Focus on Pancreatitis Relates to Chapter 44 Nursing

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Focus on Pancreatitis (Relates to Chapter 44, “Nursing Management: Liver, Pancreas, and Biliary Tract

Focus on Pancreatitis (Relates to Chapter 44, “Nursing Management: Liver, Pancreas, and Biliary Tract Problems” in the textbook) Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc.

Acute Pancreatitis • An acute inflammatory process of the pancreas • Degree of inflammation

Acute Pancreatitis • An acute inflammatory process of the pancreas • Degree of inflammation varies from mild edema to severe necrosis. Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 2

Acute Pancreatitis Etiology and Pathophysiology • Most common in middle-aged men and women •

Acute Pancreatitis Etiology and Pathophysiology • Most common in middle-aged men and women • Severity of the disease varies according to the extent of pancreatic destruction. • African American rate 3 times higher than that of whites Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 3

Acute Pancreatitis Etiology and Pathophysiology • Primary etiologic factors are • Biliary tract disease

Acute Pancreatitis Etiology and Pathophysiology • Primary etiologic factors are • Biliary tract disease • Most common in women • Alcoholism • Most common in men • Hypertriglyceridemia Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 4

Acute Pancreatitis Etiology and Pathophysiology • Less common causes • Trauma (postsurgical, abdominal) •

Acute Pancreatitis Etiology and Pathophysiology • Less common causes • Trauma (postsurgical, abdominal) • Viral infection • Penetrating duodenal ulcer • Cysts • Idiopathic causes Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 5

Acute Pancreatitis Etiology and Pathophysiology • Less common causes (cont’d) • Abscesses • Cystic

Acute Pancreatitis Etiology and Pathophysiology • Less common causes (cont’d) • Abscesses • Cystic fibrosis • Kaposi sarcoma • Metabolic disorders • Vascular diseases • Postop GI surgery Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 6

Acute Pancreatitis Etiology and Pathophysiology • Less common causes (cont’d) • Drugs • Corticosteroids

Acute Pancreatitis Etiology and Pathophysiology • Less common causes (cont’d) • Drugs • Corticosteroids • Thiazide diuretics • Oral contraceptives • Sulfonamides • NSAIDs Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 7

Acute Pancreatitis Etiology and Pathophysiology • Caused by autodigestion of pancreas • Etiologic factors

Acute Pancreatitis Etiology and Pathophysiology • Caused by autodigestion of pancreas • Etiologic factors • Injury to pancreatic cells • Activation of pancreatic enzymes Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 8

Acute Pancreatitis Fig. 44 -13. Pathogenic process of acute pancreatitis. GI, Gastrointestinal. Copyright ©

Acute Pancreatitis Fig. 44 -13. Pathogenic process of acute pancreatitis. GI, Gastrointestinal. Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 9

Acute Pancreatitis Etiology and Pathophysiology • Trypsinogen • Activated to trypsin by enterokinase •

Acute Pancreatitis Etiology and Pathophysiology • Trypsinogen • Activated to trypsin by enterokinase • Inhibitors usually inactivate trypsin. • Enzyme can digest the pancreas and can activate other proteolytic enzymes. Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 10

Pancreatitis Etiology and Pathophysiology • Elastase • Activated by trypsin • Plays a major

Pancreatitis Etiology and Pathophysiology • Elastase • Activated by trypsin • Plays a major role in autodigestion • Causes hemorrhage by producing dissolution of the elastic fibers of blood vessels Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 11

Acute Pancreatitis Etiology and Pathophysiology • Phospholipase A • Plays a major role in

Acute Pancreatitis Etiology and Pathophysiology • Phospholipase A • Plays a major role in autodigestion • Activated by trypsin and bile acids • Causes fat necrosis Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 12

Acute Pancreatitis Etiology and Pathophysiology Trypsin Edema, necrosis, hemorrhage Elastase Hemorrhage Phospholipase A Fat

Acute Pancreatitis Etiology and Pathophysiology Trypsin Edema, necrosis, hemorrhage Elastase Hemorrhage Phospholipase A Fat necrosis Kallikrein Edema, vascular permeability, smooth muscle contraction, shock Lipase Fat necrosis Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 13

