Pancreatitis And Liver Failure

Front 1

What is pancreatitis?

Back 1

inflammation of the pancreas that impairs exocrine and endocrine function.
it can range from mild to severe. severe pancreatitis can lead to necrosis and hemorrhage, and has a very high mortality rate.

Front 2

What is the etiology of pancreatitis?

Back 2

alcoholism, biliary tract disease, medications, trauma, and it can be idiopathic

Front 3

What is the pathophysiology of pancreatitis?

Back 3

Autodigestion (the organ eats its own tissues) leads to edema, interstitial hemorrhage, and necrosis.

*The release of histamines and bradykinin lead to increased vascular permeability which also causes edema.

This inflammation may lead to the obstruction of the duct which causes ischemia.

Front 4

What are the signs and symptoms of pancreatitis?

Back 4

Severe pain- epigastric or midabdominal which radiates to the back
Nausea/Vomiting
Abdominal Distention
Ascites and Jaundice (severe)
Retroperitoneal hemorrhage

Front 5

What is Turners sign?

Back 5

discoloration of the flank

Front 6

What is Cullen's sign?

Back 6

discoloration of the umbilicus

Front 7

What laboratory data will be elevated in pancreatitis?

Back 7

Serum amylase, lipase, WBCs, glucose, LFTs, bilirubin, triglycerides

Front 8

What laboratory data will be decreased in pancreatitis?

Back 8

potassium, calcium, albumin, protein

Front 9

What diagnostic tests can diagnose pancreatitis?

Back 9

CT abdomen, MRI, US, CXR, abdominal Xray, upper GI, IV cholangiogram, ERCP

Front 10

What is the treatment of pancreatitis based around?

Back 10

Fluids, elecrtrolyte replacement, pancreas rest, comfort management.

misc tx=
pharmacologic treatment with antibiotics, drainage of pseudocysts, and pancreatic resection.

Front 11

What is the specific fluid replacement treatment for pancreatitis?

Back 11

volume replacement with LR, colloids, FFP, packed RBCs(hemorrhagic type)
Monitor volume status- PA catheter, intake and output, daily weights
Vasopressors if needed

Front 12

What is the specific electrolyte replacement therapy for pancreatitis?

Back 12

calcium and potassium replacement
also treat any hyperglycemia

Front 13

How do you rest the pancreas in treatment of pancreatitis?

Back 13

Decrease gastric secretions- keep the pt NPO and perform gastric suction
-be aware of issues related to early enteral vs. parenteral nutrition

Front 14

What are comfort management measures in treating pancreatitis?

Back 14

Meperidine (demerol)- prevents spasm of the spincter of Oddi. Morphine MAY be acceptable, if the pancreatitis is unrelated to gallbladder disease.

Front 15

What are complications of pancreatitis?

Back 15

Hypovolemic shock, pulmonary complications (atelectasis, ARDS, effusion), DIC, psuedocysts and abscess formation, renal failure, high glucose and triglycerides, and low calcium

Front 16

What are the nursing care priorities for pancreatitis?

Back 16

Control pain and promote comfort. Prevent and treat shock, reduce pancreatic stimulation and maintain nutrition. Prevent or minimize complications.

Front 17

What is the prognosis for pancreatitis?

Back 17

Ranson's Criteria- parameters for determining mortality rates for pancreatitis patients.
another scale is APACHE II.

Front 18

What are four types of hepatic failure?

Back 18

hepatitis, decreased perfusion, cirrhosis, and fatty liver disease.

Front 19

What is hepatitis?

Back 19

acute inflammation of the liver cells

Front 20

What are the types of hepatitis and their causes?

Back 20

A- common, fecal contamination- vaccine available
B- blood-borne, sexual transmission. vaccine in infancy
C- blood-borne
D- combined with type B
E- fecal/oral
G- blood-borne, sexual transmission

Front 21

What are the symptoms of hepatitis?

Back 21

GI pain, fever/chills, jaundice, brown urine, RUQ pain, clay colored stools

Front 22

What is the management of hepatitis?

Back 22

there is no definitive treatment. Rest, nutritional support, and prevention of the spread of the virus is key.

Front 23

What is the definition of cirrhosis?

Back 23

the destruction of the liver parenchyma and replacement by scar tissue

Front 24

What are the types of cirrhosis?

Back 24

Laennec's (alcohol, portal), biliary, cardiac, and post-necrotic

Front 25

What happens to the liver in a patient with cirrhosis?

Back 25

The liver enlarges due to increased fat accummulation. This causes inflammation and necrosis of the cells, and leavs you with a yellow/orange, fatty and scarred liver. The liver shrinks, become hobnail (hard with lumps). The flow of blood becomes obstructed and causes portal hypertension.

Front 26

What are three complications of liver cirrhosis?

Back 26

1. portal hypertension which can lead to varices
2. impaired metabolism which can cause impaired clotting and an inability to detoxify drugs and toxins, including ammonia
3. impaired bile formation and flow

Front 27

What are signs and symptoms and cirrhosis?

Back 27

Early: anorexia, dyspepsia, flatulence, nausea, vomiting, and changes in the bowel patterns. These are all related to altered metabolism.

Late: jaundice, skin lesions, hematologic, endocrine, encephalopathy, and ascites.

Front 28

What are tests to diagnose cirrhosis?

Back 28

elevated liver enzymes, elevated bilirubin, elevated ammonia, coagulation studies, plasma proteins, and a CT of the abdomen

Front 29

What are forms of supportive therapy for cirrhosis?

Back 29

fluids, prevent injury and bleeding, and treat hypoglycemia

Front 30

What is aggressive therapy for cirrhosis?

Back 30

liver transplant, extracorporeal liver asisst (this is experimental, can bridge pts until a transplant or healing)

Front 31

What is ascites?

Back 31

ascites is fluid in the peritoneal cavity, and it is caused by a low albumin plus and obstruction to flow. Increased aldosterone causes sodium and water retention, which causes peripheral edema and further ascites.

Front 32

What is the medical management of ascites?

Back 32

bed rest, sodium and fluid restritions, diuretics, paracentesis, albumin, nutritional support, peritoneovenous shunt (for long term management)

Front 33

What is the nursing management of ascites?

Back 33

monitor fluid volume status, assess and facilitate respiratory status, and assist with procedures to relieve pressure.

Front 34

What is encephalopathy?

Back 34

encepalopathy is a cerebral toxicity from elevated ammonia levels. it causes asterixis, impaired motor ability, and LOC from confusion to coma.

Front 35

What is the medical management of encephalopathy?

Back 35

limit protein intake to 20-40g/day. Administer neomycin and lactulose, this reduces bacterial breakdown of protein in the bowel. Restrict any toxic medications, and then sedate.

Front 36

What is hepatorenal syndrome?

Back 36

This is a form of acute renal failure with end stage liver cirrhosis and ascites. There is a decreased albumin level and portal hypertension. These patients have poor outcomes.

Front 37

What are nursing priorities in hepatorenal syndrome?

Back 37

improve nutritional status, provide comfort, observe for early signs of complications, provide psychologic support, and provide information.
-be aware of intra abdominal compartment syndrome.