Acute Pancreatitis Overview
44 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most common cause of acute pancreatitis in the United States?

  • Gallbladder disease (gallstones) (correct)
  • Pancreatic cancer
  • Chronic alcohol use
  • Drug reactions

    • Which of the following is a mechanism by which gallstones can lead to acute pancreatitis?

  • Increased lipid production by the pancreas
  • Formation of microlithiasis in the intestine
  • Direct injury to pancreatic cells by gallstones
  • Reflux of bile acids into the pancreatic ducts (correct)

    • Which symptom is most characteristic of acute pancreatitis?

  • Severe abdominal pain that may radiate to the back (correct)
  • Severe headache
  • Chest pain radiating to the shoulder
  • Persistent cough with sputum

    • What percentage of patients with severe pancreatitis may experience permanent decreases in pancreatic function?

    <p>50% (D)</p> Signup and view all the answers

    Which condition is NOT a recognized cause of acute pancreatitis?

    <p>Gastroesophageal reflux disease (B)</p> Signup and view all the answers

    In acute pancreatitis, the pain is typically described as:

    <p>Severe, deep, piercing, and continuous (A)</p> Signup and view all the answers

    What is the overall fatality rate associated with severe pancreatitis?

    <p>9% (D)</p> Signup and view all the answers

    What triggers the autodigestion of the pancreas in acute pancreatitis?

    <p>Spillage of pancreatic enzymes into surrounding tissue (C)</p> Signup and view all the answers

    What is a key preventive measure against respiratory tract infections in patients post-surgery?

    <p>Assuming a semi-Fowler’s position (C)</p> Signup and view all the answers

    What is important to teach patients regarding dietary management after acute pancreatitis?

    <p>Restrict fat intake to reduce cholecystokinin stimulation (A)</p> Signup and view all the answers

    What condition should be monitored for signs in patients recovering from surgery that involves drainage or cyst treatment?

    <p>Paralytic ileus (B)</p> Signup and view all the answers

    Why should patients post-acute pancreatitis avoid crash and binge dieting?

    <p>It can precipitate future attacks of pancreatitis (C)</p> Signup and view all the answers

    What type of nurse should be consulted for managing wound care in patients with complications like anastomotic leaks?

    <p>Wound, ostomy, and continence nurse (WOCN) (D)</p> Signup and view all the answers

    What is the purpose of using skin barriers in patients recovering from surgery?

    <p>To prevent skin irritation and facilitate fluid loss measurement (A)</p> Signup and view all the answers

    Which symptom indicates ongoing destruction of pancreatic tissue and pancreatic insufficiency?

    <p>Diarrhea with foul-smelling, fatty stools (D)</p> Signup and view all the answers

    What is an expected outcome for a patient recovering from acute pancreatitis?

    <p>Maintenance of adequate fluid and electrolyte balance (D)</p> Signup and view all the answers

    What is often the first position a patient assumes to relieve severe pain associated with acute pancreatitis?

    <p>Recumbent (D)</p> Signup and view all the answers

    Which of the following complications is directly associated with the development of a pancreatic pseudocyst?

    <p>Rupture into the stomach (D)</p> Signup and view all the answers

    What symptom is indicative of severe disease due to hypocalcemia during acute pancreatitis?

    <p>Tetany (D)</p> Signup and view all the answers

    What common diagnostic tests are used to confirm acute pancreatitis?

    <p>Serum amylase and lipase (B)</p> Signup and view all the answers

    Which complication is often associated with the extensive necrosis occurring in pancreatitis?

    <p>Pancreatic abscess (B)</p> Signup and view all the answers

    What is typically the effect of trypsin on patients with acute pancreatitis?

    <p>Intravascular clot formation (D)</p> Signup and view all the answers

    Which sign is described as a bluish discoloration of the periumbilical area?

    <p>Cullen sign (B)</p> Signup and view all the answers

    What is one of the primary goals of interprofessional care in patients with acute pancreatitis?

    <p>Prevent or treat infection (A)</p> Signup and view all the answers

    What imaging modality is considered the best for diagnosing pancreatitis and related complications?

    <p>CT scan (C)</p> Signup and view all the answers

    In managing hypotension due to acute pancreatitis, which treatment is administered?

    <p>Blood volume replacements (B)</p> Signup and view all the answers

    Which of the following symptoms is less likely observed in a patient experiencing acute pancreatitis?

    <p>Severe headaches (B)</p> Signup and view all the answers

    What may occur as a result of a pancreatic pseudocyst perforating?

