Thursday, March 19, 2009

Pancreas: Acute Pancreatitis

Ø Pancreas

- fish-shaped organ extending from duodenal curve to the spleen

- both an endocrine and exocrine gland

- pancreatic cells - empty into duodenum at the hepatopancreatic papilla; secrete enzymes which digest fats, carbohydrates and proteins

- alpha cells secrete glucagon to promote liver glycogenolysis and gluconeogenesis which ultimately increases blood glucose level

- beta cells secrete insulin



Acute Pancreatitis

- Inflammation of the pancreatic tissue due to premature activation of the pancreatic digestive enzymes

- Auto digestion

- Etiology:

- Alcoholism

- Hyperlipidemia

- Biliary tract disease or obstruction

- Trauma

- Infection

- Injuries to the pancreas causes abnormal activation of the proteolytic enzymes: trypsin, chemotrypsin, elastase

- Destruction of tissues in and around the pancreas – autodigestion

- Damage tissues could lead to perforation and abscess


- Clinical Manifestation

- Pain unrelenting and sometimes vague; may radiate to chest and back

- Jaundice

- Wt loss

- low grade fever anorexia

- Steatorrhea and dark urine

- Grey Turner’s sign- dicoloration of the flank

- Cullen’s sign – discoloration in the umbilicus area

- Pleural effusion

- Peritonitis

-


-
Diagnostics

- Upper GI series shows delayed in gastric emptying and enlarged duodenum due to edema of the head of the pancreas

- Endoscopic cholangiopancreatography can confirm pancreatits

- CT scan may show tumors and abcess

- Elevated AST,ALT, Bilirubin, lactate dehydrogenase, glucose levels, WBC

Bold- Decrease protein, potassium, calcium

-


- Management

- Analgesics

- Anticholinergic

- Insulin

- Prophylactic antibiotics

- H2 antagonist to decrease HCl thus decrease pancreatic enzymes

- IV fluids

- NGT lavage

- Biliary drainage


- Nursing interventions

- manage pain

- monitor breathing patterns disturbances

- monitor nutritional status

- oral care when NPO

- if eating is allowed, diet high in proteins and carbohydrates and low in fat

- monitor fluid and electrolyte balances

- monitor vital signs

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