Acute Pancreatitis Etiology and Pathophysiology • Alcohol • May stimulate production of digestive enzymes

Acute Pancreatitis Etiology and Pathophysiology • Alcohol • May stimulate production of digestive enzymes • Increases sensitivity to hormone cholecystokinin • Stimulates production of pancreatic enzymes Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 14

Acute Pancreatitis Etiology and Pathophysiology • Edematous pancreatitis • Mild and self-limiting • Necrotizing

Acute Pancreatitis Etiology and Pathophysiology • Edematous pancreatitis • Mild and self-limiting • Necrotizing pancreatitis • Degree of necrosis correlates with severity of manifestations. Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 15

Acute Pancreatitis Fig. 44 -14. In acute pancreatitis, the pancreas appears edematous and is

Acute Pancreatitis Fig. 44 -14. In acute pancreatitis, the pancreas appears edematous and is commonly hemorrhagic (H). Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 16

Acute Pancreatitis Clinical Manifestations • Abdominal pain is predominant symptom. • Pain located in

Acute Pancreatitis Clinical Manifestations • Abdominal pain is predominant symptom. • Pain located in the left upper quadrant • Pain may be in the midepigastrium. • Commonly radiates to the back Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 17

Acute Pancreatitis Clinical Manifestations • Abdominal pain (cont’d) • Sudden onset • Severe, deep,

Acute Pancreatitis Clinical Manifestations • Abdominal pain (cont’d) • Sudden onset • Severe, deep, piercing, steady • Aggravated by eating • Onset when recumbent • Not relieved by vomiting Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 18

Acute Pancreatitis Clinical Manifestations • Flushing • Cyanosis • Dyspnea • Edema • Nausea/vomiting

Acute Pancreatitis Clinical Manifestations • Flushing • Cyanosis • Dyspnea • Edema • Nausea/vomiting • Bowel sounds decreased or absent Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 19

Acute Pancreatitis Clinical Manifestations • Low-grade fever • Leukocytosis • Hypotension • Tachycardia •

Acute Pancreatitis Clinical Manifestations • Low-grade fever • Leukocytosis • Hypotension • Tachycardia • Jaundice • Abdominal tenderness Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 20

Acute Pancreatitis Clinical Manifestations • Abnormal lung sounds • Crackles • Discoloration of abdominal

Acute Pancreatitis Clinical Manifestations • Abnormal lung sounds • Crackles • Discoloration of abdominal wall Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 21

Acute Pancreatitis Complications • Two significant local complications • Pseudocyst • Abscess Copyright ©

Acute Pancreatitis Complications • Two significant local complications • Pseudocyst • Abscess Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 22

Acute Pancreatitis Complications • Pseudocyst • Cavity surrounding outside of pancreas filled with necrotic

Acute Pancreatitis Complications • Pseudocyst • Cavity surrounding outside of pancreas filled with necrotic products and liquid secretions • Abdominal pain • Palpable epigastric mass Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 23

Acute Pancreatitis Complications • Pseudocyst (cont’d) • Nausea, vomiting, and anorexia • Elevated serum

Acute Pancreatitis Complications • Pseudocyst (cont’d) • Nausea, vomiting, and anorexia • Elevated serum amylase • May resolve spontaneously within a few weeks, or may perforate, causing peritonitis • Treatment: Internal drainage procedure Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 24

Acute Pancreatitis Complications • Pancreatic abscess • A large fluid-containing cavity within the pancreas

Acute Pancreatitis Complications • Pancreatic abscess • A large fluid-containing cavity within the pancreas • Results from extensive necrosis in the pancreas • Upper abdominal pain • Abdominal mass Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 25

Acute Pancreatitis Complications • Pancreatic abscess (cont’d) • High fever • Leukocytosis • Requires

Acute Pancreatitis Complications • Pancreatic abscess (cont’d) • High fever • Leukocytosis • Requires surgical drainage Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 26

Acute Pancreatitis Complications • Main systemic complications • Pulmonary • Pleural effusion • Atelectasis

