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PP03L039 - Disorders of The Pancreas
PP03L039 - Disorders of The Pancreas
Exocrine function
Pancreatic juice
Endocrine function
Hormones
Etiology/Pathophysiology of
Pancreatitis
Inflammation of the pancreas
Reflux of bile and duodenal contents leads to
autodigestion
Swelling results in impaired release of pancreatic
contents
Obstruction leads to further autodigestion
Etiology/Pathophysiology of
Pancreatitis
Structural/vascular abnormalities
Trauma or disruption of the pancreatic fluids
Infectious disease
Metabolic disorders Inflammatory bowel disease
Heredity
Excessive alcohol intake and certain drugs
Refeeding after prolonged fasting or anorexia
Clinical Manifestations
Necrosis, caused by autodigestion
hyperglycemia, hypocalcemia
Hemorrhage of the gland with hypovolemic
shock
Peritonitis, pancreatic abscess, pseudocyst
Clinical Manifestations
Severe fluid and electrolyte imbalance, acute
renal failure
Sepsis
Pleural effusion, ARDS
Blood coagulopathies
Assessment
The most common- Severe mid upper
abdominal pain, which may radiate to both
sides and straight up the back
Nausea, vomiting and flatulence
Stools may be frothy and foul smelling
Jaundice may be noted if common bile duct is
obstructed
Assessment
Bowel sounds may be diminished, with
abdominal distention and tenderness
Hypotension and hypovolemia
May also have Cullen’s and Turner’s signs
Fever, tachycardia
Chvostek’s sign
Trousseau’s sign
Cullen’s Sign
Chvostek’s Sign
Trousseau’s Sign
Diagnosis
Elevated serum and urine amylase, lipase and
AST/ALT levels
Billirubin level may be elevated with obstructed
common bile duct
Elevated WBC level indicated by CBC
Hyperglycemia, hypocalcemia, hypokalemia,
hypomagnesemia
CT scan (pancreatic edama and necrosis)
Diagnosis
Endoscopic and Ultrasound exams to
determine pancreatic cysts, abscesses and
pseudocysts (fibrous capsules filled with fluid,
blood, enzymes, pus and tissue debris)
Medical Management
Measures to relieve pain and spasms
Restore fluid and electrolyte loss
Prevent or treat systemic complications
Clear liquid diet with progression to low fat diet
Avoid digestive stimulants
Etiology/Pathopysiology of Chronic
Pancreatitis
Chronic pancreatitis is defined as
prolonged,progressive inflammation of the
pancreas
The gland undergoes fibrotic scarring
recurrent inflammation
The pancreas hardens and exocrine and
endocrine functions are partly or completely
lost as pancreatic tissue is destroyed
Etiology/Pathopysiology of Chronic
Pancreatitis
The most common cause is chronic alcoholism
Hyperparathyroidism
Trauma to the pancreas
Heredity pancreatitis
Hypertriglyceridemia
Etiology/Pathopysiology of Chronic
Pancreatitis
Autoimmune pancreatitis
Repeatedly formed gallstones
Most causes are similar to acute pancreatitis
Some causes are unknown
Complications
Simliar to those of acute pancreatitis
Biliary tract obstruction
Partial to complete loss of gland function
Assessment
Persistent pain in epigastrium or LUQ
radiating to the back
Weight loss
Flatulence, vomiting, and diarrhea
Firm mass may be felt in upper left quadrant
Light colored and foul smelling stools,
steatorrhea
Assessment
If pseudocysts are present, they contribute to
the severity of symptoms
If secondary diabetes occurs, patient may have
increased appetite, thirst and urination
Peripheral edema and ascites
Diagnostic procedures
Abnormal labs, as with acute pancreatitis
CT, MRI and Ultrasound
ERCP (Endoscopic Retrograde
Cholangiopancretography)
Glucose tolerance test
Medical Management
Depends on the cause and weather pancreatic
duct is obstructed
If no obstruction
Abstinence from alcohol
Clear liquid, advance to fat free diet
Correction of biliary tract disease and/or
hyperparathyriodism may give good results
Medical Management
Demerol is ordered cautiously
Insulin and pancreatic enzyme replacement
Pancreatin (Creon, Bioglan, Panazyme, Creon 10 and
Creon 20, Protilase, Ultrase, Viokase, Zymase,
Pancreacarb)
Partcial or total pancreatectomy
Reconstitution of the duct with scarring, stricture
and stenosis
Pancreatic autotransplantation
Nursing Diagnoses Associated with
Pancreatitis
Pain R/T stimulation of nerve endings caused
by enlargement of the pancreatic capsule,
obstruction, or chemical irritation from
enzymes
Ineffective breathing R/T pain, ascites
High risk for fluid volume deficit R/T
vomiting, diarrhea, gastric decompression, fluid
shifts, decrease oral intake, hemorrhage
Nursing Diagnoses Associated with
Pancreatitis
High risk for altered nutrition R/T
malabsorption, N/V, pain
High risk for ineffective management of
therapeutic regimen R/T to insufficient
knowledge or self care, diet therapy
Etiology/Pathophysiology of
Pancreatic Cancer
Pancreatic cancer is the fourth leading cause of cancer
death in men and sixth in women
High death rate attributed to the difficulty in
diagnosing the cancer at a curable stage
Occurs after middle age with peak incidence around
age 60
Found in cigarette smokers, those exposed to chemical
carcinogens and people with diabetes mellitus
Etiology/Pathophysiology of
Pancreatic Cancer
Linked to diet high in meat, fat and coffee
consumption
May be primary or metastasis from lung,
stomach, duodenum or common bile
Tumor grows rapidly and quickly invades
surrounding organs and tissue
Many patients only live 4 to 8 months after
diagnoses
Assessment of Pancreatic Cancer
Vague symptoms, which accounts for the delay
in diagnosis
Pain present in 85% of cases
Anorexia, nausea, flatulence, change in stools
Fatigue
Assessment of Pancreatic Cancer
Steady, dull and aching pain in the epigastrium
or referred to the back; usually worse at night
Weight loss
Jaundice, pruritis
Recent onset of diabetes mellitus
Medical Management
Definitive diagnosis before surgery is difficult
However, tumors are usually inoperable by the time
a diagnoses is made
Whipple produce often performed
Total pancreatectomy with resection of parts of the
GI tract
Subtotal pancretectomy has complication of
postoperative pancreatic fistulas and is not
recommended
Medical Management
Medical Management
Adjuvant therapy (surgical resection, radiation
and chemotherapy) is believed by some to be the
most effective treatment of the almost always
fatal pancreatic cancer
Immediate post-operative care is usually done in
the intensive care setting
Review of Main Points
Structureand function of the pancreas
Acute pancreatitis
Chronic pancreatitis
Pancreatic cancer
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