Pancreatitis

Etiology

100

More than 85% of Pancreatitis patients present with these 3 symptoms. What are the 3 symptoms?

1. Abdominal pain 2. Nausea 3. Vomitting

200

Which one of these cell-mediators is not amongst the cell-mediators released that causes the local and systemic symptoms of pancreatitis: IL-1, IL-6,IL-7, IL-8, IL-10, IL-11, TNF, NO, PAF

IL-7

300

Name at least 4 Class II/III Drugs that can induce Pancreatitis

Any 4 of the following: ACEI, APAP, DPP-IV, GLP-1 agonists, HAART, HCTZ, Macrolides, NSAIDS, Sitagliptin, Statins

400

Describe in detail the Cascade/Pathophysiology of Pancreatitis

Trigger mechanisms such as Alcohol and gallstones lead to acinar cell injury (intra-acinar trypsinogen activation) and causes release of pancreatic enzymes such as trypsin, elastase, phospholipase A2, etc.) which leads to cell activation (neutrophil, monocyte, lymphocyte, and endothelium cell), which causes release of mediators (IL-1,6,8,10,11, TNF, NO, PAF) and leads to local (abscess, necrosis) and systemic consequences (ARDS, shock, vascular leakage)

Signs/ Symptoms

100

Name 3 signs and symptoms.

-mild jaundice

-decrease in weight

-hyperglycemia

-abdominal distension

-abdominal tenderness

200

What are some nursing interventions?

-bed rest

-relieve pain

-maintain ng suctioning

-monitor blood glucose 

-monitor respiratory status

300

What is an abscess?

 large fluid cavity within the pancreas
that results from extensive necrosis.

400

Name some complications due from pancreatitis.

• Hypovolemia- Due to loss of fluid from self-digestion of the pancreas.
–Monitor for hypovolemic shock- Low BP, High HR.
• Type 1 Diabetes Mellitus – Due to the destruction of the pancreatic beta cells (the ones that release insulin).

Nursing Dx.

100

True or False: Treatment options for both acute and chronic pancreatitis have overlap in many respects

True

200

What is the different in treatment between moderate and severe acute pancreatitis?

Trick question: Same treatment for both levels of severity

300

What is the recommended treatment regimen for a patient diagnosed with Chronic Pancreatitis?

Avoidance of causative agent (alcohol), pain control (Begin with APAP/NSAIDs prior to meals, if inadequate consider adding low potency oral narcotic [codeine/hydrocodone]), and add pancreatic enzymes with H2RA/PPI (benefit in non-alcoholic CP)

400

What is the preferred treatment regimen for a patient diagnosed with Moderate-Severe Acute Pancreatitis?

Intensive care with aggressive fluid (250-500ml/hr) and nutrition replacement (enteral/parenteral supplementation within 7-14 days if necessary), ERCP(surgical procedure if gallstones are considered) and consider use of ABX (debatable efficacy of cipro +metronidazole vs placebo)

Pathophysiology

100

What type of digestion does the pancreas do with its own enzymes?

It auto digests.

200

What are the two types of pancreatitis?

Acute v. Chronic

300

Name 2 possible causes of Acute Pancreatitis

2 of the following: Alcohol induced(~80%), procedure-induced (~10%), drug induced (<5%), or hypertriglyceridemia (<1%, TGs >1000mg/dL)

400

Name 3 enzymes involved in pancreatitis.

-Protease (protein)

-Lipase (fat)

-Amylase (carbs)