Pancreatitis Quiz 2

Pathophysiology of Acute Pancreatitis

• Acute pancreatitis pathophysiology is best described as the premature activation of pancreatic enzymes, leading to autodigestion
• Pancreatic enzyme activation within the pancreas results in pancreatic tissue digestion, inflammation, and potential necrosis
• Severe epigastric pain radiating to the back is a hallmark assessment finding for acute pancreatitis
• Processes involved are Hemorrhage, Necrosis, and Reflux through the Sphincter of Oddi
• Pancreatic necrosis can release inflammatory mediators, leading to multi-organ dysfunction
• Pancreatitis is caused by the premature activation of enzymes in the pancreas, causing self-digestion
• Reflux through a distended Sphincter of Oddi can cause premature enzyme activation in the pancreas
• Chronic steroid use is a risk factor because it can lead to hyperlipidemia and fat metabolism issues, contributing to pancreatic inflammation

Etiology, Incidence, and Risk Factors

• Gallstones are the number one cause of acute pancreatitis due to blockage of pancreatic ducts
• Heavy alcohol use increases pancreatitis risk by stimulating pancreatic enzyme production and causing ductal injury
• A 35-year-old female in her third trimester of pregnancy with a history of gallstones is at highest risk for developing pancreatitis
• Risk factors include infections, gallbladder disease, pregnancy, and steroid use
• Chronic pancreatitis commonly is related to repeated inflammation from alcohol use or duct obstruction, leading to irreversible damage
• For suspected pancreatitis in a pregnant client in their third trimester, notify the provider and initiate NPO status
• An increase in gallstone-related admissions can lead to more pancreatitis cases

Clinical Manifestations – Acute & Chronic Pancreatitis

• Cullen’s sign involves periumbilical bruising specific to acute pancreatitis, and is a classic sign of intra-abdominal bleeding
• A common skin finding in a patient with acute pancreatitis is cool, pale, and moist skin due to shock or systemic inflammation
• Clinical signs indicating acute pancreatitis include severe epigastric pain radiating to the back, mild jaundice, bruising on the flanks, and abdominal distention with decreased bowel sounds
• A nurse should prioritize monitoring epigastric pain radiating to the back for acute pancreatitis
• Cullen’s sign suggests retroperitoneal hemorrhage, a serious complication of acute pancreatitis
• Decreased enzyme secretion impairs fat digestion, leading to fatty stools (steatorrhea)
• LUQ pain after eating a fatty meal and recent weight loss, points to fat malabsorption due to decreased enzyme production in chronic pancreatitis
• Damage to the islet cells from chronic pancreatitis leads to impaired insulin secretion, resulting in diabetes
• Findings that are more consistent with chronic pancreatitis include LUQ abdominal pain, steatorrhea, weight loss, and DM
• Bile accumulation from impaired drainage causes jaundice and dark urine
• A blood glucose of 320 mg/dL suggests uncontrolled diabetes and requires prompt intervention
• Recurrent LUQ pain and steatorrhea after fatty meals indicates pancreatic dysfunction characteristic of chronic pancreatitis

Complications

• Pancreatic necrosis involves tissue death and can lead to systemic infection, sepsis, and multi-organ failure (life-threatening)
• Complications that can occur due to chronic pancreatitis include malabsorption, diabetes mellitus, pancreatic pseudocyst, and respiratory distress
• Notify the provider immediately for a patient with a known pancreatic pseudocyst who suddenly reports sharp abdominal pain and dizziness because it is a medical emergency of cyst rupture or hemorrhage
• A pancreatic abscess presents with signs of localized infection as indicated by fever, elevated WBCs, and increasing abdominal pain
• Impaired enzyme production in chronic pancreatitis leads to poor digestion and absorption of fats
• Confusion, decreased urine output, and jaundice are classic indicators of multi-organ involvement

Diagnostics & Laboratory Findings

• MRCP (Magnetic Resonance Cholangiopancreatography) uses a magnetic technique to visualize the biliary and pancreatic ducts
• Amylase (and lipase) are key pancreatic enzymes that are elevated during acute inflammation
• Elevated pancreatic enzymes, especially amylase and lipase, are classic markers of acute pancreatitis
• Diagnostic tests to evaluate suspected pancreatitis include CT scan, MRCP, ERCP, and ultrasound
• ERCP is invasive and may cause post-procedure pancreatitis or introduce infection due to duct manipulation

Nursing & Collaborative Interventions

• Maintaining NPO status is essential for the early management of acute pancreatitis, allowing the pancreas to rest
• Priority interventions for a patient with acute pancreatitis include IV hydration, pain control, gut rest (NG tube), and nutritional support
• TPN may be initiated when oral intake is not possible to meet nutritional needs while resting the pancreas
• PPIs reduce gastric acid secretion, which helps decrease pancreatic stimulation
• A statement that indicates correct understanding of dietary changes is to avoid alcohol and fatty foods completely
• An alcohol withdrawal protocol is crucial to prevent or manage life-threatening complications in hospitalized patients
• Maintain strict NPO status and manage pain pre-operatively because pre-op care focuses on gut rest and pain control