Pancreas Flashcards
Pancreas
acinar cells
secrete inactive digestive enzymes into pancreatic duct
- Also produces bicarb & fluid to help neutralize secretions
islets of Langerhans
secretes hormones into blood
Pancreas
- functions as both an endocrine and exocrine gland
- Exocrine function- to produce enzymes to help with digestion -by acinar cells: *INACTIVE digestive enzymes get secreted into the pancreatic duct
(amylase, trypsin, lipase) - Endocrine function- to send out hormones to regulate blood glucose - by islets of Langerhans: Release hormones into the blood stream
— (insulin, glucagon)
Age considerations:
- Little change in size of the pancreas with age.
- However, there is an increase in fibrous material and some fatty deposition on the normal pancreas in people older than 70.
- Decreased rate of pancreatic enzyme secretion (Can lead to):
— Problems with digestion
— Malabsorption
— Blood sugar regulation problems - Increased risk of gallstones (a main cause of acute pancreatitis)
Acute Pancreatitis
- Sudden Inflammation of the pancreas (associated with a high risk of life-threatening complications & mortality)
- When inflammation occurs inside the pancreas , cells that secrete hormones & enzymes get very irritated.
- Cells start malfunctioning causing enzymes to active inside the pancreas
- Pancreatic duct becomes obstructed, and enzymes back up, causing autodigestion and inflammation of the pancreas
— Self digestion of the pancreas by its own enzymes (mainly trypsin) causes acute pancreatitis
Acute pancreatitis Incidence
- Older adults and post-op pancreatitis pts have high rate of incidence
- Pancreatic “attacks” are common during holidays & vacations
— When *large amounts of alcohol are consumed, especially in men
— Women are affected most often after cholelithiasis and biliary tract problems. They are also most at risk with-in several months after childbirth. - CHOLELITHIASIS & HIGH AMOUNT OF ALCOHOL
- Prognosis- *typically reversible if treated quickly and properly
— Poor prognosis if alcoholism is present
Acute Pancreatitis Causes:
Main Causes:
- Gallstones
- ETOH
-
Caused by premature activation of excessive pancreatic enzymes
- These enzymes destroy ductal tissue and pancreatic cells
— results in autodigestion and fibrosis of the pancreas
— Inflammation will cause enzymes to start working inside pancreas
— Pancreas swells and leaks digestive enzymes into surrounding tissues & organs (extreme pain) causing:
— - abnormal blood glucose levels
— - Abdominal swelling (ascites)
— - Malabsorption from digestive enzymes not digesting fats (oily stools/diarrhea)
— - Extreme GI pain
— - - NO morphine (causes spasms)
— - Free digestive enzymes can flow to surrounding tissues & organs causing damage to lungs (pul edema-ARDS) & vessels (bleeding, hemorrhage)
Pancreatitis can range from:
- Mild pancreatitis (edema & inflammation confined to pancreas)
- Severe necrotizing hemorrhagic pancreatitis (NHP)
— Diffuse bleeding of pancreatic tissue with fibrosis and tissue death.
Process of autodigestion in acute pancreatitis.
Acute pancreatitis s/s
- Acute pain (DX) in mid-epigastric or upper left abdomen
— agonizing, burning, continuous, refractory, excruciating
— Radiates towards the back, left flank or left shoulder
— feels like a “ boring” sensation pain going through the body
— Aggravating factor: supine position
— Relieving factor: sitting up and leaning forward - Ineffective breathing pattern (DX)
- Imbalanced nutrition (DX)
- Impaired skin integrity (DX)
- Pt may report wt loss from N/V
- Generalized jaundice
- *Grey Turner’s Sign : (bruising on flanks)
— Grey/blue discoloration of abd or flanks from pancreatic enzyme leakage into tissue from peritoneal cavity. - Cullen’s Sign: w/ severe pancreatitis (blueish around the umbilicus)
- Absent or decreased bowel sounds indicative of paralytic ileus.
- Abd tenderness, rigidity, guarding, and ascites present
Complications of Acute Pancreatitis- can be medical emergency associated with high risk life-threatening conditions
- Intermittent hyperglycemia
- Pancreatic infection (causes septic shock)
- Hypovolemia, Hypovolemic or septic shock
- Acute kidney failure
- Hemorrhage (necrotizing hemorrhagic pancreatitis)
— Diffusely bleeding pancreatic tissue with scarring and tissue death - Disseminated intravascular coagulation (DIC)
- Atelectasis, pneumonia
- Acute Resp distress syndrome (ARDs)
*Nsg Care of acute pancreatitis
- NPO (for 24-48hrs if severe pancreatitis) & rest
- IV isotonic solution, IV replacement of calcium
- NGT to suction for continuous vomiting –prevents gastric juices from flowing into duodenum
- Paralytic ileus is common
— Assess if pt passed flatus or had a stool - Daily wts
- Avoid caffeine containing foods and alcohol
— (tea, coffee cola, chocolate) - no caffiene - Allow pancreas to rest and control pain! This is very painful
- DIET
— Keep pt NPO initially
— Don’t want any stimulation that produces enzymes
— NPO initially then slowly introduce liquids
— Avoid alcohol or greasy fatty foods
— Low fat, bland, small meals
— Limit sugars
— Consume more complex carbs (veggies) which use less insulin
*Acute pancreatitis Meds
- Opioids
- Antiemetics
- diuretics
- H2 blockers & PPI
- antibiotics
- insulin
Nursing Safety Priority! ~Acute pancreatitis
- Monitor for significant changes in vital signs that may indicate life- threatening complications of shock.
- Hypotension and tachycardia may result from:
— pancreatic hemorrhage
— Excessive fluid volume shifting or
— Toxic effects of abdominal sepsis - Observe for changes in behavior or LOC
— May be related to alcohol withdrawal, hypoxia or impending sepsis with shock
pancreatic cancer Surgical management
- For high surgical risks pts, biliary stents are used
— To ensure patency (keep biliary ducts open) & relieve pain - Surgical management- Complete surgical resection of pancreatic tumor
— Only done with small tumors - For larger tumors: Whipple procedure
— The Whipple procedure (pancreaticoduodenectomy) is an operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. The remaining organs are reattached to allow you to digest food normally after surgery.
Whipple Procedure Pre-op care
- Enteral feedings- to prevent reflux and to facilitate absorption
— Monitor for diarrhea to determine tolerance - TPN may be necessary to provide nutrition
— Central line required - NPO 6-8 hrs before surgery
Whipple Procedure Post-op care
- Potential complications of Whipple procedure
- NPO
- NGT to decompress stomach & reduces stimulation of remaining pancreatic tissue
- Monitor GI drainage & tube patency
— In open surgical approach, tubes are placed to remove drainage & secretions and prevent stress on anastomosis sites - Semi fowler to reduce tension on suture line and anastomosis and to optimize lung expansion
- Highest priority for care= fluid volume imbalance… Why?