Acute Pancreatitis Complications • Main systemic complications • Pulmonary • Pleural effusion • Atelectasis • Pneumonia Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 27

Acute Pancreatitis Complications • Systemic complications (cont’d) • Cardiovascular • Hypotension • Tetany (caused

Acute Pancreatitis Complications • Systemic complications (cont’d) • Cardiovascular • Hypotension • Tetany (caused by hypocalcemia) Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 28

Acute Pancreatitis Diagnostic Studies • Laboratory tests • Serum amylase • Serum lipase Copyright

Acute Pancreatitis Diagnostic Studies • Laboratory tests • Serum amylase • Serum lipase Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 29

Acute Pancreatitis Diagnostic Studies • Laboratory tests (cont’d) • Liver enzymes • Blood glucose

Acute Pancreatitis Diagnostic Studies • Laboratory tests (cont’d) • Liver enzymes • Blood glucose • Triglycerides • Bilirubin • Serum calcium Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 30

Acute Pancreatitis Diagnostic Studies • Abdominal/endoscopic ultrasound • X-ray • Contrast-enhanced CT scan •

Acute Pancreatitis Diagnostic Studies • Abdominal/endoscopic ultrasound • X-ray • Contrast-enhanced CT scan • Endoscopic retrograde cholangiopancreatography (ERCP) Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 31

Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 32

Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 32

Acute Pancreatitis Diagnostic Studies • Endoscopic ultrasound • Magnetic resonance cholangiopancreatography (MRCP) • Chest

Acute Pancreatitis Diagnostic Studies • Endoscopic ultrasound • Magnetic resonance cholangiopancreatography (MRCP) • Chest x-ray Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 33

Acute Pancreatitis Collaborative Care • Objectives include • Relief of pain • Prevention or

Acute Pancreatitis Collaborative Care • Objectives include • Relief of pain • Prevention or alleviation of shock • ↓ of pancreatic secretions • Fluid/electrolyte balance • Prevention/treatment of infection • Removal of the precipitating cause Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 34

Acute Pancreatitis Collaborative Care • Conservative therapy • Supportive care • Aggressive hydration •

Acute Pancreatitis Collaborative Care • Conservative therapy • Supportive care • Aggressive hydration • Pain management • IV morphine • Combined with antispasmodic agent • Management of metabolic complications • Minimizing stimulation Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 35

Acute Pancreatitis Collaborative Care • Conservative therapy (cont’d) • Shock • Plasma or plasma

Acute Pancreatitis Collaborative Care • Conservative therapy (cont’d) • Shock • Plasma or plasma volume expanders (dextran or albumin) • Fluid/electrolyte imbalance • Lactated Ringer’s solution • Ongoing hypotension • Vasoactive drugs: dopamine (Intropin) Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 36

Acute Pancreatitis Collaborative Care • Conservative therapy (cont’d) • Suppression of pancreatic enzymes •

Acute Pancreatitis Collaborative Care • Conservative therapy (cont’d) • Suppression of pancreatic enzymes • NPO • NG suction • Prevent infections Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 37

Acute Pancreatitis Collaborative Care • Surgical therapy indicated if • Presence of gallstones •

Acute Pancreatitis Collaborative Care • Surgical therapy indicated if • Presence of gallstones • Uncertain diagnosis • Unresponsive to conservative therapy • Abscess, pseudocyst, or severe peritonitis Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 38

Acute Pancreatitis Collaborative Care • Surgical therapy • ERCP • Endoscopic sphincterotomy • Laparoscopic

Acute Pancreatitis Collaborative Care • Surgical therapy • ERCP • Endoscopic sphincterotomy • Laparoscopic cholecystectomy Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 39

Acute Pancreatitis Collaborative Care • Drug therapy • IV morphine • Nitroglycerin or papaverine

Acute Pancreatitis Collaborative Care • Drug therapy • IV morphine • Nitroglycerin or papaverine • Antispasmodics • Carbonic anhydrase inhibitors • Antacids • Histamine (H 2) receptor blockers Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 40

Acute Pancreatitis Collaborative Care • Nutritional therapy • NPO status initially to reduce pancreatic

