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Disorders of the Pancreas
Terminal Learning Objective
At the completion of this lesson you (the student) will relate planning and provision of safe and effective nursing care of a client with a disorder of the pancreas
ENABLING LEARNING OBJECTIVES
A: Describe the structure and function of the pancreas
B: Explain the etiology/pathophysiology, clinical manifestations assessment, diagnosis, and medical management of a patient with acute pancretitis.
C: Describe the etiology/pathophysiology, clinical manifestations, diagnoses, medical and nursing management of chronic pancreatitis.
ENABLING LEARNING OBJECTIVES
D: Identify nursing diagnosis and interventions for the client with pancreatitis
E: Identify the etiology/pathophysiology, assessment and medical management of pancreatic cancer.
Structure and Function of the Pancreas
The pancreas lies behind the stomach in the concavity produced by the C-shape of the duodenum
It is both an exocrine and endocrine gland
Structure and Function of the Pancreas
Exocrine functionPancreatic juice
Endocrine functionHormones
Etiology/Pathophysiology of Pancreatitis
Inflammation of the pancreas Reflux of bile and duodenal contents leads to
autodigestion Swelling results in impaired release of pancreatic
contents Obstruction leads to further autodigestion
Etiology/Pathophysiology of Pancreatitis
Structural/vascular abnormalities Trauma or disruption of the pancreatic fluids Infectious disease Metabolic disorders Inflammatory bowel disease Heredity Excessive alcohol intake and certain drugs Refeeding after prolonged fasting or anorexia
Clinical Manifestations
Necrosis, caused by autodigestion hyperglycemia, hypocalcemia
Hemorrhage of the gland with hypovolemic shock
Peritonitis, pancreatic abscess, pseudocyst
Clinical Manifestations
Severe fluid and electrolyte imbalance, acute renal failure
Sepsis Pleural effusion, ARDS Blood coagulopathies
Assessment
The most common- Severe mid upper abdominal pain, which may radiate to both sides and straight up the back
Nausea, vomiting and flatulence Stools may be frothy and foul smelling Jaundice may be noted if common bile duct is
obstructed
Assessment
Bowel sounds may be diminished, with abdominal distention and tenderness
Hypotension and hypovolemia May also have Cullen’s and Turner’s signs Fever, tachycardia Chvostek’s sign Trousseau’s sign
Cullen’s Sign
Chvostek’s Sign
Trousseau’s Sign
Diagnosis Elevated serum and urine amylase, lipase and
AST/ALT levels Billirubin level may be elevated with obstructed
common bile duct Elevated WBC level indicated by CBC Hyperglycemia, hypocalcemia, hypokalemia,
hypomagnesemia CT scan (pancreatic edama and necrosis)
Diagnosis
Endoscopic and Ultrasound exams to determine pancreatic cysts, abscesses and pseudocysts (fibrous capsules filled with fluid, blood, enzymes, pus and tissue debris)
Medical Management
Measures to relieve pain and spasms Restore fluid and electrolyte loss Prevent or treat systemic complications Clear liquid diet with progression to low fat diet Avoid digestive stimulants
Etiology/Pathopysiology of Chronic Pancreatitis
Chronic pancreatitis is defined as prolonged,progressive inflammation of the pancreas
The gland undergoes fibrotic scarring recurrent inflammation
The pancreas hardens and exocrine and endocrine functions are partly or completely lost as pancreatic tissue is destroyed
Etiology/Pathopysiology of Chronic Pancreatitis
The most common cause is chronic alcoholism Hyperparathyroidism Trauma to the pancreas Heredity pancreatitis Hypertriglyceridemia
Etiology/Pathopysiology of Chronic Pancreatitis
Autoimmune pancreatitis Repeatedly formed gallstones Most causes are similar to acute pancreatitis Some causes are unknown
Complications
Simliar to those of acute pancreatitis Biliary tract obstruction Partial to complete loss of gland function
Assessment
Persistent pain in epigastrium or LUQ radiating to the back
Weight loss Flatulence, vomiting, and diarrhea Firm mass may be felt in upper left quadrant Light colored and foul smelling stools,
steatorrhea
Assessment
If pseudocysts are present, they contribute to the severity of symptoms
If secondary diabetes occurs, patient may have increased appetite, thirst and urination
Peripheral edema and ascites
Diagnostic procedures
Abnormal labs, as with acute pancreatitis CT, MRI and Ultrasound ERCP (Endoscopic Retrograde
Cholangiopancretography) Glucose tolerance test
Medical Management
Depends on the cause and weather pancreatic duct is obstructed
If no obstruction Abstinence from alcohol Clear liquid, advance to fat free diet Correction of biliary tract disease and/or
hyperparathyriodism may give good results
Medical Management Demerol is ordered cautiously Insulin and pancreatic enzyme replacement
Pancreatin (Creon, Bioglan, Panazyme, Creon 10 and Creon 20, Protilase, Ultrase, Viokase, Zymase, Pancreacarb)
Partcial or total pancreatectomy Reconstitution of the duct with scarring, stricture
and stenosis Pancreatic autotransplantation
Nursing Diagnoses Associated with Pancreatitis
Pain R/T stimulation of nerve endings caused by enlargement of the pancreatic capsule, obstruction, or chemical irritation from enzymes
Ineffective breathing R/T pain, ascites High risk for fluid volume deficit R/T vomiting,
diarrhea, gastric decompression, fluid shifts, decrease oral intake, hemorrhage
Nursing Diagnoses Associated with Pancreatitis
High risk for altered nutrition R/T malabsorption, N/V, pain
High risk for ineffective management of therapeutic regimen R/T to insufficient knowledge or self care, diet therapy
Etiology/Pathophysiology of Pancreatic Cancer
Pancreatic cancer is the fourth leading cause of cancer death in men and sixth in women
High death rate attributed to the difficulty in diagnosing the cancer at a curable stage
Occurs after middle age with peak incidence around age 60
Found in cigarette smokers, those exposed to chemical carcinogens and people with diabetes mellitus
Etiology/Pathophysiology of Pancreatic Cancer
Linked to diet high in meat, fat and coffee consumption
May be primary or metastasis from lung, stomach, duodenum or common bile
Tumor grows rapidly and quickly invades surrounding organs and tissue
Many patients only live 4 to 8 months after diagnoses
Assessment of Pancreatic Cancer
Vague symptoms, which accounts for the delay in diagnosis
Pain present in 85% of cases Anorexia, nausea, flatulence, change in stools Fatigue
Assessment of Pancreatic Cancer
Steady, dull and aching pain in the epigastrium or referred to the back; usually worse at night
Weight loss Jaundice, pruritis Recent onset of diabetes mellitus
Medical Management Definitive diagnosis before surgery is difficult However, tumors are usually inoperable by the time
a diagnoses is made Whipple produce often performed Total pancreatectomy with resection of parts of the
GI tract Subtotal pancretectomy has complication of
postoperative pancreatic fistulas and is not recommended
Medical Management
Medical Management Adjuvant therapy (surgical resection, radiation
and chemotherapy) is believed by some to be the most effective treatment of the almost always fatal pancreatic cancer
Immediate post-operative care is usually done in the intensive care setting
Review of Main Points
Structure and function of the pancreas Acute pancreatitis Chronic pancreatitis Pancreatic cancer
QUESTIONS??