    <p>Peritonitis (A)</p> Signup and view all the answers

    What is a common non-surgical management option for pain relief in acute pancreatitis?

    <p>IV opioid analgesics (B)</p> Signup and view all the answers

    Which systemic complication can occur as a result of fluid shifts in acute pancreatitis?

    <p>Respiratory distress syndrome (D)</p> Signup and view all the answers

    What does NPO status aim to achieve in patients with acute pancreatitis?

    <p>Allow pancreatic rest (B)</p> Signup and view all the answers

    Which of the following treatments is typically reserved for patients who cannot tolerate enteral nutrition?

    <p>Total parenteral nutrition (B)</p> Signup and view all the answers

    What is the primary goal of monitoring vital signs in patients with acute pancreatitis?

    <p>To ensure hemodynamic stability (A)</p> Signup and view all the answers

    What signs may indicate hypocalcemia in a patient with acute pancreatitis?

    <p>Numbness or tingling around the lips (D)</p> Signup and view all the answers

    What surgical procedure may be performed when acute pancreatitis is caused by gallstones?

    <p>Laparoscopic cholecystectomy (C)</p> Signup and view all the answers

    What is a significant complication of acute necrotizing pancreatitis?

    <p>Sepsis due to infection (D)</p> Signup and view all the answers

    Which of the following diets is recommended when oral intake is resumed for a patient recovering from acute pancreatitis?

    <p>High in carbohydrates (B)</p> Signup and view all the answers

    Why are vasoactive drugs such as dopamine used in treating hypotension related to pancreatitis?

    <p>To increase systemic vascular resistance (C)</p> Signup and view all the answers

    What is the main reason for using NG suction in patients with acute pancreatitis?

    <p>To reduce gastric distention (A)</p> Signup and view all the answers

    Which symptom is a clear indication of intolerance to oral foods in a patient with acute pancreatitis?

    <p>Increasing abdominal girth (B)</p> Signup and view all the answers

    In managing a patient with acute pancreatitis, what should be closely monitored due to the risk of metabolic instability?

    <p>Serum magnesium levels (C)</p> Signup and view all the answers

    What is one of the overall goals in the planning stage for a patient with acute pancreatitis?

    <p>Achieve pain relief (C)</p> Signup and view all the answers

    Which nursing intervention is essential for a patient who has an NG tube?

    <p>Providing frequent oral care (D)</p> Signup and view all the answers

    What approach may be taken if a patient shows signs of infection during the management of acute pancreatitis?

    <p>Administer IV antibiotics early (B)</p> Signup and view all the answers

    Study Notes

    Acute Pancreatitis Overview

    • Acute pancreatitis is inflammation of the pancreas, causing autodigestion and severe pain.
    • Inflammation ranges from mild edema to severe hemorrhagic necrosis.

    Etiology and Pathophysiology

    • Most common causes in the US are gallbladder disease (gallstones, more common in women) and chronic alcohol use (more common in men).
    • Other causes include drug reactions, pancreatic cancer, and hypertriglyceridemia (serum levels >1000 mg/dL).
    • Biliary sludge and microlithiasis (cholesterol crystals and calcium salts) can be present.
    • The primary pathogenic mechanism is autodigestion.
    • Injury to pancreatic cells or activation of enzymes within the pancreas (rather than the intestines) occurs. Often bile reflux into pancreatic ducts through an open or distended sphincter of Oddi (often from gallstones). This can lead to pancreatic ischemia.
    • The mechanism of alcohol-induced pancreatitis is not fully understood, but thought to increase digestive enzyme production.
    • Acute pancreatitis can be either mild (edematous or interstitial) or severe (necrotizing).
    • Severe pancreatitis carries a high risk of pancreatic necrosis, organ failure, and septic complications, with an overall fatality rate of 9%.

    Clinical Manifestations

    • Main symptom is severe, deep, piercing abdominal pain (often sudden onset), in the left upper quadrant or mid-epigastric, radiating to the back.
    • Worsened by eating, unrelieved by vomiting.
    • May be accompanied by flushing, cyanosis, dyspnea, and positions involving trunk flexion to relieve the pain.
    • Other symptoms include nausea, vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice.
    • Abdominal tenderness with muscle guarding, decreased or absent bowel sounds, and paralytic ileus (marked abdominal distention) is common.
    • Potential for lung involvement (crackles)
    • Intravascular damage from trypsin can cause abdominal wall cyanosis or discoloration (greenish to yellow-brown).
    • Bruising on flanks (Grey Turner spots) and periumbilical area (Cullen's sign). These are bloodstained exudate from the pancreas.
    • Shock can occur from bleeding, toxemia, or hypovolemia from fluid shifts.