Acute Pancreatitis Collaborative Care • Nutritional therapy • NPO status initially to reduce pancreatic secretion • IV lipids • Monitor triglycerides. • Small, frequent feedings • High-carbohydrate, low-fat, high-protein diet Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 41

Acute Pancreatitis Collaborative Care • Nutritional therapy (cont’d) • Supplemental fat-soluble vitamins • No

Acute Pancreatitis Collaborative Care • Nutritional therapy (cont’d) • Supplemental fat-soluble vitamins • No alcohol Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 42

Acute Pancreatitis Nursing Assessment • Health history • Biliary tract disease • Alcohol use

Acute Pancreatitis Nursing Assessment • Health history • Biliary tract disease • Alcohol use • Abdominal trauma • Duodenal ulcers • Infection • Metabolic disorders Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 43

Acute Pancreatitis Nursing Assessment • Medication usage • Thiazides, estrogens, corticosteroids, NSAIDs • Surgical

Acute Pancreatitis Nursing Assessment • Medication usage • Thiazides, estrogens, corticosteroids, NSAIDs • Surgical procedures • Nausea/vomiting • Dyspnea • Severe pain Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 44

Acute Pancreatitis Nursing Assessment • Physical examination findings • Fever • Jaundice • Discoloration

Acute Pancreatitis Nursing Assessment • Physical examination findings • Fever • Jaundice • Discoloration of abdomen/flank • Tachycardia • Hypotension • Abdominal distention/tenderness Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 45

Acute Pancreatitis Nursing Assessment • Abnormal laboratory findings • ↑ serum amylase/lipase • Leukocytosis

Acute Pancreatitis Nursing Assessment • Abnormal laboratory findings • ↑ serum amylase/lipase • Leukocytosis • Hyperglycemia • Hyperlipidemia • Hypocalcemia • Abnormal ultrasound/CT/ERCP Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 46

Acute Pancreatitis Nursing Diagnoses • Acute pain • Deficient fluid volume • Imbalanced nutrition:

Acute Pancreatitis Nursing Diagnoses • Acute pain • Deficient fluid volume • Imbalanced nutrition: Less than body requirements • Ineffective self-health management Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 47

Acute Pancreatitis Planning • Overall goals • Relief of pain • Normal fluid and

Acute Pancreatitis Planning • Overall goals • Relief of pain • Normal fluid and electrolyte balance • Minimal to no complications • No recurrent attacks Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 48

Acute Pancreatitis Nursing Implementation • Health promotion • Assessment of predisposing factors • Early

Acute Pancreatitis Nursing Implementation • Health promotion • Assessment of predisposing factors • Early diagnosis/treatment of cholelithiasis • Elimination of alcohol intake Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 49

Acute Pancreatitis Nursing Implementation • Acute intervention • • • Monitoring vital signs IV

Acute Pancreatitis Nursing Implementation • Acute intervention • • • Monitoring vital signs IV fluids Observation of side effects of medications Assessment of respiratory function Pain assessment and management • Frequent position changes • Side-lying with HOB elevated 45 degrees • Knees up to abdomen Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 50

Acute Pancreatitis Nursing Implementation • Acute intervention (cont’d) • Fluid/electrolyte balance • Blood glucose

Acute Pancreatitis Nursing Implementation • Acute intervention (cont’d) • Fluid/electrolyte balance • Blood glucose monitoring • Monitoring for signs of hypocalcemia • Tetany (jerking, irritability, twitching) • Numbness around lips/fingers • Positive Chvostek’s or Trousseau’s sign • Monitoring for hypomagnesemia Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 51

Acute Pancreatitis Nursing Implementation • Acute intervention (cont’d) • NG tube care • Frequent

Acute Pancreatitis Nursing Implementation • Acute intervention (cont’d) • NG tube care • Frequent oral/nasal care • Observation for signs of infection • Wound care • Observation for paralytic ileus, renal failure, mental changes Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 52

Acute Pancreatitis Nursing Implementation • Ambulatory and home care • Physical therapy • Counseling

