Pancreas Flashcards by Amanda S.

pancreas releases (pancakes are TAL)

alkaline juices that neutralize acidity in stomach. trypsin - protein, lipase - fat, amalyse - carbs.

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Exocrine

Exocrine: amylase, trypsin, lipase, secretin

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Endocrine

Endocrine: insulin, glucagon, somatostatin

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med if your pancreas doesn’t work (and give with what)

Pancrealipase (Creon). Need to take with food. Must give with COLD water.

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Pancrealipase - side effects

usually due to insulin.

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pancreas also releases (pancakes are bi)

Bicarbonate and water are secreted by the epithelial cells that line the pancreatic ducts-this neutralizes the acid form the stomach

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acute pancreatitis

Inflammation of pancreas…micro and macrovascular failure…resulting autodigestion…SIRS…

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3 stages of acute pancreatitis

Trypsin and other enzymes prematurely activate
Amylase and lipase

Intrapancreatic inflammation

Extrapancreatic/systemic injury

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result of pancreatitis

Results in pancreatic pain, tissue edema, necrosis of pancreatic tissue and possibly hemorrhage

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acute pancreatitis does not mean you’ll get

chronic pancreatitis

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can develop what types of shock with pancreatitis?

hypovolemic, sepsis, and hemoragic.

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Chronic pancreatitis (alchys get fibrous)

Chronic: progressive inflammatory disorder with destruction of the pancreas; cells are replaced by fibrous tissue; pressure within the pancreas increases, obstructing the pancreatic and common bile ducts

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acute pancreatitis (just a block)

pancreatic duct becomes obstructed, and enzymes back up, causing autodigestion and inflammation of the pancreas

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acute pancreatitis causes

gallstones (30%)

Alcohol (30%)
Gall bladder disease
Drugs
Hypercalcemia, hypertryglyceridemia
Infection
IBD
PUD
Trauma
Toxins

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chronic pancreatitis causes

alcohol

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pancreatitis - s/sx (painful pancake in my stomach and back) (these pancakes are rigid)

Pain- upper abdominal/back
Abdominal distension/ascites
Rigid abdomen, guarding
Cullen’s or Turner’s signs (bruising)
Fever
N/V
Jaundice
Hypotension
Confusion or agitation

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acute pancreatitis - labs

amylase - up (2 to 3 times normal) (releasing it bc everything is out of whack)
lipase - up (2 to 3 times normal)
glucose - up
calcium - down
wbc - up
bun - up
bilirubin - up
lDH up
albumin - down

acute pancreatitis - diagnostics (need an ultra cutie to see pancakes)

KUB (just an x-ray), CT (for fluids) , ultrasound (to see gallstones)

pancreatitis is just

autodigestion.

acute pancreatitis - skin AND the ones you need to pay attention to…(cullen and grey are a cute pancake)

Skin: Cullen’s (bruising on stomach) and Grey Turner’s signs (bruisng on stomach), jaundice, bruising, redness, irritation

acute pancreatitis - Electrolyte imbalances (can’t digest, so basically everything is low but sugar)

Electrolyte imbalances: hypocalcemia, hypokalemia, hypomagnesemia, hypo/hyperglycemia

complications of acute pancreatitis - local (a cute pancake can have an abcess)

Acute fluid collections
Pancreatic fistulae
Pancreatic pseudocyst (enclosed like a cyst)
Pancreatic abscess (mortality rate doubles, these ppl are really sick)
Pancreatic necrosis
Primary infections
d/t pancreatic necrosis

complications of acute pancreatitis - systemic

Hypoxemia
Pneumonia
Pleural effusion
Hyperglycemia
Hypocalcemia
ARDS
Hypovolemic shock
Hemorrhage
ATN
Pancreatic encephalopathy
Analgesia
DIC

main issues w/ acute pancreatitis

Fluid and electrolyte disturbances
Necrosis of the pancreas
Shock
Multiple organ dysfunction syndrome
DIC (becuase we’re not absorbing vitamin K)
plueral effusion because the acid eats through the lungs

pancreatitis - gum and losenges?

nope, will stimulate pancreatic enzymes

TPN - nursing considerations

Keep refrigerated; warm (let sit out a few minutes) prior to administration Central line needed Filter needed NOTHING else should go through this line Discontinue GRADUALLY to avoid hypoglycemia Daily weights May have to start insulin Can only be hung for 24 hours Ordered daily Change tubing & filter with each bag Needs to be on a pump Most frequent complication is INFECTION

goals for pancreatitis

Stabilize hemodynamics Control pain Minimize pancreatic stimulation correct underlying problem Prevent or treat complications

chronic pancreatitis

Progressive, usually d/t alcoholism (calcification of ducts) or chronic obstructive due to obstruction of the sphincter of Oddi that causes inflammation

chronic pancreatitis - symptoms (chronic pancake is vdd -er)

S & Sx Recurrent and severe pain (upper abdominal and back) with vomiting, diarrhea, diabetes

chronic pancreatitis - management & diet (Pancakes need protein)

NO ETOH, pain management, antiemetics, enzymes to aid in food digestion, insulin,* meds, diet (high protein, high calorie, low fat) after NPO and bowel rest Sphincterotomy Pancreaticjejunotomy

ppl w/ chronic pancreatitis usually have

underlying diabetes and they've had it for awhile

chronic pancreatitis - no opiates unless

they're NPO.

chronic pancreatitis - treatments (pancakes can have whipcream surgery)

TREATMENTS and INTERVENTIONS Surgical Sphincterotomy (ERS) Pancreaticjejunotomy (lateral or Puestow procedure) Islet cell transplantation Celiac nerve block Spinal cord simulation Whipple Medications Conservative: NSAID’s, acetaminophen Opioids: morphine, meperidine, tramadol Other Enzyme replacement therapy Inhibition of gastric secretions Octreotide Metabolic testing (glucose, insulin, C-peptide levels)

pancreatic cancer - types

Fifth most common cancer in both men and women Types: adenocarcinoma, cyctadenocarcinoma, acinar cell carcinoma

pancreatic cancer - risk factors (pancreas in golden years)

Risk factors: >60 years, smoking (2-3x risk), diabetes, male, African American, family history, chronic pancreatitis, high fat diet

pancreatic cancer - s/sx (pancake cancer is frothy)

S & S: pain in upper back/abdominal, A, N, V, weight loss, jaundice, indigestion, dark frothy urine, ascites

pancreatic cancer - treatment

Treatment: pain management, C/R/S (Whipple)

pancreatic cancer - diagnostics

Diagnosis: Elevated amylase, alk phos, bili, CEA (carcinogenic antigen), CT, biopsy, ERCP, paracentesis

whipple procedure - for pancreatic cancer

take out 1/2 of stomach (distal part), the jejunum, 1st and 2nd portions of the duodenum, the head of the pancreas and the common bile duct; gall bladder and cystic duct-cholecystectomy. Then attach the hepatic duct and the pancreas to the jejunum.

post op whipple

ng tube - low to continous, irrigation tube (up to 4 total), 1 -2 JP drains, j-junostomy tube.