NURS 308: TOPIC 18 - PANCREAS & BILIARY TRACT PROBLEMS

What are the two most common causes of acute pancreatitis?

Gallbladder disease & chronic alcohol intake

Which cause of acute pancreatitis is most common in women?

Gallbladder disease

Which cause of acute pancreatitis is most common in men?

Chronic alcohol intake

What are some less common causes of acute pancreatitis?

Drug reactions (thiazides, NSAIDs), pancreatic cancer, hypertriglyceridemia, abdominal trauma, duodenal ulcers, infection, metabolic disorders, ERCP

How can ERCP lead to acute pancreatitis?

By irritating the pancreas and triggering inflammation

What is ERCP?

Endoscopic Retrograde Cholangiopancreatography, a procedure used to diagnose and treat biliary and pancreatic conditions

Why is the incidence of acute pancreatitis increasing in adults and children?

Sedentary lifestyle, diabetes, and increased consumption of processed foods

What is acute pancreatitis?

Acute inflammatory process of the pancreas.

What causes the severe pain in acute pancreatitis?

Pancreatic enzymes spill into surrounding pancreatic tissue, causing autodigestion.

What enzyme is activated within the pancreas in acute pancreatitis?

Trypsinogen is activated to trypsin.

Why is trypsin activation dangerous in acute pancreatitis?

It leads to autodigestion and bleeding within the pancreas.

What is autodigestion in acute pancreatitis?

The pancreas begins to digest its own tissue due to enzyme activation.

What fluid-related complication occurs in acute pancreatitis?

Third spacing and fluid shifts occur.

Why are fluid shifts clinically significant in acute pancreatitis?

They can lead to hypovolemia and require careful fluid management.

Acute pancreatitis — what is the hallmark clinical manifestation?

Abdominal pain

Where is the pain located in acute pancreatitis?

Left upper quadrant or mid-epigastrium, radiating to the back

What is the character of the pain in acute pancreatitis?

Sudden onset, deep, piercing, continuous

What aggravates the pain in acute pancreatitis?

Eating and lying in the recumbent position

Is the pain relieved by vomiting in acute pancreatitis?

No, it is not relieved by vomiting

What abdominal finding is common in acute pancreatitis?

Abdominal tenderness with muscle guarding

What happens to bowel sounds in acute pancreatitis?

Decreased or absent bowel sounds

What lung finding may be present in acute pancreatitis?

Crackles in the lungs (especially basilar)

What cardiovascular signs may be seen in acute pancreatitis?

Tachycardia and hypotension

What respiratory rate change may occur in acute pancreatitis?

Tachypnea

What are common neuro/psych symptoms in acute pancreatitis?

Restlessness and anxiety

What temperature change may occur in acute pancreatitis?

Low-grade fever

What skin findings can occur in acute pancreatitis?

Flushing, diaphoresis, jaundice, cyanosis, decreased skin turgor, dry mucous membranes

What does Grey Turner’s sign indicate?

Bruising/discoloration of the flanks indicating hemorrhagic pancreatitis

What does Cullen’s sign indicate?

Bruising/discoloration around the umbilicus indicating hemorrhagic pancreatitis

What is a pseudocyst in acute pancreatitis, and what does it contain?

Fluid, enzymes, debris, and exudate surrounded by a wall.

What are the common signs and symptoms of a pancreatic pseudocyst?

Abdominal pain, palpable mass, nausea and vomiting, anorexia.

How is a pancreatic pseudocyst detected?

Imaging studies.

What is the possible natural course of a pancreatic pseudocyst?

It may resolve spontaneously or perforate, leading to peritonitis.

What is the treatment for a pancreatic pseudocyst?

Surgical or endoscopic drainage.

What is a pancreatic abscess in acute pancreatitis?

An infected pseudocyst resulting from extensive pancreatic necrosis.

What are the signs and symptoms of a pancreatic abscess?

Upper abdominal pain, palpable mass, high fever, leukocytosis.

What is the major risk associated with a pancreatic abscess?

Rupture or perforation.

What is the required treatment for a pancreatic abscess?

Prompt surgical drainage.

What are the possible outcomes if acute pancreatitis is caught early?

It can resolve without complications.

What respiratory complications can occur in acute pancreatitis?

Pleural effusion, atelectasis, pneumonia, and acute respiratory distress syndrome (ARDS).

What is the severe respiratory complication that can lead to acute respiratory failure in acute pancreatitis?

Acute respiratory distress syndrome (ARDS).

What cardiovascular complications are associated with acute pancreatitis?

Hypotension and shock.

What hematologic complications can occur with acute pancreatitis?

Thrombi, pulmonary embolism, and disseminated intravascular coagulation (DIC).

What metabolic complications are associated with acute pancreatitis?

Hypocalcemia and hyperglycemia.

What are the clinical manifestations of hypocalcemia in acute pancreatitis?

Tetany.

What metabolic abnormality in acute pancreatitis can lead to elevated blood glucose levels?

Hyperglycemia.

What is the primary diagnostic lab marker for pancreatitis?

↑ Serum amylase

Which lab value is more specific for pancreatitis and stays elevated longer?

↑ Serum lipase

What does an elevated WBC count on a CBC indicate in pancreatitis?

Leukocytosis (inflammation/infection)

What does a CMP help assess in pancreatitis?

Glucose (hyperglycemia) and electrolytes

What do elevated liver enzymes or bilirubin suggest in a pancreatitis patient?

Biliary involvement

What lab value may indicate a possible cause of pancreatitis?

↑ Triglycerides

What does an elevated CRP indicate in pancreatitis?