    Complications

    • Severity depends on the extent of pancreatic destruction.
    • Can be life-threatening, but some patients recover completely, others recur, and some develop chronic pancreatitis.
    • Local complications:
      • Pseudocysts: Fluid/enzyme collection with a wall, causing abdominal pain and a palpable mass. Often resolve but can rupture.
        • Treatment includes surgical or endoscopic/percutaneous drainage.
      • Abscesses: Infection of a pseudocyst, causing upper abdominal pain, mass, high fever, and leukocytosis.
        • Requires prompt surgical drainage.
    • Systemic complications:
      • Cardiovascular and pulmonary issues (pleural effusion, atelectasis, pneumonia, ARDS) are common.
      • Pulmonary complications are from exudate-containing pancreatic enzymes from the peritoneal cavity.
      • Trypsin activation can increase risk for thrombi, emboli, and DIC.
      • Tetany (hypocalcemia) can result from calcium and fatty acids combining during fat necrosis.
      • Abdominal compartment syndrome from intra-abdominal hypertension and edema.

    Diagnostic Studies

    • Key tests are serum amylase and lipase (often elevated early, high for 24-72 hours). Lipase is a more specific marker.
    • Other abnormalities include increased liver enzymes, triglycerides, glucose, and bilirubin; and decreased calcium.
    • Imaging: Ultrasound, x-ray, and contrast-enhanced CT scan helpful to diagnose pancreatic issues. CT scan is best for complications like pseudocysts/abscesses. ERCP, EUS, MRCP, and angiography can also be used.

    Interprofessional Care

    • Goals: Pain relief, prevent/alleviate shock, reduce pancreatic secretions, correct fluid/electrolyte imbalances, prevent/treat infection.
    • Initial treatment involves aggressive hydration, pain management, and minimizing pancreatic stimulation.
    • Pain management through IV opioids and often an antispasmodic agent.
    • Avoid anticholinergics if paralytic ileus is present.
    • Reduce pancreatic secretions: NPO, NG suction, drugs to suppress gastric acid.
    • Prevent infections, especially in severe necrotizing pancreatitis, with close monitoring and antibiotic therapy if infection occurs.

    Treatments (cont'd)

    • For gallstone-related pancreatitis : ERCP with sphincterotomy and potentially later cholecystectomy.
    • Surgical or endoscopic drainage may be needed for necrotic fluid collections or pseudocysts.

    Drug Therapy

    • Many drugs are used but no cure exists.

    Nutrition Therapy

    • Initially, patients are NPO to reduce pancreatic stimulation.
    • Enteral nutrition (EN) is started based on severity; parenteral nutrition (PN) is used for those who can't tolerate EN.
    • Monitor blood triglyceride levels if IV lipids are administered.
    • Transition to small, frequent, high-carbohydrate meals as tolerated, avoiding crash diets.

    Nursing Management

    • Key assessments: subjective and objective data based on complications and potential issues (detailed in Table 48.21).
    • Clinical problems: pain, fluid imbalance, electrolyte imbalance, malnutrition.
    • Planning: goals include pain relief, normal fluid/electrolyte balance, minimal complications, and no recurrence.
    • Implementation: health promotion that focuses on assessment of risk factors and early intervention; acute care involving vital sign monitoring, assessing fluid/electrolyte balance, addressing potential respiratory complications for severe pancreatitis, and treating complications like hypocalcemia.
    • Observation for infections and preventing them including maintaining oral/nasal care (especially when taking anticholinergics).

    Ambulatory Care

    • Home care, physical therapy, continued infection prevention and complication detection.
    • Counseling on abstinence from alcohol and smoking cessation (nicotine stimulates pancreas).
    • Patient and caregiver education on the treatment plan, importance of medications, and a low-fat diet with high carbohydrates.
    • Recognizing and reporting signs of infection, diabetes, or steatorrhea, and any exogenous enzyme supplementation needs.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    This quiz covers the essential aspects of acute pancreatitis, including its etiology, pathophysiology, and common causes. Understand the mechanisms involved in pancreatic inflammation, from gallbladder disease to alcohol use. Learn about the effects of autodigestion and injury to pancreatic cells.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser