Pancreatitis

Question 1

pancreatitis

Answer 1

the inappropriate activation of pancreatic enzymes, inflammation of the pancreas resulting in autodigestion of the pancreas and damage to peri-pancreatic tissues and vascular network

Question 2

______ response causes further damage to the pancreas

Answer 2

inflammatory response

Question 3

causes and risk factors of pancreatitis

Answer 3

• gallstones
• alcohol
• pregnancy
• administration of TPN
• surgery
• AIDS
• medication complications
• hypercalcemia and or significant hypertriglyceridema
• specific genetic mutations

Question 4

chronic pancreatitis

Answer 4

progressive obstruction of exocrine functions
- irreversible
- may demonstrate diabetes
- malabsorption syndrom

Question 5

why might chronic pancreatitis demonstrate diabetes

Answer 5

b/c of destruction of insulin producing cells

Question 6

acute pancreatitis has a _____ onset

Answer 6

sudden onset

Question 7

symptoms of acute pancreatitis

Answer 7

• abdominal pain
• abdominal tenderness
• hypotension
• respiratory distress
• abdominal distention
• poor urine output
• tachycardia
• signs of hypocalcemia

Question 8

3 forms of acute pancreatitis are

Answer 8

mild form, more severe form, severe form

Question 9

mild form of acute pancreatitis

Answer 9

• called institutional or edematous pancreatitis
• resolves in 5-7 days

Question 10

more severe form of acute pancreatitis

Answer 10

extensive necrosis

Question 11

severe form of acute pancreatitis

Answer 11

• local and systemic complications
• 25-30% mortality rate with complications and co morbidities

Question 12

1st phase of pancreatitis

Answer 12

trypsin and other enzymes released

Question 13

2nd phase of pancreatitis

Answer 13

intrapancreatic inflammation

Question 14

3rd phase of pancreatitis

Answer 14

• extrapancreatic / systemic injury
• kallikrein

Question 15

in pancreatitis hypocalcemia results from

Answer 15

necrosis

Question 16

kallikrein is part of the _______ process

Answer 16

inflammatory process

Question 17

kallikrein causes

Answer 17

vasodilation and increases permeability of blood vessels, pain, and leukocyte invasion

Question 18

kallikrein is activated by

Answer 18

trypsin

Question 19

trypsin is responsible for

Answer 19

causing bradykinin formation and can lead to systemic hypotension and shock

Question 20

4 ways to diagnose pancreatitis

Answer 20

(1) pancreatic enzyme levels
(2) liver and gallbladder tests
(3) elevated C Reactive protein
(4) elevated WBC

Question 21

how to minimize pancreatic stimulation

Answer 21

• GI tract rest
• nutrition support (enteral, total parenteral)
• psychosocial support

Question 22

what to look for on integumentary assessment on pt with pancreatitis

Answer 22

• Cullens sign
• Grey Turners sign
• Jaundice
• edema
• pale, moist, cold

Question 23

what is Cullens sign

Answer 23

bruising around umbilical

Question 24

why does Jaundice occur in pt with pancreatitis

Answer 24

all enzymes are breaking down and extending the damage to the liver

Question 25

common fluid and electrolyte imbalances in pts with pancreatitis

Answer 25

- hypocalcemia - hypokalemia - hypomagnesmia

Question 26

2 signs that occur with hypocalcemia

Answer 26

(1) chvostek's sign (2) trovsseau's sign

Question 27

what is chvostek's sign

Answer 27

facial nerve trapped in front of ear - positive when muscles contract on same side of face

Question 28

trovesseau's sign

Answer 28

bp cuff inflated on upper arm to a level directly above pt sbp for 2 min - hand flexes in response to test

Question 29

what renal assessments should be done on a pt with pancreatitis

Answer 29

- monitor for acute tubular necrosis - urine output can become brownish and foamy - assess BUN and creatinine levels

Question 30

what endocrine signs may show in a pt with pancreatitis

Answer 30

- hyperglycemia - high serum glucose levels - metabolic acidosis

Question 31

what neurological symptoms might a pt show with pancreatitis

Answer 31

- confused, decreased LOC - restlessness - agitation - should assess GCS

Question 32

in pancreatitis it is important to correct the

Answer 32

underlying problem

Question 33

in some pancreatitis the underlying problem may subside with supportive therapy such as

Answer 33

binge drinking

Question 34

when the underlying problem of pancreatitis is a mechanical obstruction how may this be fixed

Answer 34

surgery - cholecystectomy - ERCP

Question 35

when the underlying problem of pancreatitis is infected pancreatic necrosis how may this be fixed

Answer 35

surgical debridement

Question 36

when the underlying problem of pancreatitis is a pancreatitis abscess how might this be fixed

Answer 36

drainage

Question 37

local complications of pancreatitis

Answer 37

- pancreatic abscess - pancreatic necrosis - pseudocyst - abdominal compartment syndrome (ACS)

Question 38

pulmonary complications of pancreatitis

Answer 38

- hypoxemia - respiratory failure - acute respiratory distress syndrome (ARDS) - pneumonia - pleural effusion (COMMON)

Question 39

systemic complications of pancreatitis

Answer 39

- systemic inflammatory response syndrome (SIRS) - vasoactive substances (vasodilation, decreased systemic vascular resistance (hypotension), increased permeability of vessel linings) - hemorrhage - hypovolemia