pancreatic abscess. a large collection of fluid in the pancreas from pancreatic necrosis.
- must be drained promptly or can cause sepsis
Manifestations of the pseudocyst
abdominal pain, palpable epigastric mass, anorexia, N&V, high serum amylase, most will resolve on their own
Systemic Complications: Pulmonary
- pleural effusion, atelectasis, and pneumonia
- pulmonary complications are caused by: passage of exudate that contains pancreatic enzymes from the peritoneal cavity. Can travel through diaphragmatic lymph channels which causes the diaphragm to be inflamed which leads to restricted movement of the diaphragm and atelectasis
Systemic Complications: Cardiovascular
hypotension because activated trypsin is present i the pancreas and can digest the pancreas and produce bleeding.
Systemic Complications: Hypocalcimia
Tetany caused by hypocalcimia. Tetany is involuntary muscle contractions and overly stimulated peripheral nerves
hypocalcimia is a sign of severe disease, caused in part by the combining of calcium and fatty acids during fat necrosis.
Complications: Trypsin
A pancreatic enzyme that can activate prothrombin and plasminogen - increasing the risk of pulmonary embolism
Diagnostic Tests (6) - lab values
Elevated serum amylase early and remains elevated for 24 hours
Serum lipase is also elevated and helps differentiate pancreatitis from other disorders (more diagnostic of pancreatitis)
WBC - increased
Calcium - decreased
Liver enzymes increased, glucose increased, bilirubin increased
Hct and hemoglobin - check for bleeding
Diagnostic Imaging
- Abdominal ultrasound
- Abdominal CT with contrast (used to detect complications)
- MRCP - magnetic resonance image
Goals of Collaborative Care for Patient with Acute Pancreatitis - (9)
- Pain relief
- Other meds (PPI, antispasmotics, IV narcotics (Demerol)
- prevention/alleviation of shock (monitor for shock, might need plasma volume expanders)
- Reduction of pancreatic secretions - NPO
- control of fluid and eletrolyte imblanaces - ensure they have adequate fluid
- prevention/treatment of infection - WBCs
- Assess respiratory functioning - ABCs, resp rate, breath sounds, supplemental O2
- Assess for hypocalcemia - tetany, labs
- Removal of the precepitating cause (if possible)
Nutrition (3)
- initially NPO
- when food is allowed, the diet is usually high in carbs because they are the least stimulating
- Abstain from alcohol
Prevention and promotion
- Avoid high fat foods, heavy meals, and alcohol
- Referral to home care if going home
- Referral to alcoholic support groups
Chronic Pancreatitis
An inflammatory disorder characterized by progressive anatomic and functional destruction of the pancreas
Pancreatic cells are replaced by fibrous tissue with repeated attacks of pancreatitis
Two types of Chronic Pancreatitis
Obstructive
Nonobstructive
Obstructive Chronic Pancreatitis
Mechanical obstruction of pancreatic, common bile duct and the duodenum d/t biliary disease
