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25 Cards in this Set
- Front
- Back
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three major disorders of the pancreas
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acute pancreatitis
chronic pancreatitis pancreatic cancer |
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acute pancreatitis etiology
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most comonly biliary tract disease and alcololism
less commonly from trauma(post surgical injury, viral infections, duodenal conditions, cystic fibrosis, kaposi's sarcoma, oral contraceptives |
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acute pancreatitis pathophysiology
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believed to be autodigestion of pancreatic cells, injury occurs, enzymes released, trypsin stays in pancreas and can digest pancereas
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acute pancreatitis clinical manifestations
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ABD pain (LUQ or midepigastrum)
pain radiates to back, sudden onset'described as severe, deep piercing pain aggrivated by eating, not relieved by vomiting |
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clinical manifestations of acute pancreatitis resulting from the inflammatory process
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cardiovascular: hypotension, tachycardia, shock, hypovolemia
Respiratory: cyanosis, dyspnea, crackles in lungs Immune: fever, leukocytosis |
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GI disturbances of acute pancreatitis
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bowel sounds decreased/absent
Ileus may be present N/V |
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Integumentary manifestations of acute pancreatitis
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may have flushing
jaundice gray turner spots, bluish flank discoloration Cullen's sign:bluish discoloration of the periumbillical area |
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complications of acute pancreatitis
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pseudocyst: cavity continuous with or surrounding the outside of thep ancreas, pseudocyst is filled with necrotic products and liquid secretions, encapulsation can occur
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pancreatic abscess
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large fluid filled cavity within the pancreas
client needs surgical intervention |
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complications of acute pancreatitis
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pulmonary: pleural effusion, atelectasis
cardiovascular: shock Hypocalcemia: indicates severe disease- monitor for tetany (Cvostek's/Trousseau's) |
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diagnostic studies of acute pancreatitis
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serum amylase: greater than 200 u/L is diagnostic, remains elevated for 24-72 hours
serum lipase urine amylase renal-anylase-creatinine clearance test hyperglycemia, hyperlipidemia, hypocalcemia, endoscopic US, CT/MRI, ERCP |
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ERCP
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diagnostic test for gallstones, pancreatic cysts, absesses
can treat stones in this test |
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objectives for treatment in acute pancreatitis
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pain management- high doses of morphine, monitor the pain
prevent shock- monitor IV fluids fluit and electrolyte balance prevention of infection/complications remove the cause-usually ETOH |
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pain management and therapy for acute pancreatitis
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hydration, antispasmotic, replace volume (LR) or blood products if needed, NPO/TPN, NGT, dialysis, antibiotics, surgery-ERCP with sphincterectomy
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chronic pancreatitis presents as
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chronis or recurrent abdominal pain, pain may diminish as fibrosis develops, heavy knawing feeling, nor relieved with food or antiacids
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symptoms of pancreatic insufficiency
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malabsorption with weight loss
constipation mild jaundice with dark urine steatorrhea frothy urine and stool |
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diagnostic studies for chronic pancreatitis
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Amylase/Lipase may be slightly elevated or normal
Increased serum bilirubin, increased sed rate, hyperglycemia, stool for fat analysis X-ray-fibrois and calcifation |
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3 diagnostic studies for chronic pancreatitis
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endoscope US
CT/MRI ERCP |
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enzymes taken before every meal in chronic pancreatitis
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Viokase and Cotazym, if steatorrhea present either not compliant of need higher dose
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surgery and treatment for chronic pancreatitis
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rouxn-en Y, choledochojejunostomy
avoid ETOH, bland low fat, high carb diet, control diabetes |
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Most pancreatic cancers are ___ and occur ____.
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adenocarcinoma, occur at head of pancreas
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risk factors for pancreatic cancer
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cigarettes, chemical exposure, high fat diet, diabetes, chronic pancreatitis
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clinical manifestations of pancreatic cancer
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extreme unrelenting upper abdominal pain, anorexia, rapid weight loss, jaundice- painless jaundice is a very bad sign
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diagnostic studies for pancreatic cancer
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CT
ERCP- gold standard Tumor markers- CEA, more specific for colon cancer, less specific for pancreatic cancer |
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treatments for pancreatic cancer
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Whipple's procedure(radical pancreaticduodenectomy)
total pancreatectomy radiation-usually palliative |