Acute Pancreatitis Nursing Implementation • Ambulatory and home care • Physical therapy • Counseling regarding abstinence from alcohol, caffeine, and smoking • Assessment of narcotic addiction Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 53

Acute Pancreatitis Nursing Implementation • Ambulatory and home care (cont’d) • Dietary teaching •

Acute Pancreatitis Nursing Implementation • Ambulatory and home care (cont’d) • Dietary teaching • High-carbohydrate, low-fat diet • Patient/family teaching • Signs of infection, high blood glucose, steatorrhea • Medications/diet Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 54

Acute Pancreatitis Nursing Implementation • Expected outcomes • Have adequate pain control • Maintain

Acute Pancreatitis Nursing Implementation • Expected outcomes • Have adequate pain control • Maintain adequate fluid volume • Be knowledgeable about treatment regimen • Get help for alcohol dependence, if appropriate Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 55

Chronic Pancreatitis • Continuous, prolonged inflammatory, and fibrosing process of the pancreas • Pancreas

Chronic Pancreatitis • Continuous, prolonged inflammatory, and fibrosing process of the pancreas • Pancreas becomes destroyed as it is replaced by fibrotic tissue. • Strictures and calcifications can also occur. Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 56

Chronic Pancreatitis Etiology and Pathophysiology • May follow acute pancreatitis • May occur in

Chronic Pancreatitis Etiology and Pathophysiology • May follow acute pancreatitis • May occur in the absence of any history of an acute condition • Two major types • Chronic obstructive pancreatitis • Chronic nonobstructive pancreatitis Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 57

Chronic Pancreatitis Etiology and Pathophysiology • Chronic obstructive pancreatitis • Associated with biliary disease

Chronic Pancreatitis Etiology and Pathophysiology • Chronic obstructive pancreatitis • Associated with biliary disease • Most common cause of this type • Inflammation of the sphincter of Oddi associated with cholelithiasis • Other causes include • Cancer of ampulla of Vater, duodenum, or pancreas Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 58

Chronic Pancreatitis Etiology and Pathophysiology • Chronic nonobstructive pancreatitis • Inflammation • Sclerosis •

Chronic Pancreatitis Etiology and Pathophysiology • Chronic nonobstructive pancreatitis • Inflammation • Sclerosis • Mainly in the head of the pancreas and around the pancreatic duct • Most common form of chronic pancreatitis Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 59

Chronic Pancreatitis Clinical Manifestations • Abdominal pain • Located in the same areas as

Chronic Pancreatitis Clinical Manifestations • Abdominal pain • Located in the same areas as in acute pancreatitis • Heavy, gnawing feeling; burning and cramplike • Abdominal tenderness • Malabsorption with weight loss Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 60

Chronic Pancreatitis Clinical Manifestations • Constipation • Mild jaundice with dark urine • Steatorrhea

Chronic Pancreatitis Clinical Manifestations • Constipation • Mild jaundice with dark urine • Steatorrhea • Frothy urine/stool • Diabetes mellitus Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 61

Chronic Pancreatitis Clinical Manifestations • Complications include • Pseudocyst formation • Bile duct or

Chronic Pancreatitis Clinical Manifestations • Complications include • Pseudocyst formation • Bile duct or duodenal obstruction • Pancreatic ascites • Pleural effusion Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 62

Chronic Pancreatitis Clinical Manifestations • Complications (cont’d) • Splenic vein thrombosis • Pseudoaneurysm •

Chronic Pancreatitis Clinical Manifestations • Complications (cont’d) • Splenic vein thrombosis • Pseudoaneurysm • Pancreatic cancer Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 63

Chronic Pancreatitis Diagnostic Studies • Confirming diagnosis can be challenging. • Based on signs/symptoms,

Chronic Pancreatitis Diagnostic Studies • Confirming diagnosis can be challenging. • Based on signs/symptoms, laboratory studies, and imaging Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 64

Chronic Pancreatitis Diagnostic Studies • Laboratory tests • Serum amylase/lipase • May be ↑

Chronic Pancreatitis Diagnostic Studies • Laboratory tests • Serum amylase/lipase • May be ↑ slightly or not at all • ↑ serum bilirubin • ↑ alkaline phosphatase Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 65

