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cute/Chronic Pancreatitis:

A. ACUTE PANCREATITIS

1. Inflammation of the pancreas due to premature activation of pancreatic enzymes,

resulting auto-digestion of tissues.

B. ETIOLOGY

1. Lipolysis lysis fat causes fatty acids bind to Ca2+ Hypocalcemia

2. Proteolysis- smaller than normal protein chains block ducts3. Necrosis blood vessels- elastin degrades blood vessels4. Inflammation- leukocytes & lymphocytes aggregate around necrotic tissue

C. CAUSATIVE FACTORS

1. Alcohol ingestion2. Biliary dx3. Post-op or blunt trauma4. Drugs & toxins

5. Infection

D. DRUGS CAUSE PANCRATITIS

1. Sulphonamides2. Oral contraceptives3. Steroids4. Opiods

5. Thiazides

E. S/S ACUTE

1. LUQ- not relieved by eating,accompanied by cyanosis,flushing, dyspnea

2. Weight loss due to N&V

3. Cullens sign4. Turners sign5. Decreased/absent bowel

sounds

6. Dullness to percussion

7. Tachycardia & hypotension8. Crackles & orthopnea9. Hemorrhage shock

10. toxaemia

11. Hypovolemia12. Jaundice w/ fever &

leukocytosis13. Increased serum lipase &

amylase

F. DIAGNOSTICS & LABS

1. Increased serum & urine amylase, increased lipasedefinitive dx2. Increased AST, ALT, Bilirubin3. Hyperlipidemia & hyperglycemia4. Hypocalcemia & hypomagnesmia

5. Abdominal ultrasound6. CXRelevated diaphram7. Contrast enhanced CT (CECT)8. ERCPr/t gallstones

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G. COMPLICATIONS

1. Pancreatic pseudocyst- tx=drain w/ anastomosis of pancreas to jejunum2. Abscess- tx drain3. Peritonitis- tx- antibiotics4. Systemic problems

i. Pulmonary & pleural effusionsii. Atelectasis & pneumonia

iii. Hypotension & tetany

H. COLLABORATIVE CARE: goals: Aggressive hydrations, pain relief, management metabolic

complaints, decrease pancreatic stimulation.

1. SUPPORTIVE

i. Pain reliefii. NPOiii. Albumin if shockiv. Iv Ca2+ if tetanyv. Ringers latate e-lyte imbalance

2. SURGERY- r/t gallstones, cholecystectomy

3. DRUG THERAPY

i. Antacidsii. H2-blockers orPPIsiii. Spasmolyticsiv. Opiodsv. Pancreatic enzymesvi. Insulinvii. Anticholinergics

4. COMFORT CARE

i. Position side w/ knees drawn

ii. Oral/nasal hygiene

5. NUTRITION

i. TPN for those NPO

ii. Sm frequent High carb, protein, low fat diet

I. NURSING MANAGEMENT

1. HEALTH PROMOTION

i. Early detection & tx biliary dxii. Avoid alcohol

2. ACUTE INTERVENTIONS

i. VSii. IV fluidsiii. Assess resp. Failureiv. Assess tetany

v. Pain relief1. Side lying w. Knees drawn

vi. Oral & nasal care for those NPOvii. Assess paralytic ileus, renal failure, change mental statusviii. Skin care

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3. AMBULATORY CARE

i. Tx alcoholism & biliary dxii. Avoid alcoholiii. Avoid smokingiv. Avoid stressv. Restrict fat intake

J. CHRONIC PANCRATITIS

1. Due to repeat episodes alcohol induced acute pancreatitis

K. S/S CHRONIC PANCREATITIS

1. DM2. Greasy stools3. Diarrhea/constipation

4. Frothy urine

L. TX CHRONIC PANCREATITIS

1. Pancreatin (Viokase)2. no alcohol3. DM management4. Surgery

i. Pancreatojejunostomyii. Cholecystectomyiii. Pancreatectomy

iv. sphincterectomy