Pancreatitis

Question 1

What is the anatomic relationship of the pancreas, the liver, and the GI tract?

Answer 1

located right next to duodenum (1st part of SI) and near the stomach and liver

Question 2

What are the 2 exocrine functions of the pancreas?

Answer 2

To provide digestive enzymes to the intestinal tract for the digestion of oral nutrients; to provide bicarbonate to neutralize the acidic nature of the fluid that arrives in the duodenum from the stomach

Question 3

How are pancreatic products delivered to intestines?

Answer 3

• pancreatic duct

- accessory pancreatic duct (dogs only)

Question 4

What cells make up the exocrine pancreas?

Answer 4

Acinar cells

Ductal cells

Question 5

3 Mechanisms designed to protect the pancreas and other tissues from the digestive actions of the pancreatic enzymes

Answer 5

1. Must be cleaved by other enzymes in intestinal lumen to become active
2. Pancreatic enzymes are packaged carefully to prevent them from prematurely escaping
3. Inhibitors of these pancreatic enzymes are found within the pancreas and within the systemic circulation

Question 6

What is autodigestion?

Answer 6

when digestive enzymes become activated within the pancreatic tissue and begin destroying the various pancreatic cells

Question 7

What are the inflammatory consequences of autodigestion?

Answer 7

• Body responds by sending inflammatory mediators which increase perfusion of blood to the pancreas bringing more WBCs to the area (swelling) AND increases permeability of blood vessels allowing for leakage of the cells, fluid and inflammatory mediators into the pancreatic tissues (edema)
• Inflammation potentiates release of additional active digestive enzymes which destroy tissue and promote more inflam.
• inflammation may extend to surrounding organs
• enlarged pancreas can impinge on common bile duct causing cholestasis
• if inflammation severe, necrosis of pancreatic tissue resulting in systemic inflammation and possibly widespread organ dysfunction/failure and death

Question 8

Common clinical signs of acute pancratitis

Answer 8

Vomiting & nausea
abdominal pain
icterus

Question 9

What causes vomiting/nausea in acute pancreatitis

Answer 9

The inflammation in the pancreas activates certain receptors in the pancreas which stimulate the vomiting center within the brain; remains as long as inflammation and pancreatic swelling are present

Question 10

If inflammation extends to the middle and distal parts of the SI in acute pancreatitis, what clinical sign may be seen?

Answer 10

diarrhea

Question 11

What is thought to cause abdominal pain in acute pancreatitis?

Answer 11

swollen and inflamed pancreas; activation of receptors that stimulate pain

Question 12

What causes icterus in acute pancreatitis?

Answer 12

Cholestasis caused by compression of bile duct by inflamed pancreas because bile flow is slowed down or obstructed

Question 13

What does acute pancreatitis look like in cats?

Answer 13

• sudden onset of anorexia +/- nausea
• weight loss due to anorexia
• depression/lethargy

Question 14

How does acute pancreatitis alter a CBC?

Answer 14

• systemic inflammation leads to inflammatory leukogram
• neutrophilia with a left shift b/c neutrophils are pulled into the circulatory pool
• monocytosis if inflammation has been present for long enough

Question 15

How does serum chemistry changes in acute pancreatitis?

Answer 15

• lipase and amylase may or may not be elevated
• serum bilirubin may be elevated if liver and common bile duct are subject to inflammation and/or the common bile duct has been obstructed by the swollen pancreas

Question 16

What is the cephalic component of the digestive process?

Answer 16

It reacts to the smell of food and tells the stomach, SI, and pancreas to begin prep for food by releasing some of their enzymes, thus stimulating the same enzymes that are causing all the inflammation in the first place

Question 17

What are some nursing interventions that may be used for acute pancreatitis?

Answer 17

• IVF to flush inflammatory mediators & toxins from body and to maintain hydration/replace fluid loss
• Antiemetics to Tx nausea
• Pain control
• PPN or TPN if food withheld longer than 48hrs
• Fresh Frozen Plasma transfusion to provide exogenous pancreatic enzyme inhibitors
• Antibiotics (preventative basis only for translocation of bacteria from inflamed intestines)

Question 18

Name 2 potential complicating disorders that may occur with acute pancreatitis

Answer 18

Pulmonary Thromboembolism (PTE)
Pancreatic "Sterile" Abscess

Question 19

What is Pulmonary Thromboembolism and its relationship to acute pancreatitis

Answer 19

The severe systemic inflammation of acute pancreatitis can lead to disorganization of body’s coagulation cascade –> this means tiny blood clots may form in circulatory system –> clots can lodge in blood vessels, especially pulmonary vessels, and disrupt blood flow to lungs

Question 20

What is a pancreatic sterile abscess? How does it occur?

Answer 20

Occurs as a result of body attempting to contain inflammation, dead cells, and debris that have been occurring within the pancreatic tissues;
made up of dead neutrophils, dead cells of the affect tissue, and debris