Acute & Chronic Pancreatitis Flashcards

Acute Pancreatitis Causes

auto-digestion of pancreas: injury to pancreatic cells,
activation of pancreatic enzymes, activation of trypsinogen to
trypsin alcohol gallbladder disease
hypertriglyceridemia smoking surgical procedures
/ trauma drugs metabolic d/o
idiopathic

Types of Acute Pancreatitis

Mild Severe: endocrine & exocrine dysfunction,
necrosis, organ failure, sepsis

Acute Pancreatitis Manifestations

abd pain: LUQ or mid-epigastrium, sudden onset, aggravated w/
eating N/V low-grade fever
leukocytosis hypotension tachycardia
physical assessment:
guarding dec. or absent bowel sounds lung
crackles abd skin discoloration: Grey Turner's - flanks,
Cullen's - umbilicus shock

Acute Pancreatitis - Labs

amylase lipase liver enzymes - AST &
ALT triglyceride bilirubin calcium

Acute Pancreatitis - Dx

abd US x-ray CT scan ERCP
endoscopic ultrasonography (EUS) MRCP - like MRI
angiography CXR

Acute Pancreatitis - Complications

Peudocyst

fluid, enzyme, debris & exudates surrounded by wall
Tx: surgical drainage, percutaneous cath placement &
drainage, endoscopic drainage

Acute Pancreatitis - Complications

Pancreatic Abscess

collection of pus secondary to necrosis Tx: prompt
surgical drainage to prevent sepsis

Acute Pancreatitis - Complications

Systemic

pleural effusion atelectasis pneumonia
ARDS hypotension hypocalcemia: tetany
metabolic imbalance coagulopathy

Acute Pancreatitis -
Care Goals

pain relief prevent, alleviate shock dec.
pancreatic secretions correct fluid/electrolyte
imbalance prevent/treat infection remove
precipitating cause

Acute Pancreatitis - Interventions

aggressive hydration - IV pain mgmt - IV morphine
& dilaudid, positioning control metabolic
complications: O2, BS, IV calcium, electrolytes nutrition:
NPO, TPN, enteral feeding, return to real food, electrolyte
imbalance: labs & accuchecks minimize pancreatic
stimulation: NPO, NG suction, reduction of gastric acid
shock: plasma or plasma volume expander - albumin, etc.
severe hypotension: vasoactive IV meds - dopamine
prevent or Tx infection - ABx assess for tetany
(hypocalcemia) - Chvostek's sign & Trousseau's sign

Acute Pancreatitis - Other Important Assessments

lung abdominal VS & I&Os
tubes / drains

Chronic Pancreatitis

continuous prolonged inflammatory & fibrosing process of
pancreas chronic calcifying & obstructive
pancreatitis

Chronic Pancreatitis
- Causes

alcohol gallstones tumor
pseudocysts trauma acute pancreatitis
idiopathic

Chronic Pancreatitis - Manifestations

abdominal pain - heavy, gnawing, burning, cramping
Sx of pancreatic insufficiency
weight loss constipation or loose stools,
steatorrhea mild jaundice w/ dark urine DM

Chronic Pancreatitis - Complications

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

Chronic Pancreatitis - Dx

S/S lab tests imaging

Chronic Pancreatitis - Labs

slightly inc. serum amylase / lipase inc. serum
bilirubin inc. alk. phosphate mild leukocytosis
inc. ESR glucose intolerance (DM) Imaging: CT,
MRI, MRCP, ERCP, sonogram stool sample (fecal fat)
secretin stimulation test

Chronic Pancreatitis - Interventions

pain relief: morphine or fentanyl transdermal patch, other
meds diet: bland, low fat, small frequent meals, pancreatic
enzyme replacements, control DM, no alcohol or caffeine
smoking cessation focus on chronic care & health
promotion pt & family teaching: diet, pancreatic enzyme
w/ meals, monitor stools & BS levels, no alcohol

Chronic Pancreatitis - Surgical Therapy

choledochojejunostomy or Roux-en-Y pancreatojejunostomy
ERCP w/ spincterotomy &/or stent placement
pancreatic drainage