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z_NUR411_Medsurge: UNIT 2 > Hepatic System: Pancreatitis > Flashcards

Hepatic System: Pancreatitis Flashcards

1
Q

What are the two most common GI disorders?

A

• Liver and pancreas disorders

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2
Q

What is pancreatitis?

A

• Inflammation of the pancreas

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3
Q

What is the patho of pancreatitis?

A

• Pancreatic digestive enzymes are activated prematurely (before reaching the duodenum), resulting in autodigestion and fibrosis of the pancreas

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4
Q

What are the risk factors for pancreatitis?

A
  • Alcohol abuse
  • Bile tract disease/gall stones
  • GI surgery
  • Trauma
  • Medication toxicity
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5
Q

What are the s/s of pancreatitis?

A
  • Tachypneic Dyspnea, basilar crackles
  • Tachycardia/Hypotension
  • Severe LUQ or epigastric pain, radiating to back or left shoulder
  • N/V – non-stop
  • Ascites
  • Jaundice
  • Tetany
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6
Q

What are the two integumentary assessment signs indicating pancreatitis?

A

• Cullen’s and Turner’s

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7
Q

Describe Cullen’s Sign.

A

• Blue/grey discoloration around the umbilicus

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8
Q

Describe Turner’s Sign.

A

• Ecchymosis on flanks

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9
Q

What labs indicate pancreatitis?

A
  • ↑ amylase, lipase, WBCs, bilirubin, glucose, PT
  • ↓ potassium, calcium, magnesium, Hgb/Hct, platelets
  • ABG = hypoxemia (metabolic acidosis)
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10
Q

What dx imaging is used for pancreatitis?

A
  • Ultrasound
  • CT/MRI
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11
Q

What is the immediate tx for suspected pancreatitis?

A
  • NPO, then slowly progress to bland/low fat diet
  • IV fluids/electrolytes (100mL NS)
  • Get type and xmatch (bleeding expected)
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12
Q

What is the medication tx for pancreatitis?

A
  • Opioid analgesics (morphine)
  • Antibiotics
  • Antiemetics
  • Insulin
  • Pancreatic enzymes w/ meals/snacks
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13
Q

What is complications is the nurse monitoring for with a pancreatitis pt?

A
  • Chronic pancreatitis
  • Pancreatic pseudocyst
  • Type 1 diabetes
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14
Q

What is the general teaching for a pancreatic pt?

A
  • No alcohol, get in a recovery program
  • No smoking
  • Low fat diet
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15
Q

What positions help relieve pancreatitis pain?

A
  • Freq position changes
  • Flex trunk and drawn knees to abdomen
  • Side lying w/ HOB @45°
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16
Q

What is the pneumonic for remembering the causes of pancreatitis?

A
  • 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
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17
Q

Who is more prone to gallstones, man or woman?

A

• Woman, due to estrogen, which increases biliary cholesterol secretion.

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18
Q

How does alcohol use cause pancreatitis?

A
  • ↑ pancreatic secretions
  • ↑ viscosity
  • ↑ fatty acid in acinar cells which causes necrosis and fibrosis (autodigestion)
19
Q

How would ERCP cause pancreatitis?

A

• Injury from catheter passage

20
Q

How is Trypsin made and what does it do?

A
  • 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
21
Q

If there is a reflux of trypsin back into the pancreas, what occurs?

A

• Trypsin starts to digest the pancreas, which leads to inflammation, pancreatic necrosis and bleeding

22
Q

What can cause trypsin to reflux into the pancreas?

A

• Pressure variants in the bile/pancreatic ducts caused by gallstones

23
Q

How does pancreatitis affect amylase secretion?

A
  • Rises early, within 2hrs of symptom onset
  • Decreases early, within 36hrs to normal level (<85 u/L)
24
Q

How does pancreatitis affect lipase secretion?

A
  • Rises 4-8hrs post s/s onset, peaking around 24hrs and staying elevated for 14 days
  • More indicative of acute pancreatitis
25
Q

What are the normal levels for amylase and lipase?

A
  • Amylase = <85 u/L
  • Lipase = 10-140 u/L
26
Q

What AST level indicates liver/pancreatic damage?

A

• > 350u/L

27
Q

Why does calcium drop with pancreatitis?

A

• Increased free fatty acid levels ↑ update of calcium out of blood into cell

28
Q

What are normal calcium levels?

A

• 8.5-10.5

29
Q

Low calcium can result in…

A

• Tetany (intermittent muscle spasms)

30
Q

Why is BUN elevated with pancreatitis?

A

• BUN rises with dehydration status (due to n/v)

31
Q

Why do glucose levels rise w/ pancreatitis?

A

• Because the pancreas can’t secrete insulin to stimulate cellular uptake

32
Q

How does pancreatitis cause fluid deficit > 6 L?

A
  • Initial phase of acute pancreatitis is characterized by inflammation.
  • This is caused by release of cytokines and other pro inflammatory mediators.
  • These further cause vasodilatation, intravascular volume depletion, and end organ hypoperfusion.
  • Patients of acute pancreatitis have significant fluid loss in third space.
  • which decreases blood volume and results in a large drop in blood pressure, possibly causing shock
33
Q

What do steroids do for pancreatitis?

A

• Reduces inflammation

34
Q

True or False
Its ok to crush PPIs to administer to patient

A

• False, they will not work if they are crushed

35
Q

How does Somatostatin or Octreotide reduce pain for pancreatitis?

A

• The suppress pancreatic secretion

36
Q

What are 5 complications of pancreatitis?

A
  • Pulmonary
  • Cardiovascular
  • Neurologic
  • Renal
  • Coagulation
37
Q

What pulmonary complication can pancreatitis cause? Give patho and consequence if unresolved.

A
  • Pleural effusion
  • Fluid leaking from pancreas increases fluid in the pleural space (pleural effusion)
  • If not remedied, the build up in pressure on the lungs will cause breathing and cardiac issues
38
Q

What cardiovascular complication can pancreatitis cause? Give patho

A
  • Shock
    • hypovolemia (fluid 3rd spacing) and vasodilation
  • Emboli
    • Inflammation process causes changes in clotting systemincreasing risk of thrombus formation
    • This can result in MI or stroke
39
Q

What renal complication can pancreatitis cause? Give patho

A

• Acute renal failure (ARF) due to hypovolemia

40
Q

How can pancreatitis result in DIC?

A
  • Trypsin is necessary for hemostasis by activating the prothrombin needed for clot formation and activating plasminogen involved in clot lysis
  • ↓ trypsin decreases both of these clotting factors and can lead to DIC
41
Q

What is calcium soap?

A
  • When the pancreas is damaged, free fatty acids are generated by pancreatic lipase.
  • The free fatty acids bind to the calcium insoluble calcium salts of the pancreas resulting in calcium deposition in the retroperitoneum
42
Q

What is a pancreatic pseudocyst?

A
  • A pancreatic pseudocyst is a fluid-filled sac that forms in the abdomen comprised of pancreatic enzymes, blood, and necrotic (dead) tissue.
  • Pancreatic pseudocysts account for approximately 75% of all pancreatic masses and typically are complications of chronic pancreatitis.
  • No pancreatitis pt leaves the hospital w/out a CT scan for pseudocysts
43
Q

What are the complications associated with a pancreatic pseudocyst?

A
  • Hemorrhage
  • Obstruction/rupture
  • Cardiac tamponade
44
Q

What is the main difference between acute and chronic pancreatitis?

A
  • Acute pancreatitis damage can generally be reversed
  • Chronic pancreatitis cannot due to the constant damage over tim

z_NUR411_Medsurge: UNIT 2 (25 decks)

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