alterations in digestion

pancreas endocrine fxn

secretes insulin and glucagon for carbohydrate metabolism

pancreas exocrine fxn

secretes digestive enzyme that assist regulation of serum glucose

secretes alkaline buffer solution

acute pancreatitis

inflammation of the pancreas

• digestive enzymes are activated before leaving the pancreas

  • causes autodigestion of pancreas

    • may cause minor swelling or life threatening hemorrhage

spillage of pancreatic enzymes into surrounding pancreatic tx causing autodigestion and severe pain

gallbladder disease is most common use

acute pancreatic cm

LUQ pain, mid epigastric

• aggravated by eating

• may radiate to back

• severe, stabbing, continuous

flushing/cyanosis/dyspnea

N/V

tachycardia

jaundice

crackles

cullens sign and grey turners sign

acute pancreatitis diagnostics

elevated amylase and lipase

low calcium

us, xray, ct scan

ERCP (endoscopic retrograde cholangiopancreatography)

MRCP (magnetic resonance cholangiopancreatography)

hypocalcemia s/s

tetany (involuntary mx contraction, tingling around lip and fingers)

chvosteks sign (cheek)

trousseau’s sign (bp cuff arm hand thing)

treat with IV calcium gluconate

acute pancreatitis collaborative care

relieve pain

• IV morphine

• antispasmodics

• position pt HOB 45, side lying

prevent/alleviate hypovolemic shock

• albumin/fluid replacement

reduce pancreatic secretions

• NPO w NG tube to decompress

treat F&E imbalances

prevent infection

remove cause

acute pancreatitis

monitor for complications

• pseudocyst/abscess

• respiratory involvement

  • -ARDS

• hypocalcemia

chronic pancreatitis

continuous inflammation leading to scarring of the pancreas

• creates strictures and calcifications

common causes

• obstructive

• - gallstones, cancer

• nonobstructive

• - alcohol abuse

chronic pancreatitis cm

LUQ pain

• heavy, gnawing, cramp like

• may be constant or diminished

weight loss, constipation, mild jaundice w dark urine

foul smelling fatty stools

• steatorrhea

diabetes

chronic pancreatitis collaborative care

pain mgmt w IV morphine and fent patches

pancreatic enzyme replacements

• control pancreatic insufficiency

• contain amylase, lipase and trypsin

nutrition

• high protein, moderate carbs, low fat

• avoid caffeine and spices

control of diabetes

• insulin and oral hypoglycemic agents

surgical procedures to restore flow of bile

• roux-en-Y pancreatojejunostomy

• choledochojejunostomy

pancreatic cancer

most pancreatic tumors are adenocarcinomas that begin in the epithelium of the ductal system

tumor grows, obstructing the common bile duct, developing into jaundice

pancreatic cancer cm

dull, aching abdominal pain

anorexia and rapid weight loss

nausea

jaundice

pancreatic cancer diagnostics

transabdominal US

EUS

CT MRI

ERCP

MRCP

fine needle aspiration

PET scan*

pancreatic cancer collaborative care

whipple procedure,total pancreatectomy (causes diabetes)

biliary tract

major fxn

• concetrates and stores bile

• secretes bile into the small intestine

• - carries waste out of liver

• -bile salts in the bile breakdown fat

cholelithiasis

most common disorder of biliary system

precipitation of bile salts, calcium, and cholesterol occur

stones in gallbladder, or migrate to ducts and causes obstruction → bilirary colic

cholecystitis

inflammation of gallbladder

usually associated w gallstones

acute vs chronic

cholecystitis pathophysiology

inflammation → edema → distension of gallbladder w bile or pus → occlusion of bile duct

• can lead to inflammation and scarring of the gallbladder

• - dec fxn

cholecystitis collaborative care and nursing mgmt

control pain (NSAIDS or morphine, anticolinergics)

control inf (abx)

maintain f&e

treat n/v (gastric decompression w ng)

cholelithiasis collaborative care

bile acids may be administered to dissolve stones

laparoscopic cholecystectomy

ERCP for stone removal

lithotripsy

cholecystectomy - laparscopic

• four small incisions

• shoulder pain caused by co2

cholecystectomy - incisional

• one large incision

• avoid heavy lifting (risk of hernia, support incision)

• no swimming/soaking in tub for at least 2 weeks