Onset
Acute
Pancreatitis
Acute
Chronic
Causes
Hepatitis, alcohol abuse, meds, cholelithiasis, blockage of bile duct, tumors & trauma
Symptoms
Cullen's sign (ecchymosis around umbilicus), mid-epigastric LUQ pain, rigid/boardlike abdomen, Grey-Turner's Signs (ecchymosis at the flanks), nausea, vomiting, pain after eating, fever, hypotension, tachycardia, & elevated WBCs.
Onset
Chronic
Chronic inflammation that is irreversible and can only be managed.
Causes
Cystic fibrosis, acute pancreatitis, alcohol and smoking, autoimmune pancreatitis.
Symptoms
Weight loss, chronic epigastric pain, jaundice due to too much bile, dark urine, hyperglycemia, fatty stools or steatorrhea, epigastric pain after eating a fatty meal or drinking alcohol. Acute pancreatitis that leads to chronic
Signs and Symptoms
Cullen's sign
Ecchymosis around umbilicus
Grey-Turner's Sign
Ecchymosis at the flanks
Rigid/Boardlike abdomen
Abdomen is distended and hard
Steatorrhea
Foul-smelling fatty stool. Seen in chronic pancreatitis. Also malabsorption of fat-soluble vitamins (ADEK)
Enzymes
↑ amylase & lipase
Electrolytes
↓ Calcium & Magnesium
CBC
↑ WBCs & ↓ Platelets
Other
↑ Glucose & ↑ Bilirubin
Pancreatitis is hypocalcemia, hypocalcemia. Calcium is deposited in necrotic areas. Serum loses calcium to necrotic areas. The lower the calcium, the sicker the client (more necrosis). The degree of hypocalcemia correlates with the severity of pancreatitis.
What is increased: Amylase, lipase, WBCs, bilirubin and glucose.
Pain Management
Demerol
Morphine causes spasms of the sphincter of oddi. Sphincter that opens to allow digestive enzymes to enter duodenum. Bur no studies show that morphine should be contraindicated.
Pancreatic Enzymes
For Chronic pancreatitis
Chronic pancreatitis clients must take pancreatic enzymes with meals.Â
NPO
For Acute Pancreatitis
Once enzyme levels (amylase/lipase) decrease, the client can start to eat.Â
Acute Pancreatitis
Treatment
NPO, NG tube to remove stomach contents, IV fluids, and antibiotics- Imipenem-cilastatin (Primaxin).
Diet for Pancreatitis (not in the acute phase)
Low fat
To prevent Steatorrhea
↑ Protein
and some complex carbs
Low sugar/carbohydrates
To prevent hyperglycemia. Remember pancreas release insulin.
No alcohol
Alcohol damages pancreas
Pancreatitis
Are these labs elevated or decreased in acute pancreatitis?