Chronic Pancreatitis Diagnostic Studies • Laboratory tests (cont’d) • Mild leukocytosis • Elevated sedimentation

Chronic Pancreatitis Diagnostic Studies • Laboratory tests (cont’d) • Mild leukocytosis • Elevated sedimentation rate • ERCP • Visualization of pancreatic/common bile duct • Stool samples Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 66

Chronic Pancreatitis Diagnostic Studies • CT • MRI • MRCP • Transabdominal ultrasound •

Chronic Pancreatitis Diagnostic Studies • CT • MRI • MRCP • Transabdominal ultrasound • EUS Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 67

Chronic Pancreatitis Diagnostic Studies • Secretin stimulation test • Assessment of degree of pancreatic

Chronic Pancreatitis Diagnostic Studies • Secretin stimulation test • Assessment of degree of pancreatic function • Not useful in diagnosis Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 68

Chronic Pancreatitis Collaborative Care • Prevention of attacks • During acute attack, follow acute

Chronic Pancreatitis Collaborative Care • Prevention of attacks • During acute attack, follow acute therapy. • Relief of pain • Control of pancreatic exocrine and endocrine insufficiency Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 69

Chronic Pancreatitis Collaborative Care • Bland low-fat, high-carbohydrate diet • Bile salts • Help

Chronic Pancreatitis Collaborative Care • Bland low-fat, high-carbohydrate diet • Bile salts • Help absorption of fat-soluble vitamins • Prevent further fat loss • Control of diabetes • No alcohol Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 70

Chronic Pancreatitis Collaborative Care • Pancreatic enzyme replacement • Acid-neutralizing and acid-inhibiting drugs Copyright

Chronic Pancreatitis Collaborative Care • Pancreatic enzyme replacement • Acid-neutralizing and acid-inhibiting drugs Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 71

Chronic Pancreatitis Collaborative Care • Surgery • Indicated when biliary disease is present, or

Chronic Pancreatitis Collaborative Care • Surgery • Indicated when biliary disease is present, or if obstruction or pseudocyst develops • Diverts bile flow or relieves ductal obstruction Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 72

Chronic Pancreatitis Nursing Management • Focus is on chronic care and health promotion. •

Chronic Pancreatitis Nursing Management • Focus is on chronic care and health promotion. • Dietary control • No alcohol • Control of diabetes • Taking pancreatic enzymes • Patient and family teaching Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 73

Audience Response Question The nurse explains to a patient with an episode of acute

Audience Response Question The nurse explains to a patient with an episode of acute pancreatitis that the most effective means of relieving pain by suppressing pancreatic secretions is the use of: 1. Antibiotics. 2. NPO status. 3. Antispasmodics. 4. H 2 R blockers or proton pump inhibitors. Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 74

Case Study Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier

Case Study Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 75

Case Study • 63 -year-old woman enters the emergency department with nausea, vomiting, epigastric

Case Study • 63 -year-old woman enters the emergency department with nausea, vomiting, epigastric pain, left upper quadrant pain. • She claims the pain is severe, sharp, and boring and radiates through to her midback. Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 76

Case Study • Pain began 24 hours ago. • She is divorced and retired,

Case Study • Pain began 24 hours ago. • She is divorced and retired, and smokes a half-pack of cigarettes a day. Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 77

Case Study • Vital signs • Blood pressure 100/70 • Heart rate 97 •

Case Study • Vital signs • Blood pressure 100/70 • Heart rate 97 • Respiratory rate 30 • Temperature 100. 2°F • She is diagnosed with acute pancreatitis and is admitted to the medical-surgical unit. Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 78

Discussion Questions 1. What are the possible causes of pancreatitis? 2. What is her

Discussion Questions 1. What are the possible causes of pancreatitis? 2. What is her priority of care? Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 79

Discussion Questions 3. What laboratory tests are the most important to monitor in acute

Discussion Questions 3. What laboratory tests are the most important to monitor in acute pancreatitis? 4. What patient teaching should you do with her? Copyright © 2011, 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 80