Inflammation

Why are ABGs monitored in pancreatitis?

To assess respiratory status and detect risk of ARDS

What electrolyte imbalance is dangerous in pancreatitis and what can it cause?

↓ Calcium (hypocalcemia) → tetany

What is the first-line imaging study for pancreatitis?

Abdominal ultrasound

What imaging study provides the most detailed view of complications?

Contrast-enhanced CT scan

What procedure can both diagnose and cause pancreatitis?

ERCP (endoscopic retrograde cholangiopancreatography)

What imaging test is used to evaluate pancreatic and biliary ducts using MRI?

MRCP (magnetic resonance cholangiopancreatography)

What is endoscopic ultrasonography (EUS) used for in pancreatitis?

Evaluating the pancreas and surrounding structures

Which imaging studies are used to assess complications rather than diagnose pancreatitis?

Angiography, chest X-ray, abdominal X-ray

What is the priority treatment approach for acute pancreatitis?

Conservative therapy.

Why is aggressive hydration important in acute pancreatitis?

To manage third spacing and fluid shifts, prevent hypovolemia and shock.

What type of pain management is commonly used in acute pancreatitis?

IV opioid analgesics (e.g., morphine) and antispasmodics.

Why is the patient kept NPO in acute pancreatitis?

To minimize pancreatic enzyme secretion and reduce pancreatic stimulation.

When might NG suction be used in acute pancreatitis?

If needed to relieve gastric contents and reduce stimulation of the pancreas.

Why is oxygen administered in acute pancreatitis?

To support oxygenation and reduce complications from hypoxia.

What should be monitored closely regarding glucose in acute pancreatitis?

Blood glucose levels due to risk of hyperglycemia from pancreatic dysfunction.

What is the purpose of plasma volume expanders like dextran or albumin?

To manage shock and restore circulating volume.

What fluids are commonly used to correct fluid and electrolyte imbalances?

Lactated Ringer’s solution.

What cardiovascular parameter may be monitored to assess fluid status?

Central venous pressure (CVP).

What medications are used to reduce acid secretion in acute pancreatitis?

Antacids, proton pump inhibitors, and carbonic anhydrase inhibitors.

When is surgical therapy indicated in acute pancreatitis?

When conservative therapy fails or in cases with complications.

What is the surgical management for gallstone-related pancreatitis?

ERCP with endoscopic sphincterotomy followed by laparoscopic cholecystectomy.

What is done if diagnosis is uncertain or the patient does not respond to treatment?

Further surgical evaluation and possible intervention.

What surgical procedure may be used for complications like necrosis or abscesses?

Drainage of necrotic fluid collections or abscesses.

What is the initial nutritional approach in acute pancreatitis?

NPO status initially.

What type of nutrition is preferred when feeding can resume?

Enteral nutrition over total parenteral nutrition (TPN).

What should be monitored if IV lipids are given?

Triglyceride levels.

What dietary pattern is recommended when reintroducing food?

Small, frequent meals that are high-carbohydrate and low-fat.

What substance must be avoided in acute pancreatitis?

Alcohol.

What vitamin supplementation is needed in acute pancreatitis?

Fat-soluble vitamins: A, D, E, and K.

Acute pancreatitis nursing management assessment — what subjective history is important to assess?

Hx of biliary tract disease, alcohol use, abdominal trauma, medications (thiazides, NSAIDs)

What cardiovascular signs are expected in acute pancreatitis?

Tachycardia, hypotension

What gastrointestinal findings are expected in acute pancreatitis?

Abdominal distention, tenderness, muscle guarding, decreased bowel sounds

What respiratory findings may occur in acute pancreatitis?

Tachypnea, basilar crackles

What skin findings may be seen in acute pancreatitis?

Diaphoresis, flushing, Grey Turner’s sign, Cullen’s sign, jaundice, decreased skin turgor

What is the priority nursing diagnosis related to pain in acute pancreatitis?

Pain related to pancreatic distention, peritoneal irritation, and biliary obstruction

What causes fluid imbalance in acute pancreatitis?

Vomiting, restricted intake, and fluid shift into the retroperitoneal space

What electrolyte imbalance is most concerning in acute pancreatitis?

Hypocalcemia

What signs indicate hypocalcemia in acute pancreatitis?

Trousseau’s sign and Chvostek’s sign

What is the priority nutrition-related nursing diagnosis in acute pancreatitis?

Nutritionally compromised due to anorexia, vomiting, and dietary restrictions

What vital signs should be closely monitored in acute pancreatitis and what abnormalities are concerning

VS should be monitored frequently; hypoTN, fever, & tachypnea are concerning

Why are intake and output (I&O) monitored closely in acute pancreatitis?

To assess fluid and electrolyte balance and detect imbalances in sodium, potassium, chloride, calcium, and magnesium

What electrolyte imbalance may occur in acute pancreatitis and how is it treated?

Hypocalcemia may occur and is treated with IV calcium gluconate

Why is respiratory function assessed in acute pancreatitis?

To monitor for risk of acute respiratory distress syndrome (ARDS)

How should pain be managed in acute pancreatitis?

Administer IV opioids before positioning and position the patient for comfort

What is the best position for a patient with acute pancreatitis and why?

Side-lying with knees drawn to the abdomen and head of bed elevated 45 degrees to reduce pain and promote comfort

What oral and nasal care interventions are important in acute pancreatitis?

Frequent oral and nasal care and proper administration of antacids

What rehabilitation considerations should be addressed during discharge for acute pancreatitis?

Physical therapy and assessment for opioid addiction history