What is pancreatitis
Auto-digestion of the pancreas
What are the two separate functions of the pancreas?
Endocrine - insulin
Exocrine -
... [Show More] digestive enzymes
What are the two types of pancreatitis
1. Acute:
#1 Cause = Alcohol
#2 Cause = Gallbaldder Disease
2. Chronic:
#1 Cause = Alcohol
Parts of the pancreas
a. Pancreatic Duct - travels through pancreas
b. Digestive Enzymes - Inactive while in pancreas until they get to the small intestines
c. Scar Tissue - forms in pancreatic duct by alcoholism which causes scar tissue and occludes duct
d. Gallstones
Enzymes get tired of waiting and activate while in the pancreas - so they start eating the pancreas
Note: if any part of the GI system gets sick - other parts of the GI can get sick as well.
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S/S of Pancreatitis
a. #1 Pain - increases with eating
b. Abdominal distention/ascites (losing protein rich fluids like enzymes and blood into the abdomen)
c. Abdominal mass - swollen pancreas
d. Rigid board-like abdomen (guarding or bleeding - developed pancreatitis)
e. Bruising around umbilical area known as Cullen's sign
Bruising in flank (side) area known as Gray Turner's sign
f. Fever (inflammation)
g. NV
h. Jaundice - liver is involved
i. Hypotension = bleeding or ascites
What is ascites?
Buildup of fluid in the space between the lining of the abdomen and abdominal organs
Pancreatitis Lab Values
Amylase: 45-200 U/L (dye)
Lipase: 0-110 U/L - most specific to pancreatitis
AST: 8-40 U/L
ALT: 10-30 U.L
Hemoglobin: 12-18 (male 14-18; female 12-16)
Hematocrit: 38-54% (male 40-54%; female 38-47%)
What is most specific in diagnosing pancreatitis?
Lipase
Dx: Serum lipase and amylase are....
Digestive enzymes and they are not supposed to be in the blood stream
Dx:
WBC's
Blood sugar
ALT, AST-liver enzymes
PT, PTT
Serium bilirubin
H/H (hemoglobin & hematocrit)
Dx:
WBC's - elevated
Blood sugar - elevated - could be a diabetic forever now
ALT, AST - liver enzymes - elevated - if liver is messed up, #1 thing to worry about is bleeding
PT, PTT - longer - for blood to clot
Serium bilirubin - elevated
H/H - (hemoglobin & hematocrit) increases or decreases
(not at the same time)
Why down? Bleeding
Why up? Dehydrated
Tx of Pancreatitis - Goal: Control Pain
1. Decrease gastric secretions by: ___________, NGT to suction, bed rest (decreases stomach secretions).
NPO
Want the stomach empty and dry.
Testing Strategy - Pancreas Client =
Keep stomach empty and dry
2. What pain medications are given?
PCA narcotics:
morphine sulfate (Morphine)
hydromorphone (Dilaudid)
Fentanyl patches (Duragesic)
3. Steriods, why?
Reduce inflammation
Long-term can get diabetes, Cushing's
4. Anticholinergics, why are they given? Name them.
Dry secretions.
Benztropine (Cogentin)
Diphenoxylate/Atropine (Lonox)
5. What is given to decrease stomach acids?
Pantoprazole (Protonix) - Proton pump inhibitor
Ranitidine HCI (Zantac) - H2 receptor antagonist
Famotidine (Pepcid) - H2 receptor antagonist
Antacids - work really quick
H2 Receptor Antagonist
H2 are histamines that are released that cause inflammation in the stomach
H2 receptor antagonists turns down the volume of HCL acid production
6. Maintain fluid and electrolyte balance.
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7. Maintain nutritional status -
ease into a diet (TPN maybe)
8. Insulin, Why?
Pancrease is sick - can't release insulin
TPN
Steroids - cause BS to increase
Last 3 treatments:
Daily weights
Eliminate alcohol
Refer to AA if this is the cause [Show Less]