Hepatic System: Pancreatitis Flashcards
(44 cards)
What are the two most common GI disorders?
• Liver and pancreas disorders
What is pancreatitis?
• Inflammation of the pancreas
What is the patho of pancreatitis?
• Pancreatic digestive enzymes are activated prematurely (before reaching the duodenum), resulting in autodigestion and fibrosis of the pancreas
What are the risk factors for pancreatitis?
- Alcohol abuse
- Bile tract disease/gall stones
- GI surgery
- Trauma
- Medication toxicity
What are the s/s of pancreatitis?
- Tachypneic Dyspnea, basilar crackles
- Tachycardia/Hypotension
- Severe LUQ or epigastric pain, radiating to back or left shoulder
- N/V – non-stop
- Ascites
- Jaundice
- Tetany
What are the two integumentary assessment signs indicating pancreatitis?
• Cullen’s and Turner’s
Describe Cullen’s Sign.
• Blue/grey discoloration around the umbilicus
Describe Turner’s Sign.
• Ecchymosis on flanks
What labs indicate pancreatitis?
- ↑ amylase, lipase, WBCs, bilirubin, glucose, PT
- ↓ potassium, calcium, magnesium, Hgb/Hct, platelets
- ABG = hypoxemia (metabolic acidosis)
What dx imaging is used for pancreatitis?
- Ultrasound
- CT/MRI
What is the immediate tx for suspected pancreatitis?
- NPO, then slowly progress to bland/low fat diet
- IV fluids/electrolytes (100mL NS)
- Get type and xmatch (bleeding expected)
What is the medication tx for pancreatitis?
- Opioid analgesics (morphine)
- Antibiotics
- Antiemetics
- Insulin
- Pancreatic enzymes w/ meals/snacks
What is complications is the nurse monitoring for with a pancreatitis pt?
- Chronic pancreatitis
- Pancreatic pseudocyst
- Type 1 diabetes
What is the general teaching for a pancreatic pt?
- No alcohol, get in a recovery program
- No smoking
- Low fat diet
What positions help relieve pancreatitis pain?
- Freq position changes
- Flex trunk and drawn knees to abdomen
- Side lying w/ HOB @45°
What is the pneumonic for remembering the causes of pancreatitis?
- I GET SMASHED
- I: Idiopathic
- G: Gallstones/genetic **she said she really only cares about this one**
- E: ETOH
- T: Trama, tumors
- S: Steroids (long term use)
- M: Microbiological (viruses
- A: Autoimmune (H. pylori)
- S: Shape of bacteria, surgery, scorpion sting
- H: Hyperlipidemia, hyperthyroidism, hypercalcemia
- E: Emboli or ischemia, ERCP
- D: Drugs/toxins
Who is more prone to gallstones, man or woman?
• Woman, due to estrogen, which increases biliary cholesterol secretion.
How does alcohol use cause pancreatitis?
- ↑ pancreatic secretions
- ↑ viscosity
- ↑ fatty acid in acinar cells which causes necrosis and fibrosis (autodigestion)
How would ERCP cause pancreatitis?
• Injury from catheter passage
How is Trypsin made and what does it do?
- Pancreatic acinar cells secrete trypsinogen which travels down the pancreatic duct into the duodenum.
- It is converted in the duodenum to trypsin
- Trypsin is an essential digestive enzyme
If there is a reflux of trypsin back into the pancreas, what occurs?
• Trypsin starts to digest the pancreas, which leads to inflammation, pancreatic necrosis and bleeding
What can cause trypsin to reflux into the pancreas?
• Pressure variants in the bile/pancreatic ducts caused by gallstones
How does pancreatitis affect amylase secretion?
- Rises early, within 2hrs of symptom onset
- Decreases early, within 36hrs to normal level (<85 u/L)
How does pancreatitis affect lipase secretion?
- Rises 4-8hrs post s/s onset, peaking around 24hrs and staying elevated for 14 days
- More indicative of acute pancreatitis
