Pancreas

Question 1

Acute Pancreatitis S/S

Answer 1

• abdominal pain (LUQ or mid-epigastric; radiates to the back; aggravated by eating)
• n/v
• flushing
• cyanosis
• low-grade fever
• leukocytosis
• shock s/s (hypotension/tachycardia)
• jaundice
• crackles in lungs
• bowel sounds may be decreased or absent
• paralytic ileus may occur
• possibly Grey Turner sign or Cullen sign

Question 2

Local Complications of Acute Pancreatitis

Answer 2

• pseudocyst
• abscess

Question 3

Pseudocyst

Answer 3

• fluid, enzyme debris, and exudates surrounded by wall
• abdominal pain, palpable mass, n/v, anorexia
• detected with imaging
• resolves spontaneously or may perforate and cause peritonitis
• surgical or endoscopic drainage

Question 4

Abscess

Answer 4

• infected pseudocyst
• may rupture or perforate
• upper abdominal pain, mass, high fever, leukocytosis
• requires prompt surgical drainage

Question 5

Systemic Complications of Acute Pancreatitis

Answer 5

• pleural effusion
• atelectasis
• PNA
• ARDS
• hypotension
• thrombi, pulmonary embolism, DIC
• hypocalcemia: tetany

Question 6

Acute Pancreatitis Dx Studies: Lab Tests

Answer 6

• serum AMYLASE level: elevated early; remains elevated 24-72 hours
• serum LIPASE level: remains elevated longer; more specific
• liver enzyme levels
• triglyceride levels
• glucose level
• bilirubin level
• serum calcium level

Question 7

Acute Pancreatitis Dx Studies: Imaging

Answer 7

• US
• X-ray
• CT scan
• ERCP

Question 8

Acute Pancreatitis: Conservative Therapy (non-pharm)

Answer 8

• aggressive hydration
• pain management
• management of metabolic complications
• O2, glucose levels
• minimizing pancreatic stimulation

Question 9

Acute Pancreatitis: Shock Management

Answer 9

• plasma or plasma volume expanders (dextran or albumin)
• fluid/electrolyte imbalance
• LR solution

Question 10

Acute Pancreatitis: Ongoing Hypotension Management

Answer 10

• Vasoactive drugs: dopamine

Question 11

Acute Pancreatitis: Med for Infection

Answer 11

ABX

Question 12

Acute Pancreatitis: Nutritional Therapy

Answer 12

• NPO initially
• enteral vs. parenteral nutrition
• monitor triglycerides if IV lipids given
• small, frequent feedings when able
• high carbohydrate diet
• no alcohol
• supplemental fat-soluble vitamins (A, ,D, E, K)

Question 13

Nursing Dx for Acute Pancreatitis

Answer 13

• Acute pain
• Deficient fluid volume
• Imbalanced nutrition

Question 14

Acute Pancreatitis: Drug Therapy

Answer 14

• IV morphine
• Antispasmodics
• Carbonic anhydrase inhibitors
• Antacids
• PPIs

Question 15

Acute Pancreatitis: Acute Care Nursing Interventions (Assessment)

Answer 15

• monitor VS (BP, HR, Temp.)
• monitor response to IV fluids
• closely monitor fluid and electrolyte balance
• assess respiratory function
• monitor for tetany
• pain assessment/management
• oral/nasal care
• Positioning! –> lying flat can exacerbate pain

Question 16

Acute Pancreatitis: Ranson’s Criteria vs. BISAP Score

Answer 16

• They look at mortality for patients with pancreatitis
• Ranson’s is for alcohol related
• BISAP is for biliary related

Question 17

Chronic Pancreatitis S/S

Answer 17

• abdominal pain (same location as acute; heavy, gnawing feeling; burning and cramp-like)
• malabsorption w/ weight loss
• constipation
• mild jaundice w/ dark urine
• steatorrhea (oily, fatty stool)
• DM

Question 18

Chronic Pancreatitis: Complications

Answer 18

• pseudocyst formation
• bile duct or duodenal obstruction
• pancreatic ascites
• pleural effusion
• splenic vein thrombosis
• pseudoaneurysm
• pancreatic cancer

Question 19

Chronic Pancreatitis: Dx Lab Studies

Answer 19

• serum amylase/lipase levels
• May be ↑ slightly or not at all
• ↑ Serum bilirubin level
• ↑ Alkaline phosphatase level
• Mild leukocytosis
• ↑ Sedimentation rate

Question 20

Chronic Pancreatitis: Dx Imaging and labs

Answer 20

• ERCP
• CT, MRI, MRCP, and/or endoscopic US
• Decreased fat-soluble vitamins (A, D, E, K) and cobalamin levels
• glucose intolerance/diabetes
• secretin stimulation test

Question 21

Chronic Pancreatitis: Medical Management

Answer 21

• analgesics for pain relief (morphine or fentanyl patch)
• Diet: bland, low-fat; small, frequent meals
• no smoking, alcohol, or caffeine
• pancreatic enzyme replacement (Pancrealipase) aids with digestion –> taken with every meal
• Bile salts to help absorb fat soluble vitamins
• insulin or oral hypoglycemic agents
• acid-neutralizing and acid-inhibiting drugs
• antidepressants

Question 22

Chronic Pancreatitis: Patient Teaching

Answer 22

• dietary control
• pancreatic enzyme with meals/snack
• observe for steatorrhea
• monitor glucose levels
• antacids after meals and at bedtime
• no alcohol

Question 23

Pancreatic Cancer: Risk Factors

Answer 23

• smoking/ETOH
• age
• family hx
• high fat diet
• diabetes
• chronic pancreatitis
• exposure to chemicals
• african american

Question 24

Pancreatic Cancer: S/S

Answer 24

• abdominal pain
• anorexia
• rapid/progressive weight loss
• nausea
• jaundice

Question 25

Pancreatic Cancer: Dx Studies

Answer 25

- US - CT scan (for metastasis/vascular involvement) - ERCP - MRI/MRCP

Question 26

Pancreatic Cancer: Management

Answer 26

- surgery, if possible - Whipple for tumors in the head of pancreas - distal pancreatectomy in the body - chemo - radiation for pain relief - palliative measures

Question 27

Pancreatic Cancer: Nursing Management

Answer 27

- like that of pancreatitis - adequate nutrition/pain relief - coping with diagnosis and prognosis