Gastrointestinal Disorders: Acute Pancreatitis, Chronic Pancreatitis, Pancreatic Cancer/Adenocarcinoma, Cholelithiasis, and Cholecystitis

What is Acute Pancreatitis?

it is an acute inflammation of the pancreas

What are some common causes of Acute Pancreatitis?

• gallbladder disease, gallstones

• chronic alcohol use

• drug reactions

• pancreatic cancer

• hypertriglyceridemia (level >1,000)

What are some signs and symptoms of Acute Pancreatitis?

• LUQ or mid-epigastric pain

• abdominal pain is sudden, severe, and continuous

• abdominal pain worsens when eating

• nausea & vomiting

• hypotension

• tachycardia

• jaundice

• decreased bowel sounds 

• Grey Turner sign (bruising in flank area)

• Cullen sign (bruising at umbilicus area 

What are some complications of Acute Pancreatitis?

• pseudocyst

• abscess

• pulmonary effusion

• pneumonia

• acute respiratory distress syndrome

•  tetany (hypocalcemia)

What are some labs and diagnostic tests for Acute Pancreatitis?

• serum amylase

• lipase

• abdominal ultrasound

• CT scan

• endoscopic retrograde cholangiopancreatography 

• chest x-ray

What are some surgical interventions for Acute Pancreatitis?

• cyst drainage of pseudocyst occurs

• cholecystectomy

• microscopic gallbladder c-section

What are some nursing actions and interventions for patients with Acute Pancreatitis?

• give pt. continuous IV fluids

• give pt. IV narcotics

• give supplement O2 when ordered

• do NG suctioning

• administer protein pump inhibitor medications when ordered

• administer antacids when ordered

• administer analgesics when ordered 

• give small, frequent meals

• give enteral feeding if pt. is NPO

• monitor glucose levels

What are some patient teachings for Acute Pancreatitis?

• tell pt. to have small, frequent meals

• tell pt. to have a complex carb, low fat diet

What is Chronic Pancreatitis?

it is a continuous, prolonged, inflammatory, and fibrosing process of the pancreas

What are the common causes of Chronic Pancreatitis?

• chronic alcohol use

• gallstones

• duodenal cancer

• pancreatic cancer

• cystic fibrosis

• lupus

What are some signs and symptoms of Chronic Pancreatitis?

• chronic, recurrent, acute abdominal pain attacks 

• weight loss

• constipation

• jaundice with dark urine

• steatorrhea (facial swelling, fatty stools) 

• diabetes

What are some surgical interventions for Chronic Pancreatitis?

• endoscopic retrograde cholangiopancreatography 

• cholecystectomy

What are some nursing actions and interventions for patients with Chronic Pancreatitis?

• administer pancreatic enzyme replacement 

• monitor stools of pt. is on pancreatic enzyme replacement

What are the risk factors for Pancreatic Cancer/ Adenocarcinoma?

• chronic smoking

• diabetes

• advanced age

• family history of pancreatic cancer/ adenocarcinoma

• high fat diet

• African American

What are some signs and symptoms of Pancreatic Cancer/ Adenocarcinoma?

• abdominal pain

• anorexia 

• rapid, progressive weight loss

• nauseous

• jaundice

What is a surgical intervention for Pancreatic Cancer/ Adenocarcinoma?

whipple procedure

What are some patient teachings for Pancreatic Cancer/ Adenocarcinoma?

• tell the pt, that smoking increases the likelihood of developing pancreatic cancer/ adenocarcinoma by 2 to 3 times

• tell pt. that the life expectancy is 5-12 months after diagnosis

• tell the pt. that there is a 9% survival rate

• tell pt. they can do chemotherapy and radiation therapy  

What is Cholelithiasis?

it is stones in the gallbladder

What is Cholecystitis?

it is inflammation of the gallbladder

What are the risk factors for Cholelithiasis and Cholecystitis?

• women who have had more than one child

• >40 years old

• sedentary lifestyle

• obesity

• family history of Cholelithiasis or Cholecystitis

• rapid weight loss

• has had a gastric bypass surgery

What are the 4 Fs for Cholelithiasis and Cholecystitis?

Female, Fat, Forty, and Fertile

What are some signs and symptoms of Cholelithiasis and Cholecystitis?

• RUQ abdominal pain when lying down

• RUQ abdominal pain 3-6 hours after high fat diet

• dark urine

• bloating

• nausea and vomiting

• fever 

• chills

• pain in right shoulder and scapula

What are some labs and diagnostic tests for Cholelithiasis and Cholecystitis?

• abdominal ultrasound

• endoscopic retrograde cholangiopancreatography

• percutaneous transhepatic cholangiography

• CBC (WBC), bilirubin, AST, ALT

• amylase 

What are some nursing actions and interventions for Cholelithiasis and Cholecystitis?

• administer vidal acids for gallstones

• administer antibiotics when ordered

• administer antiemetics when ordered

• administer bile salts when ordered

• give small, frequent meals

• give low fat, high fiber & calcium diet

• monitor electrolyte levels

What are some patient teachings for Cholelithiasis and Cholecystitis?

• tell pt. to do small, frequent meals

• tell pt. take have a low fat, high fiber & calcium diet

• tell pt. to avoid rapid weight loss if possible